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

Laparoscopic approach for inguinodynia

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

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)5267-5274
Number of pages8
JournalSurgical Endoscopy and Other Interventional Techniques
Volume31
Issue number12
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Fingerprint

Groin
Inguinal Hernia
Herniorrhaphy
Chronic Pain
Therapeutics
Pain
Quality Improvement
Abdominal Muscles
Pneumoperitoneum
Nerve Block
Hernia
Local Anesthetics
Patient Care
Outcome Assessment (Health Care)
Pressure
Recurrence

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Laparoscopic approach for the treatment of chronic groin pain after inguinal hernia repair : Laparoscopic approach for inguinodynia. / Ramshaw, Bruce; Vetrano, Vincent; Jagadish, Mayuri; Forman, Brandie; Heidel, Robert; Mancini, Matthew.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 31, No. 12, 01.12.2017, p. 5267-5274.

Research output: Contribution to journalArticle

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title = "Laparoscopic approach for the treatment of chronic groin pain after inguinal hernia repair: Laparoscopic approach for inguinodynia",
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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