Laparoscopic Approach to Inguinal Disruption in Athletes: a Retrospective 13-Year Analysis of 198 Patients in a Single-Surgeon Setting

Abstract

Background Inguinal disruption (ID) is a condition of chronic groin pain affecting mainly athletes. ID cannot be defined as a true hernia. Pathogenesis is multifactorial due to repetitive and excessive forces applied to the inguino-pelvic region. Examination reveals tenderness to palpation of the inguinal region. Differential diagnosis is challenging; imaging is helpful for excluding other pathologies. Surgery is the treatment of choice when conservative treatment fails. Primary aim of the study was to evaluate the time to return to full sport activity after transabdominal preperitoneal patch plasty (TAPP) technique in ID. Secondary aim was to evaluate the postoperative complication rate both in the immediate post-operative time and in 1 year follow-up and to verify the relapse rate after surgery. In this study, we consider time to return to full sport activity as the time needed to return to pre-injury sport activity. Results A retrospective study is reported by evaluating 198 cases of ID from a single surgeon experience. All patients failed a previous conservative treatment. All cases were treated with the TAPP approach. Time to return to full sport activity was 4 weeks for 94.4% of patients, with a total of 98.5% of active patients at 9 months. Post-operative inguinal pain was the main complication (9.1%). On 13 years follow-up, we report a recurrence rate of 2.5%. Conclusions Current management algorithm for ID, in professional athletes, supports the role of surgery after at least 2 months of conservative treatment. Recently, the role of surgery has been highlighted for a definitive treatment and a faster full recovery to sport activity, especially for elite professional athletes. In our opinion, laparoscopic surgery is the mainstay for non-responsive ID treatment. We present a long-term retrospective evaluation of a wide cohort of professional athletes diagnosed and treated in a systematic way.

Surgical Outcomes of Inguinal-, Pubic-, and Adductor-Related Chronic Pain in Athletes: A Systematic Review Based on Surgical Technique

“…Fibrin glue or mesh without anchorage was used by 30% of the surgeons inserting mesh for the surgical treatment of inguinal-related CGP in athletes, particularly in the past 5 years. 57 , 58 , 63 , 71 , 78 This tendency is explained by the increased risk of chronic pain associated with tack utilization in laparoscopic inguinal hernia repair. 70 Mesh insertion without anchorage or glue is possible in the TEP technique, which does not violate the peritoneum and allows the abdominal pressure to maintain the mesh positioning.…”

“…59 Four articles reported bilateral repair of the posterior inguinal wall in all operated cases, independently if 1 side was asymptomatic. 45,55,57,75 Matikainen et al 45 and Paajan et al 55 justified the bilateral placement of a mesh on the posterior inguinal wall because scarring of the preperitoneal space would most likely prevent a later operation of the nonaffected side. Piozzi et al 57 and Van Meirhaeghe et al 79 argued that performing a TAPP procedure unilaterally could not fully balance and stabilize the anatomic region.…”

“…11,33,54,69,76 Recent advancements have been made in surgical techniques to address inguinal-, pubic-, and adductor-related groin pain, including the extraperitoneal laparoscopic repair and the utilization of modern meshes for reinforcement without anchoring or with fibrin glue. 57,58,63,70,71,78 These advancements have created controversy as to which technique or combination of techniques provides superior outcomes based on a specific clinical condition. Additionally, longer follow-up (>6 months) using return to previous level of activity as a measure may help in differentiating patient outcomes.…”

“…2 57 2 1 2 0 0 0 0 0 0 0 0 0 5 Zoland (2018) 85 1 2 19 1 2 63 1 45 2 58 1 0 36 1 16 1 0 62 1 83 47 1…”

Arthroscopic Correction of Femoroacetabular Impingement for Concomitant Inguinal Disruption in Athletes With Dual Pathology

“…Symptoms include a sharp, burning-type pain, often unilateral, at the pubic symphysis, which may radiate to associated nerve distributions (through the lower abdomen, scrotum, perineum, rectus abdominis, and adductor tendon) and is worsened relative to the demands of athletic activity. 10,12,31,38 Aside from athletic activities and impact sports, sneezing, coughing, or similar Valsalva-type maneuvers may exacerbate the pain. 10…”