Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

23. Mesh Removal for Chronic Pain…
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and their family members by providing support and sharing their experiences.
By including others outside of the core hernia team, we are able
to participate in hernia care communities through face-to-face meetings,
video and teleconferencing, and Internet social networking. The clinical
portion of our team cares for patients through their dynamic care process
and allows for shared decision making with the patient at multiple steps
in the care process.
The first step in our process involves interaction with the clinical
manager or care coordinator, who begins to develop a caring relationship
with the patient and his or her family. From this interaction, we get
to develop a sense of the person as well as gather relevant clinical data.
Prior to having a clinical visit, it may beneficial for the patient to see
other providers first if there are areas of concern identified by the patient
care manager. Also, allowing patients to speak with former patients who
have suffered with similar types of symptoms can be very beneficial.
After the initial clinic visit, more options may be considered or surgery
may be offered. The patient’s care is followed throughout the hospital
and for the entire length of recovery by team members until the patient
returns to a good quality of life.
The clinical quality improvement portion of the hernia team is
focused on objective outcome measures and identification of anomalies
to learn and improve. The analysis of explanted synthetic hernia mesh is
the largest clinical quality improvement project currently in progress for
our hernia team. Many of these meshes have been explanted from
patients who have suffered from chronic groin pain after inguinal hernia
repair. By defining dynamic care processes and identifying and measuring
quality, satisfaction, and financial outcome measures, the objective
of our hernia team is to generate clinical quality improvement data that
will help identify ways to improve the value of care delivered.
Summary
Chronic groin pain after inguinal hernia repair is a complex problem
that can cause significant impairment to those who are affected as well
as for their loved ones. It is a difficult problem to treat and takes a tremendous
toll on the individual who suffers. For patients with severe,
lasting groin pain or those whose quality of life is impacted despite
noninvasive or minimally invasive measures to control pain, it may be
appropriate to offer a surgical option for treatment. Surgical treatment
includes a diagnostic laparoscopy to look for intra-abdominal adhesions,
interstitial and recurrent hernias, and foreign body materials in the