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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The differential diagnosis of groin pain must consider problems of the ilioinguinal and/or genitofemoral nerve. These nerves may become injured during hernia surgery or lower quadrant surgical procedures. To treat injury to these nerves, it is critical to understand their anatomic variability. In the present study the pattern of cutaneous nerve branches in the inguinal region was investigated through dissection in 64 halves of 32 human embalmed anatomic specimens. In contrast to usual textual descriptions, four different types of cutaneous branching patterns are identified: type A, with a dominance of genitofemoral nerve in the scrotal/labial and the ventromedial thigh region. In type A, the ilioinguinal nerve gives no sensory contribution to these regions (43.7 percent). In type B, with a dominance of ilioinguinal nerve, the genitofemoral nerve shares a branch with the ilioinguinal and gives motor fibers to cremaster muscle in the inguinal canal, but has no sensory branch to the groin (28.1 percent). In type C, with a dominance of genitofemoral nerve, the ilioinguinal nerve has sensory branches to the mons pubis and inguinal crease together with an anteroproximal part of the root of the penis or labia majora. The nerve was found to share a branch with the iliohypogastric nerve (20.3 percent). In type D, cutaneous branches emerge from both the ilioinguinal and the genitofemoral nerves. Additionally, the ilioinguinal nerve innervates the mons pubis and inguinal crease together with a very anteroproximal part of the root of the penis or labia majora (7.8 percent). The described patterns of innervation were bilaterally symmetric in 40.6 percent of the cadavers. The anatomic variability of both nerves has implications for all surgeons operating in the groin region and for those caring for the patient with groin pain.
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PMID:Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. 1171 38

Groin pain is defined as tendon enthesitis of adductor longus muscle and/or abdominal muscles that may lead to degenerative arthropathy of pubic symphises in an advanced stage. Pubic region is a point where kinematic forces cross. The balance between the adductor and abdominal muscles is of great importance, as well as the elasticity of pubic symphises which enables movement of up to 2 mm and rotation of up to 3 degrees. The weakness of the abdominal muscle wall, known as the sportsman's hernia, is the most common cause of painful groin. Groin pain is the most common in soccer players (6.24% in Croatia). Most authors believe that the main cause of groin pain is the adductor muscle overload. When active, sportsmen start to feel a dull pain in the groin region. The adductor test is of great importance for physical examination; the patient should be lying supine with his hips abducted and flexed at 80 degrees. The test is positive if the patient, while attempting to pull his/her legs against pressing in the opposite direction, feels a sharp pain in the groins. The treatment of groin pain is complex and individual, as its causes may vary from patient to patient. Gradual physical therapy combined with pharmacotherapy should be effective in most cases. The latter includes nonsteroid anti-inflammatory drugs and muscle relaxants. A physical therapy programme usually involves stretching and strengthening of adductor muscles, abdominal wall muscles, iliopsoas muscle, quadriceps, and hamstrings. In case that physical therapy and pharmacotherapy fail, surgery is needed, depending on the cause.
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PMID:[The groin pain syndrome]. 1183 Nov 25

Groin pain may be produced by a true hernia, trauma to the groin structures or peripheral nerve, or root compression at various levels. Approximately 4,000 patients underwent inguinal herniorrhaphy (group A). An additional 134 patients complaining of groin pain and exhibiting no evidence of primary or recurrent hernia fell into two categories: 30 patients who had a previous herniorrhaphy (group B) and 104 patients without previous surgery (group C). Group B patients underwent a diagnostic nerve block which, when positive, suggested ilioinguinal nerve compromise at the wound. Those who failed conservative measures underwent nerve division. Group C patients were advised to decrease recreational and occupational activities; if that failed, they underwent lumbosacral spine imaging. There were no neuralgias in group A. Eight group B patients responded to conservative measures; the 22 others required ilioinguinal nerve division which relieved their pain. In group C, 42 patients responded to physical activity restriction plus NSAIDs; the remaining 62 underwent imaging which revealed lumbosacral bone pathology producing root compression and were referred to orthopedists. Lumbosacral spine pathology should be suspected in patients who complain of groin pain in the absence of hernia or previous herniorrhaphy. Recognition of this syndrome may avoid negative exploratory herniorrhaphies.
Hernia 2002 Jul
PMID:Groin pain in the absence of hernia: a new syndrome. 1215 41

Groin pain in athletes is not infrequently a cause of frustration and aggravation to both doctor and patient. Complaints in the groin region can prove difficult to diagnose, particularly when they are of a chronic nature. These injuries are seen more commonly in sports that require specific use (or overuse) of the proximal musculature of the thigh and lower abdominal muscles. Some of the more common sports would be soccer, skiing, hurdling, and hockey. The differential diagnosis can cover a rather broad area of possibilities. Most common groin injuries are soft-tissue injuries, such as muscular strains, tendinitis, or contusions. More difficult areas to pinpoint are such entities as osteitis pubis, nerve entrapment, the so-called "sports hernia," or avulsion fractures, to name but a few. The evaluation of such patients includes a familiarity with the sport and possible mechanism of injury (i.e., taking a careful history), meticulous physical examination of the groin, abdomen, hips, spine, and lower extremities. Diagnostic examinations may or may not prove helpful in formulating a final diagnosis. Some patients may be required to undergo procedures, such as laparoscopic evaluation of the region to obtain adequate information that allows a proper diagnosis and treatment plan. This article describes many of the possible causes of groin pain in athletes. The list is quite lengthy, and only the more common problems will be discussed in detail.
Hernia 2003 Jun
PMID:Groin pain in athletes. 1282 26

A sportman's hernia is an injury common to athletes and other physically active people. It is unique because the injury is not identifiable on physical exam or imaging. The specific injury is a tear in the transversalis fascia. A sportman's hernia presents as chronic groin pain that flares with activity and does not hurt during periods of inactivity. Optimal treatment is an open hernia repair using mesh, performed as an outpatient procedure with local anesthesia and sedation.
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PMID:Diagnosis and treatment of sportsman's hernia. 1283 21

The main hypotheses were that the Lichtenstein inguinal hernia repair has a lower recurrence rate and similar incidence of chronic groin pain compared to sutured repairs when performed by surgical trainees. In a U.S. Veterans Administration Hospital, 150 primary hernia repairs were randomized to a Lichtenstein, McVay, or Shouldice repair. The Shouldice repair included a routine relaxing incision. First- and second-year residents, under the supervision of an experienced general surgeon, performed the procedure. Long-term follow-up was obtained in 81% of patients. Hernia recurrence rate was Lichtenstein 8%, McVay 10%, Shouldice 5% ( P>0.1) at 6-9 years follow-up. More patients had chronic groin pain following Lichtenstein repair (38%) than after Shouldice repair (7%) ( P<0.05). More information is needed on long-term groin pain following anterior mesh repair. The Shouldice inguinal hernia repair may have a role in open primary herniorrhaphy to decrease the risk of chronic groin pain.
Hernia 2004 Feb
PMID:A prospective trial of primary inguinal hernia repair by surgical trainees. 1289 90

Herein, we present a case of primary liposarcoma of the omentum found in an incarcerated inguinal hernia in a 52-year-old male patient. The patient was admitted to our hospital in June 2000 with sudden onset of left-sided abdominal and groin pain of 12 hours' duration with a large, irreducible inguinal hernia. This was not associated with nausea or vomiting. An emergency operation was performed, and in the hernia sac the tumor, arising from the greater omentum, was found. After we opened the transversal fascia and peritoneum, the tumor was resected with a block of the greater omentum, and hernioplasty was performed using Shouldice's method. The histopathological diagnosis of resected tumor showed myxoid type liposarcoma. In the English medical literature, omental liposarcoma has never before been reported as the content of a hernia sac.
Hernia 2005 Mar
PMID:Primary omental liposarcoma presenting as an incarcerated inguinal hernia. 1518 28

Sportsman's hernia is a term used to describe a weakness or disruption of is a term used to describe the musculotendinous part of the posterior inguinal wall, which causes persistent groin pain in athletes. A video-assisted placement of extraperitoneal synthetic mesh to support the damaged area may heal this injury. Forty-one male athletes at an elite level (mean age 27 +/- 7.1 years) with chronic groin pain, which was resistant to conservative therapy, were referred to surgery by sports clinics or club doctors. The majority of the patients were soccer (58%) or ice hockey players (27%) at a professional level. A 10 x 15 cm polypropylene mesh was placed into the preperitoneal space using a totally extraperitoneal video-assisted technique. The severity of pain, and the time to return to sports, were determined after 1 month and after the mean follow-up of 4 years. On operation, no macroscopic abnormality was found in 24 patients (58%), obvious musculotendinous tear was present in 10 patients, and muscle asymmetry was present in 7 patients. All except 2 patients (95%) returned to their sport activities after 1 month of convalescence. No immediate or long-term complications were associated with the operation. The placement of a retropubic mesh was safe and a mini-invasive method to repair sportsman's hernia and chronic groin pain of athletes.
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PMID:Totally extraperitoneal endoscopic (TEP) treatment of sportsman's hernia. 1547 51

Two types of anterior tension-free hernioplasty, prolene hernia system (PHS) repair and mesh plug technique (MPT), were introduced to Taiwan in 2001. This study compared the short- to mid-term outcomes following primary groin hernia repair with PHS and MPT. From January 2001 to December 2003, 393 patients with 426 primary groin hernias were operated on by a single surgeon using MPT (n=192) and PHS (n=234). Baseline perioperative details and follow-up information were compared. Demographic characteristics of both groups were similar. The laterality, types of anesthesia, postoperative stay, postoperative wound pain scores, wound complications and days to return to activities of daily life were equally distributed between the two groups. However, the distribution of Gilbert types in the PHS group was shifted a little to the right compared with that of the MPT group. PHS repair had longer operative time (34+/-17 vs 25+/-9 minutes, p<0.01). No recurrence was noted in both groups during the follow-up from 5 to 41 months. Chronic non-disabling groin pains were noted in 2.8% (6/218) of patients in the PHS group and 8.9% (14/175) in the MPT group (p=0.01). Our results show that both PHS and MPT repairs can be performed with short operation time, minor wound pain and quick return to activities of daily life without short- to mid-term recurrences, but postoperatively the MPT group had higher incidence of chronic non-disabling groin pain. Although the MPT is less invasive, the additional protective patch in the preperitoneal space of the PHS may provide a further safeguard against recurrences, especially for those patients with attenuated inguinal floor. Long-term follow-up is needed.
Hernia 2005 May
PMID:Prolene hernia system compared with mesh plug technique: a prospective study of short- to mid-term outcomes in primary groin hernia repair. 1570 58

Open tension-free hernioplasty using a prosthetic mesh is a common operation for inguinal hernia repair because of the relative ease of the operation and low recurrence rate. Wound infection is a potential complication of all hernia repairs and deep-seated infection involving an inserted mesh may result in chronic groin sepsis which usually necessitates complete removal of mesh to produce resolution. Removal of mesh would potentially result in a weakness of the repair and subsequent hernia recurrence. We reviewed the outcome of all our patients who had mesh removal for sepsis over an 8-year period, particularly examining for hernia recurrence and chronic groin pain. This was a retrospective review of the database of patients who had mesh repair of inguinal hernias over an 8-year period. There were 2,139 inguinal hernias repaired using prosthetic mesh. All patients who had mesh removal for infection were identified and followed up. Fourteen patients had deep-seated wound infection which required mesh removal for resolution of sepsis. No peri-operative complications occurred during mesh removal. After a median follow-up of 44 months (range 5-91 months), there were two asymptomatic recurrences and none of the patients had chronic groin pain. Hernia recurrence is uncommon following mesh removal for chronic groin sepsis, suggesting that the strength of a mesh repair lies in the fibrous reaction evoked within the transversalis fascia by the prosthetic material rather than in the physical presence of the mesh itself. When there is established deep infection, there should be no unnecessary delay in removing an infected mesh in order to allow resolution of chronic groin sepsis.
Hernia 2006 Mar
PMID:Fate of the inguinal hernia following removal of infected prosthetic mesh. 1691 43


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