Elsevier

Surgery

Volume 150, Issue 1, July 2011, Pages 99-107
Surgery

Original Communication
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)

https://doi.org/10.1016/j.surg.2011.02.016Get rights and content

Background

Chronic groin pain in athletes presents often a diagnostic and therapeutic challenge. Sportsman’s hernia (also called “athletic pubalgia”) is a deficiency of the posterior wall of the inguinal canal, which is often repaired by laparoscopic mesh placement. Endoscopic mesh repair may offer a faster recovery for athletes with sportsman’s hernia than nonoperative therapy.

Methods

A randomized, prospective study was conducted on 60 patients with a diagnosis of chronic groin pain and suspected sportsman’s hernia. Clinical data and MRI were collected on all patients. After 3 to 6 months of groin symptoms, the patients were randomized into an operative or a physiotherapy group (n = 30 patients in each group). Operation was performed using a totally extraperitoneal repair in which mesh was placed behind the symphysis and painful groin area. Conservative treatment included at least 2 months of active physiotherapy, including corticosteroid injections and oral anti-inflammatory analgesics. The outcome measures were pre- and postoperative pain using a visual analogue scale and partial or full recovery to sports activity at 1, 3, 6, and 12 months after randomization.

Results

The athletes in both treatment groups had similar characteristics and pain scores. Operative repair was more effective than nonoperative treatment to decrease chronic groin pain after 1 month and up to 12 months of follow-up (P < .001). Of the 30 athletes who underwent operation, 27 (90%) returned to sports activities after 3 months of convalescence compared to 8 (27%) of the 30 athletes in the nonoperative group (P < .0001). Of the 30 athletes in the conservatively treated group, 7 (23 %) underwent operation later because of persistent groin pain.

Conclusion

This randomized controlled study indicated that the endoscopic placement of retropubic mesh was more efficient than conservative therapy for the treatment of sportsman’s hernia (athletic pubalgia).

Section snippets

Patients and methods

This study was conducted between January 2007 and December 2009 in 3 hospitals. Most patient participants included athletes at an elite level in national leagues or nonprofessionals who participated regularly in heavy training. Specifically, the 60 study participants included 31 national-level soccer players, 10 runners, 5 ice hockey players, 5 cross-country skiers, and 9 individuals who engaged in various sport activities. The athletes were referred to this trial from sports clinics and

Results

Patient characteristics and the mean pain scores were similar in the operative and conservative groups (Table I). Pain scores were much greater during exercise than at rest in both groups. No patients were lost during 12 months of follow-up (Fig 1). All athletes had obscure chronic groin pain rostral to the inguinal ligament with a clinical diagnosis of sportsman’s hernia. The area of pain was either near the pubic insertion of inguinal ligament, nonspecifically in the lower abdominal wall, or

Discussion

The results of this controlled clinical trial demonstrate clearly that an endoscopic, preperitoneal hernioplasty was more effective than nonoperative treatment for sportsman’s hernia with groin pain in athletes. Operative treatment allowed excellent immediate and long-term relief of pain with low morbidity and fast recovery to full sports activity. To our knowledge, there have been only 2 previous, randomized treatment trials of chronic groin pain in athletes published in the literature. The

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