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Groin defects seen at extra-peritoneal laparoscopic dissection during surgical treatment of athletic pubalgia

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Abstract

Background

Recently new disease process, often referred to as athletic pubalgia (AP), has been acknowledged by the medical community. The patients suffering from this ailment present with unilateral or bilateral chronic groin pain associated with physical activity without a clear diagnosis of a groin hernia. Though physical therapy and medical treatments are considered first line remedies, some believe that surgical treatment may have better, quicker, and more durable outcomes and procedures aimed at groin reinforcement seem to relieve most of symptoms in the majority of the patients. Despite many surgeons consistently noting rectus insertion or adductor thinning, multiple hernia defects are often seen during dissections and the clinical significance of these findings is still not known.

Materials and methods

Between 2007 and 2011, 40 patients underwent an extra-peritoneal laparoscopic reinforcement of rectus abdominals and insertion of adductor muscles for AP. All patients underwent wide and bilateral groin dissection and the findings were cataloged.

Results

All of the patients presented with groin defects upon wide dissection. Thirty-four patients (85 %) presented with small bilateral indirect inguinal defects and 28 (70 %) of these patients did not have any additional defects. Five patients (12.5 %) were found to have only unilateral inguinal hernia defects. One patient presented with a small direct defect. In addition to these defects, five patients (12.5 %) had additional unilateral femoral hernias, whereas no patient had solitary femoral hernia defects.

Conclusion

AP is a new diagnostic entity with poorly understood etiology. It mostly affects young active adults, often involved in competitive sports and surgical methods may be most effective at achieving the cure. In our experience all of the patients presented with groin defects, though not all were the same. It is our belief that these defects, although likely not the only component, play a significant role in the pathophysiology of AP.

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References

  1. Sheen AJ, Stephenson BM, Lloyd DM, et al. (2013) ‘Treatment of the Sportsman’s groin’: British Hernia Society’s 2014 position statement based on the Manchester Consensus Conference. Br J Sports Med www.ncbi.nlm.nih.gov/pubmed/24149096. Accessed 12 Jan 2013

  2. Litwin DE, Sneider EB, McEnaney PM et al (2011) Athletic pubalgia (sports hernia). Clin Sports Med 30:417–434

    Article  PubMed  Google Scholar 

  3. Mullens FE, Zoga AC, Morrison WB et al (2012) Review of MRI technique and imaging findings in athletic pubalgia and the “sports hernia”. Eur J Radiol 81:3780–3792

    Article  PubMed  Google Scholar 

  4. Gilmore J (1998) Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports Med 17:787–793

    Article  CAS  PubMed  Google Scholar 

  5. Paajanen H, Brinck T, Hermunen H et al (2011) Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman’s hernia (athletic pubalgia). Surgery 150:99–107

    Article  PubMed  Google Scholar 

  6. Nam A, Brody F (2008) Management and therapy for sports hernia. J Am Coll Surg 206:154–164

    Article  PubMed  Google Scholar 

  7. Meyers WC, McKechnie A, Philippon MJ et al (2008) Experience with “sports hernia” spanning two decades. Ann Surg 248:656–665

    PubMed  Google Scholar 

  8. Polglase AL, Frydman GM, Farmer KC (1991) Inguinal surgery for debilitating chronic groin pain in athletes. Med J Aust 155:674–677

    CAS  PubMed  Google Scholar 

  9. Malycha P, Lovell G (1992) Inguinal surgery in athletes with chronic groin pain: the “sportsman’s” hernia. Aust NZJ Surg 62:123–125

    Article  CAS  Google Scholar 

  10. Canonico S, Benevento R, Della Corte A et al (2007) Sutureless tension-free hernia repair with human fibrin glue (tissucol) in soccer players with chronic inguinal pain: initial experience. Int J Sports Med 28:873–876

    Article  CAS  PubMed  Google Scholar 

  11. Diesen DL, Pappas TN (2007) Sports hernias. Adv Surg 41:177–187

    Article  PubMed  Google Scholar 

  12. Brannigan AE, Kerin MJ, McEntee GP (2000) Gilmore’s groin repair in athletes. J Orthop Sports Phys Ther 30:329–332

    Article  CAS  PubMed  Google Scholar 

  13. Susmallian S, Ezri T, Elis M, et al. (2004) Laparoscopic repair of “sportsman’s hernia” in soccer players as treatment of chronic inguinal pain. Med Sci Monit 10:CR52–4

  14. Griffin KJ, Harris S, Tang TY et al (2010) Incidence of contralateral occult inguinal hernia found at the time of laparoscopic trans-abdominal pre-peritoneal (TAPP) repair. Hernia 14:345–349

    Article  CAS  PubMed  Google Scholar 

  15. Putnis S, Wong A, Berney C (2011) Synchronous femoral hernias diagnosed during endoscopic inguinal hernia repair. Surg Endosc 25:3752–3754

    Article  PubMed  Google Scholar 

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Disclosures

Dr. Eid is a consultant for Apollo Surgical, Covidien, Cooper Surgical, and Bariatric Fusion, but there are no conflicts of interest to declare. Dr. Wikiel has no conflicts of interest to declare.

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Correspondence to Krzysztof J. Wikiel.

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Wikiel, K.J., Eid, G.M. Groin defects seen at extra-peritoneal laparoscopic dissection during surgical treatment of athletic pubalgia. Surg Endosc 29, 1695–1699 (2015). https://doi.org/10.1007/s00464-014-3866-2

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  • DOI: https://doi.org/10.1007/s00464-014-3866-2

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