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Endoscopic Evaluation and Treatment of Groin Pain in the Athlete

Jolanda Kluin, PhD^*, Pieter T. den Hoed, PhD^*,, Robbart van Linschoten^*,, John C. IJzerman, MD and Cornelis J. van Steensel, PhD^*

From the ^* Department of General Surgery, Ikazia Hospital, Rotterdam, the Netherlands, the Department of Sports Medicine, Sports Medical Advise Center, Rotterdam, the Netherlands, and the Department of Sports Medicine, Franciscus Hospital, Roosendaal, the Netherlands

Address correspondence to Pieter T. den Hoed, Department of General Surgery, Ikazia Hospital, Montessoriweg 1, 3083 AN Rotterdam, the Netherlands.

Background: Chronic groin pain in athletes forms a major diagnostic and therapeutic challenge.

Hypothesis: Evaluate and treat undiagnosed groin pain in the athlete by endoscopy.

Study Design: Prospective cohort study.

Methods: Athletes who were referred to the Ikazia Hospital with undiagnosed chronic groin pain between January 1998 and August 2001 were included. Radiography, bone scintigraphy, and ultrasonography were performed. In 14 athletes, groin pain remained undiagnosed. Ten patients complained of unilateral, 4 of bilateral groin pain. Patients underwent a transabdominal or extraperitoneal diagnostic endoscopy.

Results: All patients were operated ambulatory without significant difficulties. Pathology found by endoscopy was hernia inguinalis (n = 9), hernia femoralis (n = 4), preperitoneal lipoma (n = 3), and hernia obturatoria (n = 1). Only once was there no pathology. In 17 groins, a Prolene mesh was placed preperitoneally. Thirteen patients (93%) returned to full activity within 3 months of surgery. One year after surgery, one patient had minor symptoms and one patient had persistent symptoms. All other patients had no complaints.

Conclusions: An occult hernia should be high on the list of differential diagnoses in undiagnosed chronic groin pain in athletes. Operative treatment can return the patient to his sport within 3 months.

Key Words: endoscopy • groin • athlete • hernia • pain

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