Bruce Ramshaw, MD1, Vincent Vetrano2, Brandie Forman, Patient, Care, Manager1. 1University of Tennessee, Knoxville, 2University of Tennessee, Memphis
Laparoscopic and open inguinal hernia repair are commonly performed operations to treat inguinal hernias. Chronic pain can develop after any inguinal hernia repair.
Using the principles of clinical quality improvement, a hernia team reviewed the outcomes of re-operations to attempt to relieve pain after laparoscopic or open inguinal hernia repair in 94 consecutive patients.
27 patients (17 male/7 female) had 39 laparoscopic inguinal hernia repairs (12 bilateral) and 67 patients (54 male/13 female) had 81 open inguinal hernia repairs that resulted in chronic pain. After laparoscopic inguinal hernia repair, 16/27 (59%) patients developed pain immediately while 11/27 (41%) patients developed pain after a delayed period of time (1 week – 5 years). After open inguinal hernia repair, 36/67 (54%) patients developed pain immediately, while 31/67 (46%) developed pain after a delayed period of time (3 weeks – 14 years).
For patients with prior laparoscopic inguinal hernia repair, a laparoscopic approach was used to remove mesh and any fixation devices, lyse adhesions and perform a neurolysis and/or neurectomy with suture closure of any remaining defect. 11/27 (41%) patients had total or near total relief, 14/27 (52%) had significant improvement and 2/27 (7%) had little or no improvement of their chronic groin pain. 4/27 (15%) patients developed a new type of pain in their groin and 4/39 (10%) hernias recurred.
For patients with prior open inguinal hernia repair, a laparoscopic and open approach was used to remove mesh and any fixation devices, lyse adhesions, and perform and neurolysis and/or neurectomy with primary reconstruction of the groin without mesh. 30/67 (45%) patients had total or near total relief, 29/67 (43%) had significant improvement and 7/67 (10%) had little or no improvement of their groin pain. 9/67 (13%) patients developed a new type of pain in their groin and 6/81 (7%) hernias recurred.
For patients suffering from chronic pain after hernia repair, the majority of patients had significant or total improvement of their pre-operative pain with a laparoscopic approach after a laparoscopic hernia repair and a combined laparoscopic and open approach after open inguinal hernia repair. However, there are improvement opportunities and questions to explore including why there was a higher percentage of women who had chronic pain compared with the percentage of women who have inguinal hernia repair and how to improve outcomes in the patients who had little or no improvement and in patients who developed new pain and/or a recurrent hernia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80437
Program Number: S110
Presentation Session: Hernias: Inguinal and Robotics
Presentation Type: Podium