Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

27. The Role of Bioactive Prosthetic Material…
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This is lower than what is typically reported with synthetic mesh after
open repair, at approximately 12.5 %. We reported our results in 2008,
using fibrin sealant alone to laparoscopically secure BPM and polypropylene
mesh in comparable groups of 18 patients with 23 repairs [ 18 ].
The results were similar in both groups with no long-term chronic pain
or hernia recurrences. The biologic group had a few patients with shortterm
(less than 3 months) groin discomfort. Lastly, in Italy in 2008,
Agresta and Bedin reported 11 patients undergoing laparoscopic TAPP
hernioplasty with BPM and fibrin sealant [ 19 ]. There was one technical
error leading to a recurrence at 14.5 months, and there were no reports
of chronic pain. He hypothesized for use of BPM in the young patient,
where there is a fear of leaving behind a foreign body in the long term.
Acellular extracellular dermal matrix mesh was implanted in 53
patients with 56 hernias using a Lichtenstein repair by Ma et al. in a
2005 report from China [ 20 ]. They reported no infections, chronic pain,
or discomfort; however, two patients with large direct Gilbert type V and
VI hernias had recurrences noted by 18 months. Ansaloni et al. from
Italy reported his 2-year follow-up in 2007, on 45 consecutive patients
undergoing Lichtenstein repair with BPM [ 21 ]. There was a low degree
of pain and no recurrences noted. A randomized double-blind trial comparing
BPM to polypropylene mesh reported their 3-year follow-up on
70 patients [ 22 ]. The incidence of pain was similar, but the degree of
pain was less in the biologic mesh group. One recurrence was noted in
the polypropylene mesh group. Most recently, Bellows et al. reported
their randomized double-blind multicenter trial comparing patients
undergoing Lichtenstein hernioplasty with non-cross-linked porcine
dermis ( N = 84) to soft polypropylene mesh ( N = 88). Results were
equivalent at 3 months [ 23 ].
BPM and Sports Hernias
Groin pain in athletes is caused by a wide variety of musculoskeletal
disorders. The term “sports hernia ” is a poor one and should be replaced
by “ athletic pubalgia .” In patients who have this condition, the insertion
site of the rectus muscle and/or adductor longus muscle onto the pubic
bone is damaged. When an athlete engages these muscles during activity,
there is a lack of function, which can sometimes be perceived as
groin pain. Some athletes describe a “weakness.” Most athletes describe
their inability to plant and turn, or kick, or jump, or perform something
similar corresponding to their sport. The physical exam does not reveal