title: Laparoscopic hernia repair with adductor tenotomy for athletic pubalgia: an established procedure for an obscure entity.
abstract: BACKGROUND
  Athletic pubalgia is a syndrome of chronic lower abdomen and groin pain that occurs in athletes. It is the direct result of stress and microtears of the rectus abdominis inserting on the pubis from the antagonizing adductor longus muscles, and weakness of the posterior transversalis fascia and bulging of the inguinal floor.
  
  
  METHODS
  Under IRB approval, we conducted a retrospective review of our prospectively competitive athlete patients with athletic pubalgia from 2007 to 2013.
  
  
  RESULTS
  A cohort of 54 patients was examined. Mean age was 22.4 years. Most patients were football players (n = 23), triathlon (n = 11), track and field (n = 6), soccer players (n = 5), baseball players (n = 4), swimmers (n = 3), golfer (n = 1), and tennis player (n = 1). Fifty one were males and three were females. All patients failed medical therapy with physiotherapy prior to surgery. 76 % of patients had an MRI performed with 26 % having a right rectus abdominis stripping injury with concomitant strain at the adductor longus musculotendinous junction. 7 % of patients had mild nonspecific edema in the distal bilateral rectus abdominis muscles without evidence of a tear. Twenty patients had no findings on their preoperative MRI, and only one patient was noted to have an inguinal hernia on MRI. All patients underwent laparoscopic totally extraperitoneal inguinal hernia repair with synthetic mesh and ipsilateral adductor longus tenotomy. All patients were able to return to full sports-related activity in 24 days (range 21-28 days). One patient experienced urinary retention and another sustained an adductor brevis hematoma 3 months after completion of rehabilitation and surgical intervention. Mean follow up was 18 months.
  
  
  CONCLUSIONS
  Athletic pubalgia is a disease with a multifactorial etiology that can be treated surgically by a laparoscopic totally extraperitoneal hernia repair with synthetic mesh accompanied with an ipsilateral adductor longus tenotomy allowing patients to return to sports-related activity early with minimal complications.
authors.affiliation: Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Rd., PO Box 100109, Gainesville, FL, 32610-0109, USA.
authors.forename: Georgios
authors.initials: G
authors.lastname: Rossidis
authors.forename: Andrew
authors.initials: A
authors.lastname: Perry
authors.forename: Husain
authors.initials: H
authors.lastname: Abbas
authors.forename: Isaac
authors.initials: I
authors.lastname: Motamarry
authors.forename: Tamara
authors.initials: T
authors.lastname: Lux
authors.forename: Kevin
authors.initials: K
authors.lastname: Farmer
authors.forename: Michael
authors.initials: M
authors.lastname: Moser
authors.forename: Jay
authors.initials: J
authors.lastname: Clugston
authors.forename: Angel
authors.initials: A
authors.lastname: Caban
authors.forename: Kfir
authors.initials: K
authors.lastname: Ben-David
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000601:surgery*; D005260:Female; D006552:Hernia, Inguinal / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010146:Pain / Q000209:etiology; D017568:Rectus Abdominis / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D058971:Tenotomy / Q000379:methods; D055815:Young Adult