Do postoperative complications correlate to chronic pain following inguinal hernia repair? A prospective cohort study from the Swedish Hernia Register

Purpose To analyse if postoperative complications constitute a predictor for the risk of developing long-term groin pain. Methods Population-based prospective cohort study of 30,659 patients operated for inguinal hernia 2015–2017 included in the Swedish Hernia Register. Registered post-operative complications were categorised into hematomas, surgical site infections, seromas, urinary tract complications, and acute post-operative pain. A questionnaire enquiring about groin pain was distributed to all patients 1 year after surgery. Multivariable logistic regression analysis was used to find any association between postoperative complications and reported level of pain 1 year after surgery. Results The response rate was 64.5%. In total 19,773 eligible participants responded to the questionnaire, whereof 73.4% had undergone open anterior mesh repair and 26.6% had undergone endo-laparoscopic mesh repair. Registered postoperative complications were: 750 hematomas (2.3%), 516 surgical site infections (1.6%), 395 seromas (1.2%), 1216 urinary tract complications (3.7%), and 520 hernia repairs with acute post-operative pain (1.6%). Among patients who had undergone open anterior mesh repair, an association between persistent pain and hematomas (OR 2.03, CI 1.30–3.18), surgical site infections (OR 2.18, CI 1.27–3.73) and acute post-operative pain (OR 7.46, CI 4.02–13.87) was seen. Analysis of patients with endo-laparoscopic repair showed an association between persistent pain and acute post-operative pain (OR 9.35, CI 3.18–27.48). Conclusion Acute postoperative pain was a strong predictor for persistent pain following both open anterior and endo-laparoscopic hernia repair. Surgical site infection and hematoma were predictors for persistent pain following open anterior hernia repair, although the rate of reported postoperative complications was low.

Desarda’s Repair Vs Lichtenstein Repair in Indirect Inguinal Hernia -Preferred technique

Aim: To compare the outcome of Desarda`s technique with that of Lichtenstein mesh hernioplasty in terms of chronic pain, recurrence and infection. Methods: A prospective comparative study with randomized controlled trial was conducted at Lahore General Hospital in Surgical Department to appraise the outcome of Desarda Hernioplasty in comparison with Lichtenstein Hernioplasty technique to evaluate recurrence, wound infection and chronic groin pain. The Desarda repair is used to treat inguinal hernia without the use of mesh. Results: Total sixty (n=60) patients were included in the study by dividing into two groups Group A and B with mean age 40.5 and 39.5 years for Desarda vs Lichtenstein groups correspondingly. Insignificant statistical difference was noted in both groups regarding wound infection but considerable statistical advantage was noted regarding recurrence and Chronic groin pain for Group A patients in comparison to Group B. Conclusion: We concluded that Desarda repair is emerging technique and cost effective with lesser pain, infection and recurrence than other techniques. Keywords: Desarda`s repair, Lichtenstein repair, wound infection, chronic groin pain and recurrence

Factors Associated with Hip and Groin Pain in Elite Youth Football Players: A Cohort Study

Background Despite hip and groin pain being commonly reported in elite youth football players, little evidence on risk factors exists. Risk factors in adult football players include reduced hip adductor strength and hip adductor/abductor strength ratios, and lower Copenhagen Hip and Groin Outcome Score (HAGOS) subscale scores. It is unknown if these factors are also predictive of pain development in youth football players. Objective To identify whether preseason hip adductor and abductor strength and HAGOS subscale scores of male and female elite youth football players are associated with in-season or historical (lifetime) hip and groin pain. Methods Preseason hip adductor and abductor strength testing and the HAGOS were undertaken by 105 elite male (n = 58) and female (n = 47) football players aged 11–15 years. Medical staff documented both players’ self-reported historical and in-season hip and groin pain. Univariate and multivariate logistic regression models were undertaken with main outcome measures in-season hip and groin pain and historical hip and groin pain and independent variables of hip muscle strength, hip muscle torque and HAGOS subscale scores. Results Twenty-three players (21.9%) self-reported in-season hip and groin pain, while 19 players (18.1%) self-reported historical hip and groin pain. Pre-season hip adductor and abductor variables and HAGOS subscale scores failed to predict in-season hip and groin pain. However, a higher body mass index (odds ratio [OR] = 1.32; 95% CI 1.01, 1.73, p = .043) and being male (OR 5.71; 95% CI 1.65, 19.7) were associated with having in-season hip and groin pain (R2 = 0.211). There was also an association between historical hip and groin pain (R2 = 0.579) and both HAGOS subscale Quality of Life (odds ratio [OR] = 0.84; 95% CI 0.77, 0.91, p < .001) and mean abductor torque (OR = 11.85; 95% CI 1.52, 91.97; p = .018). Conclusion Pre-season hip adductor and abductor strength and HAGOS subscale scores did not predict subsequent in-season hip and groin pain in elite youth football players. However, pre-season higher hip abductor strength and lower HAGOS scores were retrospectively associated with historical hip and groin pain.

Cam morphology is associated with MRI-defined cartilage defects and labral tears: a case–control study of 237 young adult football players with and without hip and groin pain

ObjectiveFootball players are at risk of developing hip osteoarthritis (OA). Cam morphology (present in almost two of every three football players) may explain this heightened risk, but there is limited research on its role in hip OA development in younger athletes. Knowledge of this relationship will advance our understanding of the aetiology of hip OA in football players. We aimed to study the relationship between cam morphology size and MRI-defined cartilage defects and labral tears, and if this relationship differs by symptomatic state in young adult football players.MethodsFor this case–control study, 182 (288 hips) symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 (110 hips) pain-free football players (soccer or Australian football) underwent anteroposterior and Dunn 45° radiographs, and 3-Tesla MRI. Cam morphology size was defined using alpha angle, and cartilage defects and labral tears were scored semiquantitatively. Presence, location and score (severity) of cartilage defects and labral tears were determined. Each participant completed the International Hip Outcome Tool 33 and Copenhagen Hip and Groin Outcome Score.ResultsGreater alpha angle was associated with cartilage defects (OR 1.03, 95% CI 1.01 to 1.04) and labral tears (OR 1.02, 95% CI 1.01 to 1.04). Greater alpha angle was associated with superolateral cartilage defects (OR 1.03, 95% CI 1.02 to 1.05) and superior labral tears (OR 1.03, 95% CI 1.02 to 1.05). The association of alpha angle with MRI-defined cartilage defects and labral tears was no greater in football players with symptoms than in those without (p=0.189–0.937)ConclusionCam morphology size was associated with cartilage defects and labral tears in young adult football players with and without pain. This study provides evidence that cam morphology may contribute to the high prevalence of hip OA in football players. Prospective studies of football players are now needed to establish if cam morphology causes progression of cartilage defects and labral tears and development of hip OA.

Validation of the Copenhagen Hip and Groin Outcome Score (HAGOS) using modern test theory across different cultures and languages: a cross-sectional study of 452 male athletes with groin pain

BkgroundNo studies have tested the validity of the Copenhagen Hip and Groin Outcome Score (HAGOS) using modern test theory, across different cultures and languages.ObjectiveTo validate the Danish, English and Norwegian versions of HAGOS and its six subscales (Symptoms (S, Item 1–7), Pain (P, Item 1–10), activities of daily living (Item 1–5), Sport and recreation (Sport/rec, Item 1–8), Participation in physical activity (item 1–2) and quality of life (item 1–5)) by evaluating differential item functioning (DIF) and measurement invariance across the three language versions in male multidirectional team athletes with groin pain. Second, to modify subscales depending on goodness-of-fit to the item response theory models and calculate conversion tables if language DIF was observed.MethodsWe included individual responses to the Danish (n=157), English (n=146) and Norwegian (n=149) language versions of HAGOS from 452 athletes (median age 24 years old, range 20–28) with groin pain. Overall fit, model fit, individual item fit, local response dependence and measurement invariance was examined using confirmatory factor analysis and graphical Rasch models.ResultsThe removal of seven misfitting items (S2, P1, P2, A4, SP1, SP5, Q3) resulted in 6 HAGOS subscales with acceptable psychometric properties. For the Symptoms, Pain and Sports subscales evidence of DIF was disclosed between the three different language-versions of HAGOS and conversion tables were created.ConclusionsA revised HAGOS derived using modern test theory provides valid measurements for male multidirectional athletes with groin pain across different cultures and languages. Conversion tables must be applied to compare HAGOS scores from Danish, Norwegian and English language versions.

How Point-of-Care Ultrasound led to a diagnosis of May-Thurner Syndrome

A 65-year-old man with a history of a left-sided inguinal hernia presented with three days of left-sided groin pain worsened with exertion and fatigue. The patient was afebrile but tachycardic, and physical examination revealed a tender, erythematous immobile bulge in his left groin. Laboratory studies revealed leukocytosis. Lymphadenopathy secondary to infectious or inflammatory etiology was suspected. However, point-of-care ultrasound (POCUS) identified extensive deep vein thrombosis (DVT) of the lower left limb. Follow-up imaging revealed this to be secondary to May-Thurner syndrome, a mechanical compression of an iliocaval vein against the lumbar vertebrae by a common iliac artery. This report demonstrates how POCUS can be used to identify lower extremity DVT, thereby expediting diagnosis and treatment and potentially preventing complications.

Long-standing pubic-related groin pain in professional academy soccer players: a prospective cohort study on possible risk factors, rehabilitation and return to play

Background Despite being a common overuse entity in youth soccer, scientific data on risk factors, rehabilitation and return to play for long-standing pubic-related groin pain is still rare. The current prospective cohort study aims to evaluate potential risk-factors, propose a criteria-based conservative rehabilitation protocol and assess return-to-play outcomes among professional youth soccer players suffering from long-standing pubic-related groin pain. Methods Male soccer players with long-standing (> 6 weeks) pubic-related groin pain from a professional soccer club’s youth academy were analyzed for possible risk factors such as age, team (U12 - U23), younger/older age group within the team, position and preinjury Functional movement score. All injured players received a conservative, standardized, supervised, criteria-based, 6-level rehabilitation program. Outcome measures included time to return to play, recurrent groin pain in the follow-up period and clinical results at final follow-up two years after their return to play. Results A total of 14 out of 189 players developed long-standing pubic-related groin pain in the 2017/2018 season (incidence 7.4%). The average age of the players at the time of the injury was 16.1 ± 1.9 years. Risk factor analysis revealed a significant influence of the age group within the team (p = .007). Only players in the younger age group were affected by long-standing pubic-related groin pain, mainly in the first part of the season. Injured players successfully returned to play after an average period of 135.3 ± 83.9 days. Only one player experienced a recurrence of nonspecific symptoms (7.1%) within the follow-up period. The outcome at the 24-month follow-up was excellent for all 14 players. Conclusions Long-standing pubic-related groin pain is an overuse entity with a markedly high prevalence in youth soccer players, resulting in a relevant loss of time in training and match play. In particular, the youngest players in each team are at an elevated risk. Applying a criteria-based rehabilitation protocol resulted in an excellent return-to-play rate, with a very low probability of recurrence. Trial registration The trial was retrospectively registered under DRKS00016510 in the German Clinical Trials Register on 19.04.2021.