Piozzi Guglielmo Niccolò, Cirelli Riccardo, Salati Ilaria, Maino Marco Enrico Mario, Leopaldi Ennio, Lenna Giovanni, Combi Franco, Sansonetti Giuseppe Massimiliano
General Surgery Residency Program, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy.
Department of General Surgery, Ospedale S. Carlo Borromeo, Via Pio II, 3, 20153, Milan, Italy.
Sports Med Open. 2019 Jun 24;5(1):25. doi: 10.1186/s40798-019-0201-4.
Inguinal disruption (ID) is a condition of chronic groin pain affecting mainly athletes. ID cannot be defined as a true hernia. Pathogenesis is multifactorial due to repetitive and excessive forces applied to the inguino-pelvic region. Examination reveals tenderness to palpation of the inguinal region. Differential diagnosis is challenging; imaging is helpful for excluding other pathologies. Surgery is the treatment of choice when conservative treatment fails. Primary aim of the study was to evaluate the time to return to full sport activity after transabdominal preperitoneal patch plasty (TAPP) technique in ID. Secondary aim was to evaluate the postoperative complication rate both in the immediate post-operative time and in 1 year follow-up and to verify the relapse rate after surgery. In this study, we consider time to return to full sport activity as the time needed to return to pre-injury sport activity.
A retrospective study is reported by evaluating 198 cases of ID from a single surgeon experience. All patients failed a previous conservative treatment. All cases were treated with the TAPP approach. Time to return to full sport activity was 4 weeks for 94.4% of patients, with a total of 98.5% of active patients at 9 months. Post-operative inguinal pain was the main complication (9.1%). On 13 years follow-up, we report a recurrence rate of 2.5%.
Current management algorithm for ID, in professional athletes, supports the role of surgery after at least 2 months of conservative treatment. Recently, the role of surgery has been highlighted for a definitive treatment and a faster full recovery to sport activity, especially for elite professional athletes. In our opinion, laparoscopic surgery is the mainstay for non-responsive ID treatment. We present a long-term retrospective evaluation of a wide cohort of professional athletes diagnosed and treated in a systematic way.
腹股沟区损伤（ID）是一种主要影响运动员的慢性腹股沟疼痛病症。ID不能被定义为真正的疝气。由于腹股沟-盆腔区域反复受到过度外力作用，其发病机制是多因素的。体格检查可发现腹股沟区触痛。鉴别诊断具有挑战性；影像学检查有助于排除其他病变。保守治疗失败时，手术是首选治疗方法。本研究的主要目的是评估经腹腹膜前补片修补术（TAPP）治疗ID后恢复全面体育活动的时间。次要目的是评估术后即刻及1年随访期内的术后并发症发生率，并验证术后复发率。在本研究中，我们将恢复全面体育活动的时间定义为恢复到受伤前体育活动所需的时间。
一项回顾性研究报告了对一位外科医生诊治的198例ID病例的评估。所有患者先前的保守治疗均失败。所有病例均采用TAPP方法治疗。94.4%的患者恢复全面体育活动的时间为4周，9个月时共有98.5%的患者恢复活动。术后腹股沟疼痛是主要并发症（9.1%）。在13年的随访中，我们报告复发率为2.5%。
目前针对职业运动员ID的治疗方案支持在至少2个月的保守治疗后进行手术。最近，手术在确定性治疗和更快全面恢复体育活动方面的作用得到了凸显，尤其是对于精英职业运动员。我们认为，腹腔镜手术是治疗无效的ID的主要手段。我们对一大组经过系统诊断和治疗的职业运动员进行了长期回顾性评估。
