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

34. Patient with Groin Pain After an Athletic Event
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For this patient, nonoperative treatment strategies had been employed
for 6 months without significant improvement in symptoms. Further
attempts at rehabilitation were felt unlikely to provide relief. Surgical
intervention was offered.
Operative Treatment
Laparoscopic Bilateral Transabdominal Pre-peritoneal (TAPP)
Repair The technique utilized for sports hernia repair is identical to the
standard repair of inguinal hernias and is well described in the literature.
Briefly, a three-port technique is used, with a Hasson cannula at the
umbilicus and one 5-mm port lateral to the rectus on either side of the
umbilicus. The peritoneum is sharply opened at the medial umbilical
ligament in a curvilinear fashion extending laterally. The pre-peritoneal
space of Retzius is entered medially and the bladder bluntly dissected
away from the pubis and Cooper’s ligaments. The inferior peritoneal flap
is retracted and the cord structures are dissected away from the
peritoneum. Any direct or indirect inguinal hernia defects are reduced.
The posterior aspect of the rectus insertion is inspected to confirm
evidence of attenuation or avulsion injuries of the rectus insertion onto
the pubis.
After development of a wide pre-peritoneal pocket bilaterally, a large
polypropylene mesh (minimum 12 × 15 cm) is used to reinforce the
entire myopectineal orifice on each side. Bilateral mesh prosthetics are
confirmed to overlap in the midline in order to provide for complete
reinforcement of the entire myopectineal orifice, Cooper’s ligaments,
and the pubic tubercle (Figs. 34.5 and 34.6 ). The mesh is secured with
several tacks or staples to Cooper’s ligament and then further secured
circumferentially with fibrin glue. No tacks or staples are placed into the
abdominal wall musculature and no mechanical fixation is utilized
below the iliopubic tract. The peritoneum is re-approximated. The same
procedure is performed for the contralateral groin in order to allow for
wide coverage of all potential inguinal defects on both sides.
Postoperative Course
The patient was discharged to home following surgery and seen in
follow-up at 2 weeks and at 6 weeks postoperatively. His postoperative
course was uncomplicated and he returned to activity following our