Inguinal Hernia Repair but No Hernia Present: A Nationwide Cohort Study.

INTRODUCTION: Groin hernia repair can relieve pain from conditions other than groin hernias, such as "sports groin." The aim of this study was to assess the nationwide frequency of surgically treated sports groins and identify conditions found during groin hernia surgery with no hernia present. MATERIALS AND METHODS: In this nationwide cohort study, we included patients with no hernia found during groin hernia repair. Patients were identified in the nationwide Danish Hernia Database. Outcomes were assessed from medical and surgical records. Medical history, preoperative examinations, and operative details were extracted. RESULTS: Data from 259 patients were included. Of these, 152 (58%) were considered to have a sports groin. A weak posterior inguinal wall was identified in 41 sports groins, a wide profound inguinal ring in 10, and no specific anatomic pathology was described in the remaining patients with a sports groin. A lipoma was found in addition to a sports groin in 60 patients. Findings in patients without a sports groin were predominantly lipomas, and less frequent findings were a cyst and hydrocele. CONCLUSIONS: More than half of the patients were assessed to have a sports groin. Frequent findings that co-existed with a sports groin were weak posterior inguinal wall and/or lipoma.

Long-term pain relief after groin hernia repair for sports groin: A nationwide cohort study.

BACKGROUND: The groin is a complex anatomical area with multiple structures that can be injured and cause pain. One condition with groin pain is the so-called "sports groin," which can be treated with a groin hernia repair even though no hernia is present. The aim of this study was to assess the prevalence of chronic groin pain several years after a groin hernia repair performed in patients with a sports groin. METHODS: This nationwide cohort study included adults who had a groin hernia repair for a sports groin through the years 1998-2011. The patients were identified through the Danish Hernia Database and in surgical records. Patients were asked to fill out four questionnaires several years after the repair: a visual analogue scale, the Activity Assessment Scale, the Inguinal Pain Questionnaire, and a questionnaire about treatment satisfaction. RESULTS: Of 118 contacted patients, 71 gave informed consent and were included in the study (60%), and of these the response rate was 100%. The questionnaires were filled out median 14 years after surgery. Most of the patients were pain-free in the operated groin (87%), and only a few had physical impairment caused by groin pain (20%). Prior to surgery, 79% had groin pain that they could not ignore. Overall, 90% of the patients were satisfied with the treatment. CONCLUSIONS: Most patients were pain-free and without physical impairment several years after groin hernia repair for a sports groin and with high satisfaction rate.

Shorter Total Length of Stay After Intraperitoneal Fosfomycin, Metronidazole, and Molgramostim for Complicated Appendicitis: A Pivotal Quasi-Randomized Controlled Trial.

Background: We aimed to investigate the difference in the total length of hospital stay (LOS) after intraperitoneal vs. intravenous antibiotic treatment in patients with complicated appendicitis. Methods: We conducted a quasi-randomized prospective clinical trial. The intervention group received 4 g fosfomycin, 1 g metronidazole, and 50 µg recombinant human granulocyte-macrophage colony-stimulating factor intraperitoneally, which was left in the abdominal cavity, immediately after laparoscopic appendectomy. Postoperatively, this group received antibiotics orally. The control group received intravenous antibiotics both during surgery and postoperatively. We primarily evaluated total LOS within 30 days. Furthermore, we evaluated harms and adverse events, Gastrointestinal Quality of Life Index, postoperative complications, and convalescence. Participants were followed for 30 days postoperatively. Results: A total of 12 participants concluded the trial. The total LOS was significantly shorter in the intervention group (six participants, median 13 h; range 2-21 h) than in the control group (six participants, median 84 h; range 67-169 h), p = 0.017. Comparable harms and Gastrointestinal Quality of Life Index scores were found in the two groups. The time to return to normal activities was median 6 and 10 days for the intervention and the control group, respectively. There were no serious adverse events related to the trial nor any complications in the intervention group. In the control group, two patients developed intraabdominal abscesses. Conclusions: The intervention group had a significantly shorter total LOS. The study was not powered to assess differences in complications, but the results indicate that the intervention seems to be a safe regimen, which can be investigated further to treat patients with complicated appendicitis. Identifiers: EudraCT no. 2017-004753-16. ClinicalTrials: https://clinicaltrials.gov/ct2/show/NCT03435900?term=NCT03435900&draw=2&rank=1">draw=2&rank=1.

[Sports hernia is not a hernia].

This review summarises aetiology, diagnostic approach, and treatment of longstanding groin pain, which can be divided in adductor-related, pubis-related, iliopsoas-related, and inguinal-related pain. Among the diagnoses included in the inguinal-related entity is the so-called sports hernia. However, the terminology is a misnomer since sports hernia is characterised by not being a hernia. Both athletes and non-athletes are affected, and the condition may cause long sick leaves. The treatment is primarily exercise treatment. If this treatment is unsuccessful after 2-6 months, surgery is an option.