Symptoms include pain in the groin area and pubic adhesions, sometimes so severe that in the past it has forced great athletes to interrupt their careers. It should be noted that this type of hernia accounts for 2% – 5% of all sports injuries.
How is it created?
“The causal mechanism of this condition is the acute or chronic injury that can occur to any athlete, but, due to specific movements,” seems to prefer “footballers (many shots) and basketball players (many jumps). Thus, we have diffuse pain that worsens with exercise and especially during the extension of the hips, twisting and turning “, points out Dr. Diamantis E. Thomas, MD, PhD, FACS, General Surgeon at the Metropolitan Hospital.
The pain reflects on the adductor or testicles, and becomes more intense with coughing, sneezing, or during sexual intercourse. It may be the result of:
-Relaxation of the external inguinal orifice
Rupture of the external oblique muscle denervation
Separation of the inguinal ligament
Rupture of the common plantar tendon
Rupture of the transverse abdominal denervation.
How is the diagnosis made?
Investigating inguinal pain in athletes requires extensive experience from the physician for two reasons: a) the anatomy of the area is complex, b) usually 2 to 3 different injuries coexist. It is clinically difficult to distinguish between athlete’s hernia and other causes of inguinal pain. X-rays, ultrasounds, x-rays, magnetic resonance imaging can be used for differential diagnosis to rule out other causes.
What is the treatment?
Conservative treatment with drugs and physiotherapy usually fails but can be tried in cases of uncertain diagnosis. However, the treatment is primarily invasive. In recent years, the operation is performed robotically or laparoscopically with the e-TEP technique, ie with extraperitoneal access, and is currently the most modern in the world for the treatment of this problem.
Laparoscopic or robotic treatment of the hernia, with extraperitoneal access
The development of medicine and technology has helped to successfully overcome any problems of the past, with the result that today the repair of hernia robotically or laparoscopically with extraperitoneal access (e-TEP) takes only 40 to 50 minutes and has a success rate that exceeds 98%.
This grid approach offers several advantages over open surgery and has now been established as a method of choice. It is performed through 3 incisions of 5 mm in the skin, without cutting fascia, denervation or muscles, with the immediate consequence of reducing postoperative pain and the rapid return of the athlete to the competition areas (rapid recovery). It is worth mentioning that when the problem is bilateral, the laparoscopic repair is done from the same incisions on both sides.
Most importantly, however, the athlete’s stay in the hospital is limited to a few hours to a maximum of one day. The operated person can walk and sit on the same day, while returning to his daily activities such as bathing, climbing a ladder, driving, lifting up to five kilos, and even sexual activities, take place in within three to five days.
In addition, robotic or laparoscopic surgery guarantees an excellent aesthetic result as there is no scar, while at the same time ensuring minimization of inflammation, postoperative infections and avoidance of visceral injury.
Thus, 95% of the operated athletes return after 4-6 weeks to their normal sports activities, in contrast to the cases of open surgery where the corresponding period is 3-4 months.
What is the best time for surgery?
“The best time to recover from an athlete’s hernia is in the summer, as most athletes, especially footballers and basketball players, are out of obligation. In addition, the fact that the recovery period in this case lasts only 4 to 6 weeks gives every athlete with a hernia problem the opportunity to deal with it without time pressure “, concludes Dr. Thomas.
Writes:
Dr. Diamantis E. Thomas, MD, PhD, FACS, Director General Surgeon at Metropolitan Hospital
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