Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman's hernia (athletic pubalgia)

Surgery. 2011 Jul;150(1):99-107. doi: 10.1016/j.surg.2011.02.016. Epub 2011 May 5.


Background: Chronic groin pain in athletes presents often a diagnostic and therapeutic challenge. Sportsman's hernia (also called "athletic pubalgia") is a deficiency of the posterior wall of the inguinal canal, which is often repaired by laparoscopic mesh placement. Endoscopic mesh repair may offer a faster recovery for athletes with sportsman's hernia than nonoperative therapy.

Methods: A randomized, prospective study was conducted on 60 patients with a diagnosis of chronic groin pain and suspected sportsman's hernia. Clinical data and MRI were collected on all patients. After 3 to 6 months of groin symptoms, the patients were randomized into an operative or a physiotherapy group (n = 30 patients in each group). Operation was performed using a totally extraperitoneal repair in which mesh was placed behind the symphysis and painful groin area. Conservative treatment included at least 2 months of active physiotherapy, including corticosteroid injections and oral anti-inflammatory analgesics. The outcome measures were pre- and postoperative pain using a visual analogue scale and partial or full recovery to sports activity at 1, 3, 6, and 12 months after randomization.

Results: The athletes in both treatment groups had similar characteristics and pain scores. Operative repair was more effective than nonoperative treatment to decrease chronic groin pain after 1 month and up to 12 months of follow-up (P < .001). Of the 30 athletes who underwent operation, 27 (90%) returned to sports activities after 3 months of convalescence compared to 8 (27%) of the 30 athletes in the nonoperative group (P < .0001). Of the 30 athletes in the conservatively treated group, 7 (23 %) underwent operation later because of persistent groin pain.

Conclusion: This randomized controlled study indicated that the endoscopic placement of retropubic mesh was more efficient than conservative therapy for the treatment of sportsman's hernia (athletic pubalgia).

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Abdominal Pain / physiopathology
  • Abdominal Pain / surgery*
  • Abdominal Pain / therapy
  • Adult
  • Athletes
  • Athletic Injuries / diagnosis
  • Athletic Injuries / physiopathology
  • Athletic Injuries / surgery*
  • Athletic Injuries / therapy
  • Chronic Disease
  • Female
  • Groin
  • Hernia, Inguinal / diagnosis
  • Hernia, Inguinal / physiopathology
  • Hernia, Inguinal / surgery*
  • Hernia, Inguinal / therapy
  • Humans
  • Laparoscopy / methods*
  • Magnetic Resonance Imaging
  • Male
  • Pain Measurement
  • Physical Therapy Modalities
  • Prospective Studies
  • Surgical Mesh
  • Treatment Outcome
  • Young Adult