Laparoscopic approach for the treatment of chronic groin pain after inguinal hernia repair : Laparoscopic approach for inguinodynia
| Autor: | Vincent Vetrano, Eric Heidel, Brandie Forman, Matthew L. Mancini, Bruce Ramshaw, Mayuri Jagadish |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.drug_class Hernia Inguinal Groin 03 medical and health sciences 0302 clinical medicine medicine Humans Pain Management Hernia Anesthetics Local Laparoscopy Herniorrhaphy Aged Pain Measurement Aged 80 and over Pain Postoperative medicine.diagnostic_test business.industry Local anesthetic General surgery Chronic pain Nerve Block Middle Aged medicine.disease Quality Improvement Surgery Inguinal hernia Regimen medicine.anatomical_structure 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Female Chronic Pain business Abdominal surgery |
| Zdroj: | Surgical endoscopy. 31(12) |
| ISSN: | 1432-2218 |
| Popis: | 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. 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. 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. 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. |
| Databáze: | OpenAIRE |
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