Miles Landry, MBBS, Rachel Lewis, MD, Michael Lew, MD, Brandie Forman, Hernia Clinician, Bruce Ramshaw, MD. UTMCK
Introduction: The development of chronic groin pain after inguinal hernia repair is a complex problem with many potential factors contributing to its development. Factors interacting to result in the development of chronic pain include medical conditions, surgical technique, mesh choice and even neuro-cognitive and emotional factors. Surgical options for alleviation of symptoms are limited and only performed by a few centers dedicated to its treatment. There is an opportunity to apply the principles of a prehabilitation program, including Cognitive Behavioral Therapy (CBT) in an attempt to improve the outcomes of surgery for this condition.
Methods and Procedures: A multi-disciplinary hernia team has implemented a clinical quality improvement (CQI) effort in an attempt to better measure and improve outcomes for patients suffering with chronic groin pain after inguinal hernia repair. Between April 2011–August 2018, 129 patients (157 groins) underwent surgical treatment for chronic groin pain after inguinal hernia repair. During this time multiple improvement initiatives have been introduced, including the utilization of CBT as part of a robust prehabilitation program. Data was collected to compare outcomes for those undergoing preoperative CBT and patients who did not have CBT prior to their operation. All patients had a laparoscopic approach to perform procedures in an attempt to relieve pain. Some patients also had an open approach in addition to laparoscopy, especially if their original hernia repair was performed through an open groin incision.
Results: Of 129 total patients, baseline demographics were similar in terms of gender, age and BMI. In total 27 patients (32 groins) underwent prehabilitation with CBT (20.93%). We found significantly less total morphine equivalents used in the CBT group (3.24 vs 6.74), and noted total resolution of pain In 16 patients (59.3%) compared to 46 (45.1%) of non-CBT group. Overall 15 (14.7%) patients had no improvement in symptoms from the non-CBT group, whereas there were no patient reports of no improvement within the CBT group (0%)
Conclusion: This attempt at process improvement demonstrated beneficial effects for patients who had CBT as part of a prehabilitation program prior to a surgical procedure to attempt to relieve groin pain after inguinal hernia repair. As with any CQI analysis, other factors may have contributed to these outcomes and these results may be different in another local environment.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95280
Program Number: S097
Presentation Session: Inquinal and Ventral Hernia
Presentation Type: Podium