Hernia or Groin Pain in Athlete
Seance of wednesday 17 april 2019 (Chirurgie du sportif)
DOI number : 10.26299/dj66-9862/emem.2018.3.002
Abstract
Purpose: Understand the principles which make it possible to differentiate a hernia from a pubalgia and guide the choices of the various surgical techniques used in the surgical treatment of pubalgia.
News: An inguinal hernia is a pathological protrusion of a portion of peritoneum possibly containing abdominal viscera through the inguinal canal or directly through the opening of the abdominal muscles through the abdominal wall.
A pubalgia is a pain in the pubic region that occurs in athletes.
Since Nesovic, numerous publications have spoken of the surgical treatment of pubalgia. How in practice to have a rational approach and offer the athlete a reliable intervention, this is the challenge. After having investigated the cause of pubalgia and faced with the failure of conservative measures, two types of surgery can be proposed, isolated or associated: strengthening the abdominal wall or tenotomy of the adductors. The strengthening of the wall will use the wall repair techniques used in hernia treatments. The use of prosthesis is contraindicated for young athletes because it is a technique providing chronic pain. Suture techniques are preferable, according to the inventory of lesions, a repair in four thicknesses according to schouldice or in two thicknesses according to Muschaweck is carried out. The adductor tenotomy treats the adductor enthesopathy, the risk of postoperative adhesions requires early and constant mobilization. There is no consensus for the treatment of pubic osteoarthropathies, direct surgical procedures are not very effective and burdened with disabling complications, the resting of the symphysis by the association of a parietal strengthening and a tenotomy is recommended.
Conclusion: No prospective study of level of evidence 1 or 2 exists, allowing to choose the best surgical solution. It is therefore EBM (expert based medicine and not evidence based medicine) which allows you to choose the best solution taking into account the experience acquired and the mastery of the different techniques
News: An inguinal hernia is a pathological protrusion of a portion of peritoneum possibly containing abdominal viscera through the inguinal canal or directly through the opening of the abdominal muscles through the abdominal wall.
A pubalgia is a pain in the pubic region that occurs in athletes.
Since Nesovic, numerous publications have spoken of the surgical treatment of pubalgia. How in practice to have a rational approach and offer the athlete a reliable intervention, this is the challenge. After having investigated the cause of pubalgia and faced with the failure of conservative measures, two types of surgery can be proposed, isolated or associated: strengthening the abdominal wall or tenotomy of the adductors. The strengthening of the wall will use the wall repair techniques used in hernia treatments. The use of prosthesis is contraindicated for young athletes because it is a technique providing chronic pain. Suture techniques are preferable, according to the inventory of lesions, a repair in four thicknesses according to schouldice or in two thicknesses according to Muschaweck is carried out. The adductor tenotomy treats the adductor enthesopathy, the risk of postoperative adhesions requires early and constant mobilization. There is no consensus for the treatment of pubic osteoarthropathies, direct surgical procedures are not very effective and burdened with disabling complications, the resting of the symphysis by the association of a parietal strengthening and a tenotomy is recommended.
Conclusion: No prospective study of level of evidence 1 or 2 exists, allowing to choose the best surgical solution. It is therefore EBM (expert based medicine and not evidence based medicine) which allows you to choose the best solution taking into account the experience acquired and the mastery of the different techniques