Preperitoneal Hernia Repair: Robotic v Open Study Shows Open Repair Delivers on Value Based Care

Wednesday, May 29, 2024
Boston Hernia - Wellesley, MA

Newly published review of outcomes after open preperitoneal v robotic inguinal hernia repair is further evidence of value in providing the open technique - offering the highest quality care with lower cost to the healthcare system

Open preperitoneal and robotic surgery are two approaches to repairing inguinal hernias. Both aim to place mesh in the same location, but the methods differ significantly. Robotic surgery requires three incisions higher up on the belly, general anesthesia, and inflating the abdomen with gas. Surgeons go into the abdominal cavity to get to the groin where they work back out through a layer of the abdominal wall to get to the location of the hernia. Conversely, the open preperitoneal approach utilizes just one groin incision, local anesthesia with sedation, and directly reaches the repair space without entering the abdomen.

In a recent paper by V. Rodrigues-Goncalves, in which Boston Hernia’s work was cited, the effectiveness of these two approaches and the associated risk of complications were evaluated. This study suggests that open and robotic preperitoneal inguinal hernia repairs performed by experienced surgeons achieve similar long-term outcomes with respect to risk of complications like chronic pain and recurrence. Open repairs also offered advantages of shorter surgery and less anesthesia. These are factors that improve the experience of all patients undergoing inguinal hernia repair and are also of particular benefit to those with more medical conditions. 

They conclude that the best approach may depend on the patient's health, surgeon's experience, and healthcare resources. In this time when healthcare costs are soaring and outpacing society’s ability to afford this care, providers have to consider the costs of the care they provide and ensure the high quality of that care. 

The open preperitoneal approach to inguinal hernia repair takes less time, costs less in equipment and supplies, and requires fewer resources to care for these patients all the while providing the highest quality of care without increase in associated risks.  

This study supports the emergence of the open preperitoneal approach as a minimally invasive, faster, and more cost-effective solution for inguinal hernia repair, especially when performed by experienced surgeons. This method provides excellent patient outcomes while being mindful of the current healthcare landscape.

Boston Hernia and HealthMe featured in Yahoo Finance News

Friday , April 26, 2024
Boston Hernia - Wellesley, MA

Dr. Michael Reinhorn featured in OR Manager Magazine discusses leveraging data to enhance surgical patient quality.

This month's OR Magazine spotlights Dr. Michael Reinhorn's insights on data-driven quality improvement for surgical patients. The article delves into utilizing data when complication rates are low, but outcomes vary significantly after procedures. Examples include unnecessary spine surgeries (50% rate) and chronic opioid use following common procedures.

Dr. Reinhorn emphasizes Michael Porter's framework: value equals quality divided by cost. Organizations like the AHCQQ nationally and Boston Hernia locally, collaborating with partners, have successfully defined value through quality improvement projects and cost-reduction initiatives. We're proud to be at the forefront of this transformative movement.


Boston Hernia and HealthMe featured in Yahoo Finance News

Wednesday, January 18, 2024
Boston Hernia - Wellesley, MA

Yahoo Finance featured about how we are working with HealthMe to provide a higher level of transparency when it comes to pricing our services.  We've been practicing value based care in the way Michael Porter at HBS has defined it for a decade.  Quality divided by cost = Value.  We focused on quality initially, and now we have partnered with surgery centers, anesthesia groups and companies like HealthMe to deliver the highest quality ambulatory hernia care at competitive transparent pricing.


Our second book chapter was just published!

Wednesday, November 28, 2023
Boston Hernia - Wellesley, MA

We just published our second book chapter in Mastery of Surgery. This one took a long time to write and publish.  I spent days writing and revising last winter.  One of our pre-med medical assistants spent days going back and forth with me to create drawings of the repair to use for the chapter while all of our providers read through the manuscript to check for accuracy.  During my visit to Shouldice, I spent. day with Dr. Shouldice and Dr Bendavid. We discussed the anterior inguinal anatomy as well as the preperitoneal space. Dr. Bendavid dedicated his life to leaning inguinal anatomy and even translated Henri Fruchaud's book "The Surgical Anatomy of Hernias of the Groin" from French to English in 2006.  I enjoyed reading the copy he gave me! It was a life altering visit to spend time with great minds in hernia surgery. These surgeons understood the anatomy so well that they could fix almost any hernia without mesh.  It's a bit ironic that Fruchaud's book provided me with the foundation of why posterior mesh repairs make more sense than anterior repairs, thus the reason we perform about 80% open preperitoneal repairs and 20% Shouldice.

Our first book chapter was just published

Wednesday, November 8, 2023
Boston Hernia - Wellesley, MA

We just published our first book chapter in Surgical Clinics. We had the privilege of traveling to the Shouldice Hospital with the late Professor Jon Chilingerian in 2016.  We went to learn their model of excellence and fell in love with the technical aspects of their surgery.  We have taken all the lessons we learned to create the best quality and patient experience in ambulatory hernia care.  The Shouldice repair is an excellent option for patients who want to avoid mesh or are not candidates for a posterior mesh repair.


Boston Hernia Surgeons Present Patient Reported Outcomes Data for the American College of Surgeons

Wednesday, October 25, 2023
Boston Hernia - Wellesley, MA

This morning, one of the outstanding residents of the Mass General Hospital Residency program presented our group data at the American College of Surgeons annual Clinical Congress.

Here is a summary of the presentation and pertinent findings


Boston Hernia Surgeons Recognized as National Leaders in Quality Hernia Care

Wednesday August 2nd, 2023
Boston Hernia - Wellesley, MA

Boston Hernia has always been focused on improving the quality of hernia care. As active members of the Abdominal Core Health Quality Collaborative (ACHQC), a coalition of hernia surgeons committed to quality and value of care for patients with hernia or other abdominal wall diseases, Boston Hernia surgeons have dedicated time and effort to constant quality improvement. The ACHQC recently developed a Verified Surgeon program which distinguishes certain participating surgeons for their outstanding level of dedication to the organization’s mission. Both Boston Hernia surgeons, the only two surgeons recognized in New England, were included on this short list. 

Boston Hernia was founded on the belief that the quality of hernia care can and should be improved- that dangerous and life altering complications like the development of chronic pain (afflicting 5-15% of patients after hernia repair) should not occur. Through their efforts to better tailor surgeries to patients’ needs, dedication to patient education and awareness, and employment of surgical approaches with significant advantages in recovery and reduction of complication risks, Boston Hernia has set the bar for quality in hernia care. We are very proud to have our hard work recognized by the ACHQC and are most proud of how this work has led to better outcomes for our patients. Read more… 



Boston Hernia publishes outcomes in Journal Hernia

Tuesday March, 14, 2023
Boston Hernia - Wellesley, MA

After years of collecting post-operative data in the ACHQC, the team at Boston Hernia finally published their research showing short- and long-term advantages of the open preperitoneal hernia repair compared to robotic and laparoscopic for inguinal hernia when performed in a high-volume center. The open preperitoneal (OPP) repair, performed by Drs. Fullington and Reinhorn about 750 times per year, virtually eliminates chronic postoperative inguinal pain, an all too common complication after traditional hernia surgery. When compared to laparoscopic and robotic hernia repairs, OPP results in lower opioid use and improved patient reported quality of life. The open preperitoneal repair is typically done under local anesthesia with sedation (avoiding general anesthesia), and without expensive laparoscopic or robotic equipment, which makes it more cost effective.

Our published paper in Journal Hernia is quite technical, but the data shows what we have known anecdotally for years: patients recover faster with less pain, less opioids, and lower complication rate when they have an open preperitoneal repair performed by a high volume hernia surgeon like Dr. Fullington or Dr. Reinhorn.


Boston Hernia Surgeons Collaborate to Reduce Opioid Prescriptions

This fall, the Abdominal Core Health Quality Collaborative (ACHQC) Opioid Reduction Task Force, headed by Dr. Michael Reinhorn, published its first manuscript related to the work that the task force has been doing for years trying to reduce opioid prescribing habits by hernia surgeons. The ACHQC was formed to have dedicated hernia surgeons work together to implement quality improvement projects related to hernia surgery. Thanks to the leadership of the ACHQC, Dr. Reinhorn was tasked with creating and leading the Opioid Reduction Task Force with the goal of improving postoperative pain management while decreasing patient opioid use.

Almost six years ago, the co-founders of Boston Hernia, Dr. Reinhorn and Lauren Ott, PA-C, examined their patients’ opioid use after hernia surgery. They then compared....Read more



Dr. Reinhorn Elected to the ACHQC Board - Winter 2020-2021

At the end of 2020, the Americas Hernia Society (AHS) elected Dr. Reinhorn to serve as an AHS representative to the Abdominal Core Health Quality Collaborative (ACHQC) board.  Dr. Reinhorn is joined by several surgeons throughout the United States who are committed to improving the quality of hernia surgery. Since 2018, Dr. Reinhorn has chaired the Opioid Reduction Task for of the ACHQC, and has led national efforts to reduce opioid prescribing after hernia surgery. By joining the board of the ACHQC, Dr. Reinhorn is able to further influence quality improvement initiatives across the country. The ACHQC was initially started as the Americas Hernia Society Quality Collaborative in 2013.  Since then over 450 surgeons throughout the country have voluntarily registered over 75,000 patients into the registry.

Information about the ACHQC  quoted from the ACHQC website 

“About the ACHQC: Through continuous quality improvement, real world data collection, rigorous analysis and collaborative learning, the ACHQC identifies areas where abdominal core health may be enhanced and shares this information in meaningful ways that have direct impact on patient care. The ACHQC is a CMS Qualified Clinical Data Registry and is an authoritative resource for organizations to assess quality metrics and demonstrate a commitment to efficient, value-based patient centered care. Participation in the ACHQC is free to surgeons and fulfills Part 4 of the American Board of Surgery Maintenance of Certification Program.”


NBC 10 Boston pays Boston Hernia a visit - Summer 2019


Summer 2019 -

Dr. Reinhorn was recently interviewed by Kristy Lee of Boston NBC Chanel 10.  She asked some very insightful questions about the approach we use to inguinal hernia repair. Kristy shows an actual bicycle tire, in order to explain the differences between the way we fix a hernia and the way most surgeons repair a hernia.



Publication on Opioid Prescribing - Summer 2017


Lauren Ott and Michael Reinhorn partnered with surgeons from the MGH to study the number of opioid tablets prescribed for hernia surgery.  They were innterviewed in the local Newton Tab while the MGH published an article about their work.  As a result of this work, Dr. Reinhorn is helping lead an effort to measure and reduce opioid prescribing nationally through the Americas Hernia Society.