Randomized clinical trial of open suture repairversustotally extraperitoneal repair for treatment of sportsman's hernia

Abstract

Background: Sportsman's hernia/athletic pubalgia is a recognized cause of chronic groin pain in athletes. Both open and laparoscopic surgical repairs have been described for treatment, but there are no comparative studies. The hypothesis here was that relief of pain would be achieved earlier in patients treated with open minimal suture repair than totally extraperitoneal repair. Methods: A randomized multicentre trial in four European countries was conducted to compare open minimal suture repair with totally extraperitoneal repair. The primary endpoint was complete relief of pain (visual analogue scale (VAS) score 20 or less on a scale from 0 to 100 mm) at 1 month. Secondary endpoints included complications, time to return to sporting activity, and number of patients returning to sport within 1 year. Results: A total of 65 athletes (92 per cent men) with a median age of 29 years were enrolled (31 open repair, 34 totally extraperitoneal repair). By 4 weeks after surgery, median preoperative VAS scores had dropped from 70-80 to 10-20 in both groups (P < 0⋅001). Relief of pain (VAS score 20 or less) during sports activity 4 weeks after surgery was achieved in 14 of 31 patients after open repair and 24 of 34 after totally extraperitoneal repair (P = 0⋅047). Return to full sporting activity was achieved by 16 and 18 patients respectively after 1 month (P = 0⋅992), and by 25 versus 31 after 3 months (P = 0⋅408). Conclusion: Totally extraperitoneal repair was less painful than open repair in the first month, but otherwise both procedures were similarly effective in treating chronic pain due to sportsman's hernia. Registration number: NCT02297711 (http://www.clinical.trials.gov).

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

“…From the 47 articles selected, 44 were classified as level 4 evidence, 1 was classified as level 3, 1 randomized controlled trial as level 1b, and another randomized controlled trial as 2b. The randomized trial comparing open with endoscopic repair of the posterior inguinal wall 71 was considered a high-quality trial, with 21 of 25 points according to CONSORT-based scoring. 3 , 29 The second randomized trial comparing surgical with nonoperative treatment 52 was considered an intermediate-quality trial, with 14 of 25 points according to CONSORT-based scoring.…”

“… 7 , 26 , 41 , 59 , 84 In the past 20 years, only 2 (11%) of the 18 articles reported repairs without mesh reinforcement. 71 , 75 The posterior inguinal wall was repaired in 1513 patients in 21 studies. ∥ Repair of the anterior inguinal wall (external oblique aponeurosis) and neurotomy of the iliohypogastric or ilioinguinal nerve was performed in 45 patients in 2 studies.…”

“…Among the 15 studies (653 patients) reporting return to play at preinjury or higher level after repair of the posterior inguinal wall, 89.5% (95% CI, 84%-94%) of the athletes with open repair and 96% (95% CI, 92%-98%) with TEP/TAPP repair were able to return at preinjury or higher level of activity, a statistically significant difference ( P = .0012). A randomized controlled trial 71 compared open suture repair (31 patients) versus endoscopic mesh repair (TEP; 34 patients), and the rates of return to full sport activity were 90.3% and 94.1%, respectively, for a nonsignificant difference ( P = .238).…”

A retrospective cohort study of open preperitoneal repair versus open suture repair for the treatment of emergency femoral hernia

“…The VAS scoring system is a good evaluation method for chronic pain after hernia surgery. In recent years, some studies have evaluated the postoperative effect of hernia using this evaluation system 24,25 .…”

Early recovery after endoscopic totally extraperitoneal (TEP) hernia repair in athletes with inguinal disruption: A prospective cohort study

“…Management of inguinal disruption by surgical exploration and mesh placement should be considered when non-operative treatment fails [6,11,12]. A variety of surgical techniques have been reported in the literature [11,13,14], where laparoscopic surgery tends to have lower pain scores [15] and faster recovery rates compared to open surgery [11,16–19]. However, there is a lack of prospective studies on the effectiveness of operative treatment of groin pain in athletes.…”