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Ellis R, Maskal S, Prabhu A, Petro C, Beffa L, Rosen M, Miller B, Krpata D. Surgical approaches for core abdominal injuries: a review of the Abdominal Core Health Quality Collaborative database. Surg Endosc 2023; 37:8799-8803. [PMID: 37592045 DOI: 10.1007/s00464-023-10350-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/30/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Core abdominal injury (CAI) is a broad term that describes injuries resulting from repetitive loading of the pubis that leads to inflammation, rupture, or destabilization of the core muscles from the pubic bone. There is no clear recommendation on the surgical approach to CAI. We aimed to describe how hernia surgeons within the Abdominal Core Health Quality Collaborative (ACHQC) address this problem surgically and the short-term outcomes. METHODS We queried the ACHQC registry for patients undergoing surgery for isolated CAI and concomitant inguinal hernias (IH) and CAI. Operative approach and quality of life (using EuraHS survey scores) was abstracted. RESULTS A total of 29,451 patients underwent surgery for IHs, CAIs, or both within the registry. Twenty patients underwent surgery for isolated CAI (median age 29, 90% males). Eleven patients (55%) underwent surgery with mesh (four Lichtenstein, three TAPP, and four TEP). Nine patients (45%) underwent tissue-based repairs (four closure of floor, one Bassini, one McVay, one Shouldice, one femoral exploration, and one laparoscopic-to-open conversion). There were no postoperative complications or reoperations within 30 days. EuraHS scores showed improvement at 30 days from baseline (median 29 [6.75-41.75] from 42 [29.42-57.61]). Sixty patients had both IHs and CAIs (median age 31, 97% males). All patients received mesh. Thirty-one patients (52%) underwent open surgery (23 Lichtenstein, 1 plug, 7 TREPP) and 29 underwent minimally invasive repairs (23 TAPP, 6 TEP). There was one seroma at 30 days. EuraHS scores showed improvement at 30 days from baseline (median 16 [5.17-27.33] from 37.5 [26.44-46.58]). CONCLUSIONS Despite technical variability, CAIs with or without concomitant IH generally undergo operations commonly used for IH repairs. Within our series, there was inconsistency with approach and mesh placement. Future work should be focused on standardizing the approach to CAI and capturing long-term data within the ACHQC.
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Affiliation(s)
- Ryan Ellis
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Sara Maskal
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Ajita Prabhu
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Clayton Petro
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Lucas Beffa
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Michael Rosen
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Benjamin Miller
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - David Krpata
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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Biswas S, Pilkington JJ, Stathakis P, Jamdar S, Harwood R, Paajanen H, Sheen AJ. The Sheen Paajanen grOin Recommended Treatment 'SPoRT' score for groin pain. Hernia 2023; 27:1085-1093. [PMID: 37093340 DOI: 10.1007/s10029-023-02771-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/12/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Evaluating groin pain still evades many clinicians at times as they have difficulty determining the cause of pain when no true hernia exists. This study's aim was to evaluate a simple and novel scoring system which is reproducible, to help determine whether conservative measures or surgery is recommended for the management of groin pain attributable to inguinal disruption. MATERIAL & METHODS A retrospective analysis of all patients from 2018 to 2020 that underwent surgery or conservative management for inguinal disruption with at least a 1-year follow-up were evaluated. The scoring system is based on MRI and ultrasound imaging as well as clinical findings, with scores given from - 2 to + 2 based on the defined findings listed. A maximum total of four points scored for each assessment was used. Sensitivity and specificity analysis was conducted for each potential score cut off point. RESULTS A total of 172 patients were evaluated with 33 patients (19%) undergoing conservative management and 139 patients (81%) undergoing surgery. The median SPoRT score for the surgery group was 2.0 (1.0, 3.0), and - 1.0 (- 3.0, 0.0) in the physiotherapy group which was a significant difference (p < 0.001). An optimal cut off of ≤ 0 for physio and ≥ 1 for surgery was established, yielding a sensitivity of 90.9% (95% CI 75.7%-98.1%), a specificity of 89.2% (95% CI 82.8%-93.8%) and an area under the curve (AUC) of 0.936 (95% CI 0.874-0.997). DISCUSSION SPoRT score of ≤ 0 can recommend a patient should undergo conservative measures or physiotherapy as a mainstay of treatment with a score of ≥ 1 recommending surgery. Further validation of the score is necessary.
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Affiliation(s)
- S Biswas
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - J J Pilkington
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - P Stathakis
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Jamdar
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Harwood
- Department of Medical Statistics, Manchester University NHS Foundation Trust, Manchester, UK
| | - H Paajanen
- Department of Surgery, University of Eastern Finland and Mikkeli Central Hospital, Mikkeli, Finland
| | - A J Sheen
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
- Manchester Academic Health Science Centre (MAHSC), Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Meuzelaar RR, Visscher L, den Hartog FPJ, Goedhart EA, Verleisdonk EJMM, Schiphorst AHW, Burgmans JPJ. Athletes treated for inguinal-related groin pain by endoscopic totally extraperitoneal (TEP) repair: long-term benefits of a prospective cohort. Hernia 2023; 27:1179-1186. [PMID: 37391498 PMCID: PMC10533610 DOI: 10.1007/s10029-023-02815-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/25/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE Inguinal-related groin pain (IRGP) in athletes is a multifactorial condition, posing a therapeutic challenge. If conservative treatment fails, totally extraperitoneal (TEP) repair is effective in pain relief. Because there are only few long-term follow-up results available, this study was designed to evaluate effectiveness of TEP repair in IRGP-patients years after the initial procedure. METHODS Patients enrolled in the original, prospective cohort study (TEP-ID-study) were subjected to two telephone questionnaires. The TEP-ID-study demonstrated favorable outcomes after TEP repair for IRGP-patients after a median follow-up of 19 months. The questionnaires in the current study assessed different aspects, including, but not limited to pain, recurrence, new groin-related symptoms and physical functioning measured by the Copenhagen Hip and Groin Outcome Score (HAGOS). The primary outcome was pain during exercise on the numeric rating scale (NRS) at very long-term follow-up. RESULTS Out of 32 male participants in the TEP-ID-study, 28 patients (88%) were available with a median follow-up of 83 months (range: 69-95). Seventy-five percent of athletes were pain free during exercise (p < 0.001). At 83 months follow-up, a median NRS of 0 was observed during exercise (IQR 0-2), which was significantly lower compared to earlier scores (p <0.01). Ten patients (36%) mentioned subjective recurrence of complaints, however, physical functioning improved on all HAGOS subscales (p <0.05). CONCLUSION This study demonstrates the safety and effectivity of TEP repair in a prospective cohort of IRGP-athletes, for whom conservative treatment had failed, with a follow-up period of over 80 months.
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Affiliation(s)
- R R Meuzelaar
- Department of Surgery/Hernia Clinic, Diakonessenhuis, Utrecht/Zeist, The Netherlands.
| | - L Visscher
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F P J den Hartog
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E A Goedhart
- Sports Medical Centre Royal Netherlands Football Association/FIFA Medical Centre of Excellence, Zeist, The Netherlands
| | - E J M M Verleisdonk
- Department of Surgery/Hernia Clinic, Diakonessenhuis, Utrecht/Zeist, The Netherlands
| | - A H W Schiphorst
- Department of Surgery/Hernia Clinic, Diakonessenhuis, Utrecht/Zeist, The Netherlands
| | - J P J Burgmans
- Department of Surgery/Hernia Clinic, Diakonessenhuis, Utrecht/Zeist, The Netherlands
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Palumbo P, Massimi F, Lucchese S, Grimaldi S, Vernaccini N, Cirocchi R, Sorrenti S, Usai S, Intini SG. Open Surgery for Sportsman’s Hernia a Retrospective Study. Front Surg 2022; 9:893390. [PMID: 35784930 PMCID: PMC9243487 DOI: 10.3389/fsurg.2022.893390] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Sportsman’s hernia is a painful syndrome in the inguinal area occurring in patients who play sports at an amatorial or professional level. Pain arises during sport, and sometimes persists after activity, representing an obstacle to sport resumption. A laparoscopic/endoscopic approach is proposed by many authors for treatment of the inguinal wall defect. Aim of this study is to assess the open technique in terms of safety and effectiveness, in order to obtain the benefit of an open treatment in an outpatient management. From October 2017 to July 2019, 34 patients underwent surgery for groin pain syndrome. All cases exhibited a bulging of the inguinal posterior wall. 14 patients were treated with Lichtenstein technique with transversalis fascia plication and placement of a polypropylene mesh fixed with fibrin glue. In 20 cases, a polypropylene mesh was placed in the preperitoneal space. The procedure was performed in day surgery facilities. Early or late postoperative complications did not occur in both groups. All patients returned to sport, in 32 cases with complete pain relief, whereas 2 patients experienced mild residual pain. The average value of return to sport was 34.11 ± 8.44 days. The average value of return to play was 53.82 ± 11.69 days. With regard to postoperative pain, no substantial differences between the two techniques were detected, and good results in terms of the resumption of sport were ensured in both groups. Surgical treatment for sportsman’s hernia should be considered only after the failure of conservative treatment. The open technique is safe and allows a rapid postoperative recovery.
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Affiliation(s)
- Piergaspare Palumbo
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
- Correspondence: Piergaspare Palumbo
| | - Fanny Massimi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Sara Lucchese
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Serena Grimaldi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Sofia Usai
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
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Pilkington JJ, Obeidallah R, Baltatzis M, Fullwood C, Jamdar S, Sheen AJ. Totally extraperitoneal repair for the 'sportsman's groin' via 'the Manchester Groin Repair': a comparison of elite versus amateur athletes. Surg Endosc 2020; 35:4371-4379. [PMID: 32909207 DOI: 10.1007/s00464-020-07930-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgery has a recognised role in the treatment of 'sportsman's groin'. This study hypothesises that elite athletes have a superior advantage in both pre- and post-op rehabilitation and therefore will present and resume sporting activities quicker. METHODS A retrospective analysis on a secure database of athletes presenting with groin pain that underwent surgery for 'inguinal disruption'. All data were explored via appropriate descriptive statistics and comparisons made between elite and amateur athletes. RESULTS All patients were male (n = 144). The median age 33 years (range 14-72). The median return to sporting activity was 4.5 weeks (range 2.0-16.0) with one amateur athlete being unable to return to sporting activity. Using the mean of both sides, a comparison of VAS pain scores at pre-operative and 1 month post-operative time points showed a significant reduction (p < 0.001). Comparing 'elite' versus 'amateur' athletes, significant differences were seen in patient age (median 26 vs 40 years; p < 0.001), lead time to clinic presentation (median 62.0 vs 111.5 days; p = 0.004), and time to return to sporting activity (4 vs 5 weeks; p = 0.019). Additional MRI findings within the groin girdle were found in 89 patients (66.4%) and 34 patients (23.6%) had an MRI finding within the adductor tendon. CONCLUSION The Manchester Groin Rrepair is an effective surgical management for 'inguinal disruption'. Elite athletes present quicker and return to sport sooner. Given the prevalence of other findings, a multidisciplinary approach to the 'sportsman's groin' is required.
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Affiliation(s)
- J J Pilkington
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Bioscience, Manchester Metropolitan University, Manchester, UK
| | - R Obeidallah
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Baltatzis
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - C Fullwood
- Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Biostatistics, Manchester University, Manchester, UK
| | - S Jamdar
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - A J Sheen
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK. .,Centre for Bioscience, Manchester Metropolitan University, Manchester, UK. .,Fortius Clinic, 17 Fitzhardinge street, London, UK.
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Affiliation(s)
- Brian S. Zuckerbraun
- Division of General and Trauma Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Anthony R. Cyr
- Division of General and Trauma Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Craig S. Mauro
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Feldman K, Franck C, Schauerte C. Management of a nonathlete with a traumatic groin strain and osteitis pubis using manual therapy and therapeutic exercise: A case report. Physiother Theory Pract 2018; 36:753-760. [PMID: 29979902 DOI: 10.1080/09593985.2018.1492658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Without a definitive single pathoanatomical origin for groin pain, management is difficult. The purpose of this case report is to describe the differential diagnosis and management of an individual with a traumatic groin strain. Case Description: A 47-year-old sedentary male truck driver presented to physical therapy with a 2-month history of right medial groin pain. Pushing the gas pedal and sitting were painful activities. Pain was 3-8/10 on the Numeric Pain Rating Scale (NPRS). The patient reported 46/80 on the Lower Extremity Functional Scale. Examination: Tenderness was noted along the adductor longus muscle belly, right pubic ramus and hip range of motion was limited. Special tests directed at the hip and pelvic region indicated intraarticular and pelvic dysfunction. Treatment included hip and pubic symphysis joint mobilizations, lumbopelvic manipulation, adductor longus soft-tissue mobilization, and core strengthening. Outcome: 12 sessions of physical therapy resulted in LEFS to 80/80, Global Rating of Change (GROC) + 7, and NPRS 0/10 at worst. The patient returned to full work without restriction. Discussion: Groin pain has many pathoanatomical drivers. Management of a traumatic groin injury requires a thorough evaluation and a global treatment approach, in order to improve outcomes and reduce the risk of the pathology becoming chronic.
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Affiliation(s)
- Kyle Feldman
- Physical Therapy Specialists of Winchester , Winchester, VA, USA
| | - Carla Franck
- Kepros Physical Therapy and Performance , Cedar Rapids, IA, USA
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Sheen AJ, Pilkington JJ, Dudai M, Conze JK. The Vienna Statement; an Update on the Surgical Treatment of Sportsman's Groin in 2017. Front Surg 2018; 5:45. [PMID: 30035112 PMCID: PMC6043792 DOI: 10.3389/fsurg.2018.00045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/15/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Aali J Sheen
- Manchester University Foundation Trust, Manchester, United Kingdom.,Centre for Biomedicine, Manchester Metropolitan University, Manchester, United Kingdom
| | - J James Pilkington
- Manchester University Foundation Trust, Manchester, United Kingdom.,Centre for Biomedicine, Manchester Metropolitan University, Manchester, United Kingdom
| | - Moshe Dudai
- Hernia Excellence, Ramat Avic Medical Center, Tel Aviv, Israel
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Athletes with inguinal disruption benefit from endoscopic totally extraperitoneal (TEP) repair. Hernia 2018; 22:517-524. [DOI: 10.1007/s10029-018-1741-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/19/2018] [Indexed: 10/18/2022]
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10
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Voorbrood CEH, Goedhart E, Verleisdonk EJMM, Sanders F, Naafs D, Burgmans JPJ. Endoscopic totally extraperitoneal (TEP) hernia repair for inguinal disruption (Sportsman's hernia): rationale and design of a prospective observational cohort study (TEP-ID-study). BMJ Open 2016; 6:e010014. [PMID: 26739740 PMCID: PMC4716196 DOI: 10.1136/bmjopen-2015-010014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Chronic inguinal pain is a frequently occurring problem in athletes. A diagnosis of inguinal disruption is performed by exclusion of other conditions causing groin pain. Up to now, conservative medical management is considered to be the primary treatment for this condition. Relevant large and prospective clinical studies regarding the treatment of inguinal disruption are limited; however, recent studies have shown the benefits of the totally extraperitoneal patch (TEP) technique.This study provides a complete assessment of the inguinal area in athletes with chronic inguinal pain before and after treatment with the TEP hernia repair technique. METHODS AND ANALYSIS We describe the rationale and design of an observational cohort study for surgical treatment with the endoscopic TEP hernia repair technique in athletes with a painful groin (inguinal disruption).The study is being conducted in a high-volume, single centre hospital with specialty in TEP hernia repair. Patients over 18 years, suffering from inguinal pain for at least 3 months during or after playing sports, and whom have not undergone previous inguinal surgery and have received no benefit from physiotherapy are eligible for inclusion. Patients with any another cause of inguinal pain, proven by physical examination, inguinal ultrasound, X-pelvis/hip or MRI are excluded.Primary outcome is reduction in pain after 3 months. Secondary outcomes are pain reduction, physical functioning, and resumption of sport (in frequency and intensity). ETHICS AND DISSEMINATION An unrestricted research grant for general study purposes was assigned to the Hernia Centre. This study itself is not directly subject to the above mentioned research grant or any other financial sponsorship. We intend to publish the outcome of the study, regardless of the findings. All authors will give final approval of the manuscript version to be published.
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Affiliation(s)
- C E H Voorbrood
- Department of Surgery, Diakonessenhuis, Utrecht/Zeist, Zeist, The Netherlands
| | - E Goedhart
- KNVB/FIFA Medical Centre of Excellence (Sport Medical Centre of the Royal Netherlands Football Association/FIFA Medical Centre of Excellence), Zeist, The Netherlands
| | - E J M M Verleisdonk
- Department of Surgery, Diakonessenhuis, Utrecht/Zeist, Zeist, The Netherlands
| | - F Sanders
- Department of Radiology, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands
| | - D Naafs
- Department of Radiology, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands
| | - J P J Burgmans
- Department of Surgery, Diakonessenhuis, Utrecht/Zeist, Zeist, The Netherlands
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Paksoy M, Sekmen Ü. Sportsman hernia; the review of current diagnosis and treatment modalities. ULUSAL CERRAHI DERGISI 2015; 32:122-9. [PMID: 27436937 DOI: 10.5152/ucd.2015.3132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/12/2015] [Indexed: 11/22/2022]
Abstract
Groin pain is an important clinical entity that may affect a sportsman's active sports life. Sportsman's hernia is a chronic low abdominal and groin pain syndrome. Open and laparoscopic surgical treatment may be chosen in case of conservative treatment failure. Studies on sportsman's hernia, which is a challenging situation in both diagnosis and treatment, are ongoing in many centers. We reviewed the treatment results of 37 patients diagnosed and treated as sportsman's hernia at our hospital between 2011-2014, in light of current literature.
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Affiliation(s)
- Melih Paksoy
- Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ümit Sekmen
- Clinic of General Surgery, Acıbadem Fulya Hospital, İstanbul, Turkey
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Sheen AJ, Paajanen H. The next step towards rational treatment for 'The sportsman's groin'. Br J Sports Med 2015; 49:764-5. [PMID: 26031640 DOI: 10.1136/bjsports-2015-094829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Aali J Sheen
- Department of Hernia Surgery, University of Manchester, Central Manchester Foundation NHS Trust, Manchester, UK
| | - Hannu Paajanen
- Department of Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
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Sheen AJ, Iqbal Z. Contemporary management of 'Inguinal disruption' in the sportsman's groin. BMC Sports Sci Med Rehabil 2014; 6:39. [PMID: 25937929 PMCID: PMC4417524 DOI: 10.1186/2052-1847-6-39] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/10/2014] [Indexed: 11/27/2022]
Abstract
Background This article helps define the basic principles to diagnosis and manage one of the surgically correctable causes of the ‘painful groin’, which is commonly described as the sportsman’s groin. Discussion Often many surgeons will describe a single pathology for the sportsman’s groin such as a ‘hernia’ but often other coexisting etiologies may be present. Management relies on a multidisciplinary approach with a diagnosis initially made by a history of pain in the groin on exercise. Physiotherapy is the recommended first line treatment and is designed to concentrate on strengthening of the abdominal wall muscle and tendon groups around the groin area. Surgery does have a role in the sportsman’s groin but only once all conservative measures have been exhausted or if there is a clear identified pathology causing the groin symptoms such as posterior wall defect. Surgical principles for an inguinal disruption include either open or laparoscopic techniques reinforcing the inguinal canal with a mesh or suture repair followed by an active rehabilitation programme. Summary Once an accurate diagnosis has been achieved, contemporary guidance for inguinal disruption requires a multidisciplinary approach including a specially designed physiotherapy regime and possibly surgery.
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Affiliation(s)
- Aali J Sheen
- Department of Hernia Surgery, Central Manchester Foundation Trust, Manchester Royal Infirmary, Manchester, M13 9WL UK
| | - Zafar Iqbal
- Sport's Medicine, Liverpool FC Training Ground, Melwood Drive, West Derby, Liverpool, L12 8SY U.K
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