Inguinal surgery for debilitating chronic groin pain in athletes

Abstract

Objectives: To identify and surgically treat correctable inguinal injuries in athletes with chronic groin pain and to assess the results of surgical treatment.

Design: Sixty-four athletes presented between March 1987 and January 1990 for treatment of chronic groin pain in which surgical exploration of the inguinal canal was considered necessary. Follow-up was performed by questionnaire.

Main outcome measure: Patient self-assessment of the success of the operation, including postoperative pain, ability to return to active sport and any further treatment required.

Results: Sixty-four athletes were treated, Australian Rules footballers predominated (46/64, 72%). Eight athletes had bilateral groin pain. Fifty-nine (92%) reported an incipient onset of pain. The most common operative finding was of a substantially deranged posterior wall of the inguinal canal which was evident in 61/72 instances (85%). Apparent splitting of the conjoint tendon was found in 19 instances (26%) and previously occult indirect inguinal hernias were discovered in six (8%). Repair of the posterior wall of the inguinal canal was by the standard Bassini repair and Tanner slide or by plication of the transversalis fascia followed by a nylon darn. Follow-up by questionnaire of the 64 athletes revealed that 40 athletes (62.5%) considered themselves cured and had returned to competitive sport. Twenty athletes (31.3%) were partially satisfied with the results of their operation, and also able to return to active sport. Three athletes (4.7%) were dissatisfied with the operative result. One patient was lost to follow-up.

Conclusion: The most common finding in athletes with chronic groin pain was a deficiency of the posterior wall of the inguinal canal. Surgical exploration and repair of the posterior wall of the inguinal canal in athletes with chronic debilitating groin pain achieved excellent or good relief of pain in 93.8% of athletes and improved physical performance.