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Evaluating effectiveness of cognitive behavioral therapy within multimodal treatment for chronic groin pain after inguinal hernia repair



The development of chronic groin pain after inguinal hernia repair is a complex problem with many potential factors contributing to its development. Surgical options for alleviation of symptoms are limited and only performed by a few centers dedicated to its treatment. Opportunities to apply the principles of a prehabilitation program, including Cognitive Behavioral Therapy (CBT), aim to improve the surgical outcomes 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 and August 2018, 129 patients (157 groins) underwent surgical treatment for chronic groin pain after inguinal hernia repair. Data were collected to compare outcomes for those undergoing preoperative CBT and patients who did not have CBT prior to their operation.


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 none of the patients who underwent preoperative CBT had new postoperative pain and all patient procedures were able to be performed on an outpatient basis. Overall, 15 (14.7%) patients had no improvement in symptoms after surgery from the non-CBT group, whereas there was improvement in chronic pain for all patients who underwent CBT.


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.

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No funding was received for this study.

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Correspondence to Miles Landry.

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Dr Bruce Ramshaw has received honoraria and/or consulting fees for providing speaking and/or advisory services for WL Gore, Medtronic, Ethicon, Pacira, Acelity, B Braun, Atrium, BG Medical CondMed, and Ariste Medical. He is also a Founder and Shareholder in CQInsights, a healthcare data analytics company. Brandie Forman is a Founder and Shareholder in CQInsights. Eric Heidel has received consulting fees for consulting services from CQInsights. Drs. Miles Landry, Rachel Lewis, and Michael Lew have nothing to disclose.

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Landry, M., Lewis, R., Lew, M. et al. Evaluating effectiveness of cognitive behavioral therapy within multimodal treatment for chronic groin pain after inguinal hernia repair. Surg Endosc (2019). https://doi.org/10.1007/s00464-019-07082-5

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  • Clinical quality improvement (CQI)
  • Inguinodynia
  • Chronic pain
  • Inguinal hernia
  • Cognitive behavioral therapy (CBT)