Sportsman’s hernia (Gilmore’s groin)
A diffuse pain in the inguinal region
The term Sportsman’s hernia (so called Gilmore’s groin) is frequently used to describe a diffuse and undefined pain in the groin. However, correctly the term does not imply a symptom but describes a malfunction of the anatomical structure of the abdominal wall.
From a sports surgeon’s perspective, a sportsman’s hernia implies a beginning instability of the posterior abdominal wall. This can be diagnosed almost exclusively during the sonographic examination.
Here, ventral bulging of the fascia transversalis is observed when the lying patient attempts to press. This bulge can be quantified and is therefore objectively verifiable. This layer of the abdominal wall (fascia transversalis) confines the posterior inguinal region. Its stability is of crucial importance for the local nerve structures and their protection from pressure-induced strain. In case of a fascia transversalis instability (bulging more than 3 mm) we speak of the Gilmore’s groin.Clinical symptoms of a Gilmore’s groin
During daily activities a Gilmore’s groin is rarely painful. However, sport activities can lead to the bulging of the fascia transversalis and consequent compression of nerves (ilioinguinal nerve, iliohypogastric nerve, genitofemoral nerve) which causes pain in the area supplied by these nerves.
Typically, patients suffering from Gilmore’s groin complain about testicular pain, pain in the groin, and pain in the lower abdomen above the pubic bone or in the upper 2/3rds of the thigh.
If a Gilmore’s groin is diagnosed and other disorders are excluded, the condition can be surgically repaired. Here, laparoscopic (so called minimal invasive surgical techniques) as well as open surgical techniques are available.
We prefer the open net-free stabilisation of the abdominal wall since most patients suffering from this condition are young athletes. According to our opinion these patients should be treated without using foreign material. The open surgical procedure ensures the stability of the inguinal region and allows a safe exploration of the abdominal wall considering additional injuries frequently observed in athletes (muscle injuries, fascia injuries, neurinomes of the nerves etc.).
In our opinion the therapy of the Gilmore’s groin using minimal invasive techniques is not adequate. During the procedure additional injuries or pathologies of the groin can not be diagnosed and treated.