The muscles that undergo injury / fracture are the adductor muscles and the lower abdominal muscles (rectus abdominis and external oblique fascia), which both ‘tie’ to the same bone, the pubic bone, which is located above the our bladder “.
What is the relationship with the “classic” inguinal hernia?
Fracture of these muscles will cause severe pain, which is quite similar to the pain caused by an inguinal hernia, in approximately the same localization area. Nevertheless:
• The characteristic “lump” observed in an inguinal hernia (and which usually disappears with rest) does not coexist
• The pain is much more constant and permanent
• The pain is triggered by the same constant movements and not so much by coughing, sneezing or “tightening” the abdomen
Almost always, with rest and relaxation and perhaps with appropriate physiotherapy, the intense pain disappears but usually returns with the start of exercise.
So we understand that there is no hernia, in the classic sense of the gap in the groin and the exit of the intestine, which causes the pain of the inguinal hernia. The term “hernia” in this painful syndrome is abusive and unreal, as it simply has the same symptoms but a completely different etiology.
Thus, it is much more appropriate to use other, more representative terms that accurately describe the condition, such as:
• Syndrome abdominal adduction
• Athletic pain
• Ibo-inguinal pain syndrome
• Pubic symphysitis etc.
Cause
Abdominal-adductor syndrome is found in a very large percentage of athletes, who strain their body daily with extreme movements, especially rotational, with sharp accelerations and changes of direction and with large tensile positions of specific muscles, as happens in football, basketball, hockey. on ice or in wrestling. This leads to rupture or fracture of the muscles, tendons or ligaments in the groin area just where the abdominal wall muscles join the pelvis. However, it can often occur in amateur or “casual” athletes, who without the necessary warm-up before exercise, or due to poor technique, cause muscle injuries.
Symptoms
These include extreme pain in the groin when the injury occurs, which improves with rest but returns during sports that include twisting, turning and kicking. If left untreated for a long time, it can lead to chronic pain that will no longer prevent even simple walking, and of course will force the patient to stop all exercise and sports activities. Over time, the muscles of the groin area significantly weaken, resulting in the appearance of the “classic” inguinal hernia, with the appearance of protrusion and bowel movements.
Diagnosis
Chronic inguinal pain requires careful history and thorough clinical examination, with special diagnostic exercises, which will raise strong suspicion to the doctor.
The diagnosis often requires examination by the hernia surgeon, as well as by a specialist orthopedist and a physiatrist or physiotherapist, who will submit special tests to the patient. It is also necessary to perform a dynamic ultrasound and magnetic resonance imaging of the groin.
Treatment – Treatment
In the initial, early phase of the injury and after the necessary diagnosis, the treatment is always conservative. Complete abstinence from any exercise and sports activity, ice therapy and taking painkillers and anti-inflammatory drugs is required for a period of 10-15 days.
If the attempt to repeat mild exercise triggers pain again then abstinence should last more than 6 weeks with concomitant intensive physiotherapy by a physiotherapist or physiotherapist specializing in ventricular adductor syndrome.
Surgery:
If conservative treatment does not relieve the symptoms, or enough time has passed since the injury without any significant improvement, then surgery is the only way, and the only method that will offer a definitive cure.
The surgery will restore muscle injuries or nerve entrapment, but mainly will strengthen the inguinal area, and the corresponding muscles, using a special mesh. The surgery is done with the exact same techniques that are used for the surgical repair of an inguinal hernia.
The surgeon specializing in hernia of the abdominal wall will evaluate all the peculiarities and individual characteristics of the patient and will seriously choose the technique that will give the best possible result to his patient.
What are the available surgical techniques?
1. Open Surgical Rehabilitation
In the past, athletes’ hernia repair was performed surgically with many sutures and sutures that caused pain. Modern surgery uses state-of-the-art grids with tension free repair technique, which minimizes postoperative pain, while, very recently, the use of biological glue eliminates the pain.
A typical example is the ONSTEP technique (and the TIPP techniques) for the inguinal hernia repair. This technique is performed only by a properly trained and certified abdominal wall hernia surgeon, using a single, special mesh. The incision is very small, and the patient can return home the same day. The pain is minimal and the return to daily activities is done quite quickly.
2. Laparoscopic – Endoscopic Surgical Rehabilitation
A large number of scientific articles show the superiority of laparoscopic / endoscopic hernia repair in athletes, as well as inguinal hernias, especially in specific groups of patients.
Abdominal adduction syndrome can be treated with laparoscopic techniques TAPP, TEP, or even e-TEP, depending on the knowledge, experience and of course the specialization of the surgeon.
The advantages of laparoscopic surgery include:
• Short-term hospitalization (DayClinic)
• Extremely reduced postoperative pain
• Taking less medication
• The faster return of the patient to his daily activities
• The best aesthetic result
• Reduced relapses.
3. Robotic Surgery
Surgical repair of athletes’ hernia can also be done using a robotic system. This gives the technique chosen by the specialized hernia surgeon all the advantages of an endoscopic operation, plus:
• Excellent movement accuracy
• Particularly complex and complex movements that resemble those of the human hand
3D illustration of the surgical field
• Comfortable and ergonomic position of the surgeon.
These additional features make robotic surgery even more secure, with an even lower chance of recurrence and a significantly greater reduction in postoperative pain.
Writes:
Dr. Fotios Archontovasilis MD, PhD, FISS, FEHS,
Director of the Center of Excellence in Abdominal Hernia Surgery (Center of Excellence in Hernia Surgery) & Director of the 6th Surgery Clinic of the Metropolitan General
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