M. Landry1, L. Grimsely1, M. Mancini1, B. Forman1, N. Shokur3, V. Vetrano2, B. Ramshaw1 1University Of Tennessee Medical Center,Division Of Surgery,Knoxville, TENNESSEE, USA 2University Of Tennessee Health Sciences Center,College Of Medicine,Memphis, TENNESSEE, USA 3East Tennessee State Univeristy,Quillen College Of Medicine,Johnson City, TENNESSEE, USA
Introduction:
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–January 2017, 104 patients underwent 105 operations in an attempt to relieve pain. Patients who had prior laparoscopic inguinal hernia repair (28) had their procedure completed laparoscopically only (mesh removal and neurolysis). Patients who had open inguinal hernia repair (77) had a combination of a laparoscopic and open procedure (mesh removal, neurectomy and primary reconstruction of the groin) in an attempt to relieve pain. This evaluation of outcomes was intended to investigate whether there are differences in outcomes depending on if the initial hernia repair was done open or laparoscopic.
Results:
Of the laparoscopic only procedure, nine patients (32.14%) reported significant improvement, thirteen patients (46.42%) reported moderate improvement and six patients (21.42%) reported little or no improvement. Of the laparoscopic-open procedure group, forty-two patients (54.54%) reported significant improvement, twenty-six patients (33.76%) reported moderate improvement and nine patients (11.68%) reported little or no improvement. There was a 17.85% hernia recurrence rate for the laparoscopic only group (5/28) and a 10.38% hernia recurrence rate for the combined laparoscopic-open group (8/77).
Conclusion:
These results suggest the laparoscopic only patients did not have as much improvement as the patients who had prior open inguinal hernia repair. Based on these results, additional process improvement ideas will be implemented in an attempt to improve outcomes, especially for the group of patients who have prior laparoscopic inguinal hernia repair.
