A Literature Review on the Role of Totally Extraperitoneal Repairs for Groin Pain in Athletes

Abstract

A literature review was made on the role of totally extraperitoneal (TEP) hernia repairs for groin pain in athletes. Electronic databases were searched for literature published from January 1993 to November 2011. There were 10 articles incorporating 196 patients included in this review. Thirty percent of patients were reported to have direct inguinal hernias, 22% had indirect inguinal hernias, and 41% had dilated internal rings. Of note, 30% of cases had no macroscopic abnormality. Four studies reported on an early followup ranging between 3 and 6 weeks. Only minimal or mild symptoms were reported. Up to 33% of patients had impaired ability to perform at peak levels. Up to 53% of patients had persistence of symptoms at the early follow-up. Total follow-up time ranged from 3 to 80 months, and most patients were active (90%-100%). At long-term follow-up, 3% to 10% were unable to play, and 5% were reported as being unable to train. Two studies from the same center reported on TEP surgery for osteitis pubis, and most patients returned to sporting activity after 4 to 8 weeks. TEP repair is a good operative intervention in athletes with chronic groin pain not relieved by conservative measures. Athletes recover quickly and return to sport early.

Sportsman hernia; the review of current diagnosis and treatment modalities

“…They reported that a new-onset hernia was identified in 65% and true inguinal hernia in 35% of the patients in a series of 55 sportsmen. Recent studies recommend that surgical treatment should now be selected as the first treatment method by skipping conservative treatment in order to treat inguinal pain in sportsmen (39). It could be stated that our own practice is also in parallel with the literature in that sense.…”

“…Many surgeons have acknowledged that laparoscopic therapy, which has an increasing popularity among surgical treatments, ensures an effective and quicker return to full sports activity (87-92% of patients in 2-8 weeks) (20,23,35,(39)(40)(41)(42). Genitsaris (42) stated in his study that 97% of his patients returned to full sports activity in 2-3 weeks.…”

“…However, TEP might not be performed due to prostate surgery or previous lower abdominal surgery. Although the single-port method is preferred with cosmetic concerns, the duration of surgery is longer in comparison to standard TEP (39).…”

“…Tenotomy may be required later for relieving pain caused by adductor tendinopathy. Furthermore, prophylactic repair can also be made during TEP in asymptomatic contralateral groins (39). Sportsman's hernia is treated via laparoscopic and open methods based on the surgeon's preference, experience and mastery.…”

Systematic review: laparoscopic treatment of long-standing groin pain in athletes

“…In a recent randomised trial including 60 athletes with ID/AP, the efficacy of TEP compared with non-operative treatment was further confirmed 18. A recent review summarises that TEP repair is a good alternative in athletes with intractable groin pain who do not respond to non-operative treatment strategies 30. This review examined 10 publications that incorporated 196 patients from a literature search of electronic databases from January 1993 to November 2011.…”