Surgical Management of Sportsman's Hernia in Professional Soccer Players

Soccer players frequently experience acute and chronic groin pain. Sportsman's hernia is a common injury in professional soccer players, that causes inguinal pain. The authors discuss their experience with the management of sportsman's hernia in professional soccer players competing in national and international competition in a retrospective review of prospectively collected data. Between March 2004 and December 2009, seventy-one professional soccer players were surgically treated for sportsman's hernia. Average age at surgery was 24 years, and average duration of symptoms from onset to surgical repair was 11 months. Conservative treatment improved symptoms temporarily or to some extent in 18 athletes. All athletes underwent a bilateral open hernia repair with concurrent adductor tendon release. Average follow-up was 4 years, and average time to return to competitive sport was 4 months. At final follow-up, 95% of soccer players were still active, 48 at the same level and 19 at a lower level. Four athletes had stopped their careers because of another injury (n=2) or recurrence (n=2).Sportsman's hernia is a potentially career-ending injury in professional soccer players. Conservative management is often unsuccessful. An open surgical hernia repair combined with an adductor longus tenotomy relieves the symptoms caused by a sportsman's hernia and restores activity in 95% of athletes. This study offers insight into the management of sportsman's hernia and offers a successful treatment to salvage the careers of professional soccer players.     

腹股沟疝 UHS 手术

超普疝修补装置（ ULTRAPRO Hernia System, UHS）由上片、下片和中间连接柱构成。下片位于腹膜与腹横筋膜之间（腹膜前间隙）,覆盖整个肌耻骨孔,起到了腹膜前间隙修补的作用;将上片分别固定于腹股沟韧带和耻骨结节,加强腹股沟管后壁;中间连接柱既充填了疝环缺损,又连接和稳定了上、下片,可防止网片移位造成的复发。 UHS同时对腹膜前间隙和腹股沟管后壁进行双重修补,理论上最大限度地减少了腹股沟疝的复发。     

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自Ｂassini首创疝修补术以来,至今已有１００余年历史。尽管其总体疗效尚称满意,但有关各术式的立论依据及其适应证一直有着争论,疝修补的术后复发和并发症仍存在问题。据报道,初发腹股沟疝的术后复发率约为１０％,而复发性疝可高达２０％,总的并发症发生率也在７％－１２％之间。因此,如何提高腹外疝手术的成功率,降低术后并发症发生率,是临床外科亟待解决的课题。     

无张力疝修补术与传统疝修补术治疗腹股沟疝的疗效分析

目的探讨无张力疝修补术与传统疝修补术治疗腹股沟疝的疗效,为基层医院的治疗提供参考。方法将86例患者按照随机原则分为观察组与对照组,每组43例,观察组采用无张力疝修补术进行治疗,对照组采用传统疝修补术进行治疗,比较两组患者的手术时间、住院时间、住院费用、术后恢复时间、并发症及复发情况。结果两组患者的手术时间比较,差异无统计学意义（P〉0.05）;两组患者的住院时间、术后恢复时间、住院费用比较,差异有统计学意义（P〈0.05）。两组患者的并发症发生率,观察组为30.2%,对照组为58.1%,两组比较,差异有统计学意义（P〈0.05）。两组患者的复发率对照组为18.6%、观察组为2.3%,两组比较,差异有统计学意义（P〈0.05）。结论无张力疝修补术操作简单、复发率低、并发症少,易为患者接受,较适合在基层医院推广应用。     

Spigelian hernia presenting as an incarcerated incisional hernia

Summary Spigelian hernia, first described at the 18th century, is a rare ventral abdominal hernia occuring through the spigelian fascia. The diagnosis is difficult especially when there is no palpable mass. The case presented here had a spigelian hernia mimicking an incarcerated incisional hernia. This patient had undergone an appendectomy through a right paramedian incision proviously. Three years later she was operated for a suspected incisional hernia. Exploration did not reveal any defects in the external oblique aponeurosis so no further exploration was done. Our operative findings showed also an intact external oblique aponeurosis but when incised a spigelian hernia was observed beneath this structure, which was repaired promptly. A high index of suspicision is necessary for diagnosis both pre and intraoperatively.     

Operation hernia: humanitarian hernia repairs in Ghana

Ghana has a high incidence of inguinal hernias and the healthcare system is unable to deliver an adequate repair rate. This results in morbidity and mortality and has a knock-on effect on the local economy. A project has been set up to try and reduce the burden of these hernias by establishing Africa’s first Hernia Centre. This is supported by structured visits by European surgeons to the centre. In October 2006, a team of four surgeons, two specialist registrars, one hernia nurse specialist, and three nurses was assembled in order to open the Hernia Centre, which will provide a base for the delivery of hernia services in the West of Ghana. A 2-year teaching programme has been formulated, tailored to the needs of local surgeons and nurses, with the aim of developing an integrated team that will initially deliver up to 50 hernia repairs each month. It is planned that the centre will be supported by structured periodic visits from surgeons and nurses based in Plymouth, the European Hernia Society, and any other volunteers wishing to support the link.     

Spigelian hernia: a rare lateral ventral hernia

The authors take a treated clinical case as a starting point to consider lateral ventral hernia, generally referred to as "Spigelian hernia". Such hernias are rare (1-2% of all hernias), with a slightly higher incidence in the female sex. Obesity and multiparous status are known to be predisposing factors. Instrumental tests of great importance in terms of specificity and definition such as ultrasonography and computed tomography are available, in cases of diagnostic doubt, for a pathology that in any case has to be detected early in order to avoid possible complications. The treatment is essentially surgical. A personal variant of the surgical repair technique is described with the use of prosthetic material, which guarantees a better result in terms of strength and resistance compared to simple repair surgery.     

Indirect inguinal hernia masquerading as a Spigelian hernia

Inguinal hernia usually developed and descended into scrotum. The clinical presentation is inguinal or inguino-scrotal swelling. Abdominal wall weakness as it is frequently seen in African tropical zones produces often rare clinical case. We report a case of inguinal hernia presented as an abdominal wall swelling clinically suggestive of a Spigelian hernia and discuss the mechanism.     

Spigelian hernia

The diagnosis of spigelian hernia presents greater difficulties than its treatment. The clinical presentation varies, depending on the contents of the hernial sac and the degree and type of herniation. The pain, which is the most common symptom, varies and there is no typical pain of spigelian hernia. Findings to facilitate diagnosis are palpable hernia and a palpable hernial orifice. Large, easily palpable spigelian hernias are not a diagnostic problem. It is small hernias and hernial orifices that are overlooked because they are masked by the subcutaneous fat and an intact external aponeurosis. In the absence of a palpable orifice or sac, persistent point tenderness in the spigelian aponeurosis with a tensed abdominal wall most strongly suggests the diagnosis. Spigelian hernia can be ruled out in patients without palpable tenderness. Ultrasonic scanning can be recommended for verification of the diagnosis in both palpable and nonpalpable spigelian hernia. The hernial orifice and sac can also be demonstrated by computed tomography, which gives more detailed information on the contents of the sac than does ultrasonic scanning. The treatment of spigelian hernia is surgical, and the risk of recurrence is small. A gridiron incision is excellent for operations for palpable hernias. If the hernia cannot be palpated preoperatively, preperitoneal dissection through a vertical incision is recommended. This gives good exposure, facilitates hernioplasty, and permits preperitoneal exploration and treatment of other abdominal wall hernias. The incision is also suitable for exploratory laparotomy, which should be performed on patients with abnormal ultrasonographic or computed tomographic findings in whom no palpable hernia can be detected preoperatively.

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Resumen El diagnóstico de la hernia spigeliana presenta mayores dificultades que su tratamiento. La presentación clínica varía según el contenido del saco herniario y el grado y tipo de herniación. El dolor, que es el síntoma más común, es variable y no existe un dolor que sea típico de la hernia spigeliana. Los signos físicos que facilitan el diagnóstico son la hernia palpable y un orificio herniano palpable. Las hernias spigelianas grandes y fácilmente palpables no constituyen un problema diagnóstico. Son más bien las hernias pequeñas y los orificios mínimos los que pueden pasar desapercibidos al ser enmascarados por la grasa subcutánea y por una aponeurosis intacta. En ausencia de un orificio o de un saco palpable, el dolor a la presión sobre la aponeurosis spigeliana, manteniendo tensa la pared abdominal, sugiere fuertemente este diagnóstico; la hernia spigeliana puede ser excluída como posibilidad diagnóstica en pacientes que no exhiban tal dolor a la palpación. La ultrasonografía puede ser recomendada para verificación del diagnóstico, tanto en las hernias spigelianas palpables como en las no palpables. El orificio y el saco herniarios también pueden ser demostrados mediante tomografía computadorizada, estudio que provee información más detallada que la ultrasonografía sobre el contenido del saco.El tratamiento es quirúrgico y el riesgo de recurrencia es bajo. Una incisíon oblicua o transversa resulta excelente para la operación en hernias palpables; si la hernia no es palpable en el examen preoperatorio, se recomienda realizar disección preperitoneal a través de una incisión vertical. Esto da buena exposición, facilita la hernioplastia, y permite la exploración preperitoneal y el tratamiento de otras hernias de la pared abdominal. La incisión también es adecuada para la laparotomía exploratoria, la cual debe ser realizada en pacientes con hallazgos anormales en la ultrasonografía o en la tomografía computadorizada y en quienes no haya sido posible detectar una hernia palpable preoperatoriamente.

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Résumé Le diagnostic d'une hernie de Spiegel est plus difficile que son traitement. Les signes de découverte varient, dépendant du contenu du sac herniaire, d l'importance, et du type de la hernie. La douleur, symptôme le plus fréquent, n'est pas typique. Les signes qui aident au diagnostic sont la palpation de la hernie et de l'orifice herniaire. Lorsque l'orifice est large et palpable, le diagnostic de hernie de Spiegel ne pose pas de problème. Ce sont les hernies de petite taille, à orifice réduit, qui sont souvent masquées par la graisse sous-cutanée et l'aponévrose oblique externe. En l'absence d'orifice ou de hernie palpable, la persistance de la douleur à la palpation au niveau de l'aponévrose, alors que la paroi abdominale est sous tension, est significative. En l'absence de cette douleur provoquée, on peut pratiquement éliminer ce diagnostic. On conseille de vérifier le diagnostic par une échographie, que cette douleur existe ou pas. L'orifice et le sac herniaire se voient bien également par la tomodensitométrie plus performante que l'échographie en ce qui concerne le contenu herniaire.Le traitement de la hernie est chirurgical; le risque de récidive est réduit. Une incision centrée sur la hernie, sans section musculaire, est excellente. Si la hernie ne peut être palpée, on conseille une incision verticale avec un abord extrapéritonéal. L'exposition est excellente, la cure est aisée et l'exploration prépéritonéale ainsi facilitée, permet en outre la cure d'autres hernies pariétales associées. La même incision convient également pour une laparotomie exploratrice, au cas où l'échographie ou la tomodensitométrie ne montrent rien de spécifique et où il n'existe pas de hernie détectée préopérativement.

     

Pulmonary hernia

Chest-wall hernia is a very unusual pathological event. The Authors report a singular diagnostic case of chest-wall hernia, miming rib tumor. Instrumental diagnostic tools and surgical treatment is reported. Finally patient's follow-up is discussed.