Our series reflects the multidisciplinary approach performed in a sports medicine center in which patients are initially evaluated by orthopedic surgeons in order to discard the most common causes of "pubalgia". "Sports hernias" are often associated with adductor muscle strains and other injuries of the groin allowing speculate that these respond to a common mechanism of production. We believe that, considering the difficulty to design randomized trials, only a high coincidence among the diagnostic and therapeutic instances can ensure a rational health care.

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Aim To analyze the safety, feasibility, and effectiveness of a systematized laparoscopic transabdominal preperitoneal approach for a recurrent inguinal hernia. Material & Methods A retrospective observational analysis of a database between July 2012 and July 2022. Inclusion: all patients with a standard laparoscopic tapp approach to treat a recurrent inguinal hernia. The variables were compared with our results in primary inguinal hernias: laparoscopic finding (cause and type using the EHS classification) conversion rate, cause of conversion, complications, and quality of life outcomes. Demographic analysis of the population Age, BMI, and a number of recurrences. Results In this period, 5452 patients underwent a tapp laparoscopic approach to treat an inguinal hernia. 372 (6.82%) were registered as recurrent hernias. Men (98.4%). BMI: (26). When comparing the patients with a previous anterior approach: 316 patients (90%), there were no differences with the results of the primary hernia. Patients with the antecedents of the posterior approach were 39 patients (10,4%). Reviewed case by case, the effectiveness in diagnosis was (100%), and the conversion rate of 8 patients (20,5%). The cause of conversion was severe mesh adhesions to the vascular triangle and vesical preperitoneal space. There were no significant differences when comparing the results between patients who underwent tapp repair in primary and recurrent hernias. There was also no significant difference according to the number of recurrences. Conclusions The laparoscopic systematized approach in recurrent hernias shows effective rates in providing safe diagnosis and treatment while maintaining the quality of life standards.

Aim Lumbar hernias are a rare clinical entity and surgical treatment is constantly evolving and changing. We propose a systematization step-by-step guiding a safe and effective repair with similar conditions to the inguinal region. Material & Methods The patient lies down in a dorsal decubitus position with a 45° elevation of the hernia side. The first port is in the umbilicus access, and the accessory ports are along the middle line. Start the dissection by marking the anatomical limits that involve the semilunar lines, epigastric vessels, spine, and imaginary line between the iliac crest and 11 th rib. Releasing the peritoneal flat until visualizing the psoas iliacus and quadratus muscles until the 11 th ribs, preserving the avascular plane avoids nerves and vascular damage. Hernia sac reduction. Placement of a polypropylene mesh (24×22 cm) covering all the dissected areas. Mesh fixation using absorbable sutures. Closure of the peritoneum.Vacuum maneuver and bulge compression. Results Systematic standardization was applied to all patients. The mean operative time was 90 min. Outpatient surgery was achieved with a fast return to usual activity. The procedures were performed without intraoperative complications, mortality, or conversion to open surgery. Conclusions The step-by-step guide for landmarks and tips provides a safe and effective repair of this rare entity. Finally, clinical studies are needed to measure the impact of this technique's implementation in lumbar hernia repair.