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Laparoscopic approach for the treatment of chronic groin pain after inguinal hernia repair

Laparoscopic approach for inguinodynia

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Abstract

Background

Traditional methods of clinical research may not be adequate to improve the value of care for patients with complex medical problems such as chronic pain after inguinal hernia repair. This problem is very complex with many potential factors contributing to the development of this complication.

Methods

We have implemented a clinical quality improvement (CQI) effort in an attempt to better measure and improve outcomes for patients suffering with chronic groin pain (inguinodynia) after inguinal hernia repair. Between April 2011 and June 2016, there were 93 patients who underwent 94 operations in an attempt to relieve pain (1 patient had two separate unilateral procedures). Patients who had prior laparoscopic inguinal hernia repair (26) had their procedure completed laparoscopically. Patients who had open inguinal hernia repair (68) had a combination of a laparoscopic and open procedure in an attempt to relieve pain. Initiatives to attempt to improve measurement and outcomes during this period included the administration of pre-operative bilateral transversus abdominis plane and intra-operative inguinal nerve blocks using long-acting local anesthetic as a part of a multimodal regimen, the introduction of a low pressure pneumoperitoneum system, and the expansion of a pre-operative questionnaire to assess emotional health pre-operatively.

Results

The results included the assessment of how much improvement was achieved after recovery from the operation. Forty-five patients (48%) reported significant improvement, 39 patients (41%) reported moderate improvement, and 10 patients (11%) reported little or no improvement. There were 3 (3%) complications, 13 (11%) hernia recurrences, and 15 patients (13%) developed a new pain in the inguinal region after the initial pain had resolved.

Conclusions

The principles of CQI can be applied to a group of patients suffering from chronic pain after inguinal hernia repair. Based on these results additional process improvement ideas will be implemented in an attempt to improve outcomes.

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Authors and Affiliations

  1. Department of Surgery, University of Tennessee, Knoxville, 1934 Alcoa Hwy, Bldg D, Suite 285, Knoxville, TN, 37920, USA

    Bruce Ramshaw, Vincent Vetrano, Mayuri Jagadish, Brandie Forman, Eric Heidel & Matthew Mancini

Authors
  1. Bruce Ramshaw
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  2. Vincent Vetrano
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  3. Mayuri Jagadish
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  4. Brandie Forman
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  5. Eric Heidel
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  6. Matthew Mancini
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Corresponding author

Correspondence to Bruce Ramshaw.

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Disclosures

Bruce Ramshaw has received honoraria and/or consulting fees for providing speaking and/or advisory services for WL Gore, Medtronic, Ethicon, Pacira, Acelity, B Braun, Atrium, BG Medical ConMed, and Ariste Medical. He is also Founder and a Shareholder in CQInsights, a healthcare data analytics company. Brandie Forman is a Founder and Shareholder in CQInsights. Matthew Mancini has received honoraria for providing speaking services from Olympus, Medtronic, WL Gore, Pacira, and Mallinckrodt. Eric Heidel has received consulting fees for consulting services from CQInsights. Vincent Vetrano and Mayuri Jagadish have no conflicts of interest or financial ties to disclose.

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Ramshaw, B., Vetrano, V., Jagadish, M. et al. Laparoscopic approach for the treatment of chronic groin pain after inguinal hernia repair. Surg Endosc 31, 5267–5274 (2017). https://doi.org/10.1007/s00464-017-5600-3

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  • DOI: https://doi.org/10.1007/s00464-017-5600-3

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