Transabdominal Preperitoneal Laparoscopic Approach for the Treatment of Sportsman's Hernia

Abstract

The transabdominal preperitoneal laparoscopic approach is safe and feasible in the diagnosis and treatment of Sportsman's hernia, enabling a full return to sports activities.

Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal Hernia [International Endohernia Society (IEHS)]

“…Although, according to general opinion, only 10 mm and bigger trocar site defects should be closed, the development of incisional hernia with consequences was described even with 3-5-mm trocars [59][60][61][62][63][64][65].…”

“…Felix et al [33] found an occult femoral hernia incidence of 9% in his 1996 series of laparoscopic repair of recurrent inguinal hernia. Mikkelsen et al found the risk of femoral hernia to be 15 times higher after inguinal hernia repair than in the general population, and Chan believes prior inguinal hernia repair may precipitate femoral hernia [65,66]. He found that 50.9% of his series of 225 femoral hernia repairs had concurrent inguinal hernia and 18.2% had prior groin hernia repair.…”

“…Two types of laparoscopic surgery are successfully applied: the transabdominal preperitoneal patch plasty (TAPP) [19,28,35,65], and the total extraperitoneal preperitoneal patch plasty [12,51,55,57,60]. No studies have shown the true efficacy of these different techniques, thus a recommendation for one or the other method cannot be given and depends on the skill and personal preference of the surgeon involved.…”

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

“…25,32,33 Given that most athletes are concerned about recovery time after surgery, 22 the laparoscopic approach may be the more suitable approach. 28 Other approaches such as TAPP repairs may be equivalent in terms of outcomes 32,34 ; however, TEP may offer advantages such as less pain 20 and lower risk of injury to intraabdominal viscera; TEP may be challenging or inappropriate in other circumstances, as in patients with previous abdominal surgery or the need for prostate surgery. 35 Further developments, especially in relation to cosmesis, include single-port surgery but may take longer to perform than standard TEP repairs.…”

Laparoscopic Hernia Repair

“…The exact pathophysiology is unclear and various theories have emerged in literature considering the presences of an occult hernia, a tear or microtears in the transversalis fascia or muscle strain. The theory that posterior weakness in the inguinal wall is the prime cause of groin pain in athletes is supported by the fact that reinforcement of the posterior wall often resolves the groin pain (Malycha & Lovell, 1992;Paajanen et al, 2004;van Veen et al, 2007;Ziprin et al, 2008). Sportmen hernia are found almost exclusively in men and only sporadically in women (Hackney, 1993;Moeller, 2007).…”