Sports hernias: experience in a sports medicine center.

PURPOSE: Chronic pain of the inguino-crural region or "pubalgia" explains the 0.5-6.2% of the consultations by athletes. Recently, areas of weakness in the posterior wall called "sports hernias," have been identified in some of these patients, capable of producing long-standing pain. Several authors use different image methods (CT, MRI, ultrasound) to identify the lesion and various techniques of repair, by open or laparoscopic approaches, have been proposed but there is no evidence about the superiority of one over others due to the difficulty for randomizing these patients. In our experience, diagnosis was based on clinical and ultrasound findings followed by laparoscopic exploration to confirm and repair the injury. The present study aims to assess the performance of our diagnostic and therapeutic management in a series of athletes affected by "pubalgia". METHODS: 1450 athletes coming from the orthopedic office of a sport medicine center were evaluated. In 590 of them (414 amateur and 176 professionals) sports hernias were diagnosed through physical examination and ultrasound. We performed laparoscopic "TAPP" repair and, thirty days after, an assessment was performed to determine the evolution of pain and the degree of physical activity as a sign of the functional outcome. We used the U Mann-Whitney test for continuous scale variables and the chi-square test for dichotomous variables with p < 0.05 as a level of significance. RESULTS: In 573 patients ultrasound examination detected some protrusion of the posterior wall with normal or minimally dilated inguinal rings, which in 498 of them coincided with areas affected by pain. These findings were confirmed by laparoscopic exploration that also diagnosed associated contralateral (30.1%) and ipsilateral defects, resulting in a total of 1006 hernias. We found 84 "sport hernias" in 769 patients with previous diagnosis of adductor muscle strain (10.92%); on the other hand, in 127 (21.52%) of our patients with "sport hernias" US detected concomitant injuries of the adductor longus tendon, 7 of which merited additional surgical maneuvers (partial tenotomy). Compared with the findings of laparoscopy, ultrasound had a sensitivity of 95.42% and a specificity of 100%; the positive and negative predictive values were 100 and 99.4% respectively. No postoperative complications were reported. Only seven patients suffered recurrence of pain (successful rate: 98.81%); the ultrasound ruled out hernia recurrence, but in three cases it diagnosed tendinitis of the rectus abdominis muscle. CONCLUSIONS: Our series reflects the multidisciplinary approach performed in a sports medicine center in which patients are initially evaluated by orthopedic surgeons in order to discard the most common causes of "pubalgia". "Sports hernias" are often associated with adductor muscle strains and other injuries of the groin allowing speculate that these respond to a common mechanism of production. We believe that, considering the difficulty to design randomized trials, only a high coincidence among the diagnostic and therapeutic instances can ensure a rational health care.

Hidrosadenitis supurativa glútea y perianal: tratamiento quirúrgico / Perianal and gluteal suppurativa hidradenitis: surgical treatment

Introducción: La hidrosadenitis supurada (HS) es una enfermedad inflamatoria crónica que compromete las glándulas sudoríparas apócrinas, comenzando por la oclusión de los folículos pilosos. Puede localizarse en axilas, ingle, periné, periano y glúteos. Fue descripta en 1.839, es infrecuente y afecta a1 c/300-600 adultos. De acuerdo a sus características y estadio puede ser tratada médicamente o en forma quirúrgica. Objetivo: Comunicación del tratamiento quirúrgico realizado a pacientes portadores de HS localizada en la región glútea y perianal. Diseño: Trabajo descriptivo, retrospectivo y multicéntrico. Lugar de aplicación: Hosp. Santa María Magdalena de Magdalena, Hosp. HIGA San Martin de La Plata y práctica privada. Pacientes y métodos: Se analizan los resultados del tratamiento quirúrgico realizado a 7 pacientes que fueron tratados entre los años 2001 y 2011, que presentaban HS supurada glútea y perianal, con una edad promedio de 35,4 y un rango de 23 a 56. Cuatro de ellos con estadio II de Hurley a los cuales se les realizó marsupialización y drenaje y 3 con estadio III extirpación e injertos diferidos con piel del mismo paciente y una variante de injerto de piel porcina liofilizada que aceleró el tiempo de regeneración. Resultados: No se observó enfermedad de Crohn o carcinoma de células escamosas. De los 4 que fueron tratados con marsupialización, 2 evolucionaron favorablemente y fueron controlados durante 3 y 6 años respectivamente. El resto de ellos tuvieron recidivas a los 4 y 8 meses respectivamente, siendo tratados de la misma forma. Solamente 1 permanece en control desde hace tres años. Los 3 con extirpaciones e injertos diferidos son controlados en la actualidad sin presentar nuevas alteraciones, con un periodo de evolución de 5, 3 y 2 años respectivamente. No se realizaron colostomías de derivación. Conclusiones: Los métodos conservadores de tratamiento tienen poco efecto cuando la HS glútea y perianal es extensa...

Introduction: The hidrosadenitis suppurativa (HS) is a chronic inflammatory disease that affects the apocrine sweat glands. This condition occludes the hair follicles and it can be found in the armpits, the groin, the perineum, the perianal area and the gluteus. It was first described in 1839 and it is a rare disease that affects 1 among 300-600 adults. Due to the stage and the features of the disease, it can be treated either with medication or with surgery. Purpose: The aim of this study is to report the surgical treatment carried out on patients suffering from HS in the perianal area and the gluteus. Layout: This is a descriptive, retrospective and multicentre study. Place: This study was carried out in the 'Hospital Santa María Magdalena', Magdalena, in the 1 Hospital HIGA San Martín, La Plata and in private practice. Patients and Methods: The results of the surgical treatment carried out on 7 patients who suffered from HS in the perianal area and the gluteus during the years 2001 and 2011 are analyzed. Those patients were 23-56 years old on average 35.4. Marsupialization and drainage was carried out on 4 patients who were in Hurley stage II. Surgical excisions and skin grafts stage III with the patient's own skin and lyophilized pigskin that speeded the time of regeneration were done to 3 patients. Results: Crohn's Disease or squamous cell carcinoma was not observed. 2 of the 4 patients who were treated with marsupialization recovered favorably and they were monitored during 3 and 6 years. The rest of the patients had recurrences within a period of 4 and 8 months. Only 1 patient has still been monitored for the last three years. The 3 patients who had excisions and skin grafts are monitored at present and they do not show alterations within a period of evolution of 5,3 and 2 years. No colostomy was perfonned. Conclusion: The traditional methods do not show useful results when the HS in the perianal area and the gluteus is extensive...

Hidrosadenitis supurativa glútea y perianal: tratamiento quirúrgico / Perianal and gluteal suppurativa hidradenitis: surgical treatment

Introducción: La hidrosadenitis supurada (HS) es una enfermedad inflamatoria crónica que compromete las glándulas sudoríparas apócrinas, comenzando por la oclusión de los folículos pilosos. Puede localizarse en axilas, ingle, periné, periano y glúteos. Fue descripta en 1.839, es infrecuente y afecta a1 c/300-600 adultos. De acuerdo a sus características y estadio puede ser tratada médicamente o en forma quirúrgica. Objetivo: Comunicación del tratamiento quirúrgico realizado a pacientes portadores de HS localizada en la región glútea y perianal. Diseño: Trabajo descriptivo, retrospectivo y multicéntrico. Lugar de aplicación: Hosp. Santa María Magdalena de Magdalena, Hosp. HIGA San Martin de La Plata y práctica privada. Pacientes y métodos: Se analizan los resultados del tratamiento quirúrgico realizado a 7 pacientes que fueron tratados entre los años 2001 y 2011, que presentaban HS supurada glútea y perianal, con una edad promedio de 35,4 y un rango de 23 a 56. Cuatro de ellos con estadio II de Hurley a los cuales se les realizó marsupialización y drenaje y 3 con estadio III extirpación e injertos diferidos con piel del mismo paciente y una variante de injerto de piel porcina liofilizada que aceleró el tiempo de regeneración. Resultados: No se observó enfermedad de Crohn o carcinoma de células escamosas. De los 4 que fueron tratados con marsupialización, 2 evolucionaron favorablemente y fueron controlados durante 3 y 6 años respectivamente. El resto de ellos tuvieron recidivas a los 4 y 8 meses respectivamente, siendo tratados de la misma forma. Solamente 1 permanece en control desde hace tres años. Los 3 con extirpaciones e injertos diferidos son controlados en la actualidad sin presentar nuevas alteraciones, con un periodo de evolución de 5, 3 y 2 años respectivamente. No se realizaron colostomías de derivación. Conclusiones: Los métodos conservadores de tratamiento tienen poco efecto cuando la HS glútea y perianal es extensa...(AU)

Introduction: The hidrosadenitis suppurativa (HS) is a chronic inflammatory disease that affects the apocrine sweat glands. This condition occludes the hair follicles and it can be found in the armpits, the groin, the perineum, the perianal area and the gluteus. It was first described in 1839 and it is a rare disease that affects 1 among 300-600 adults. Due to the stage and the features of the disease, it can be treated either with medication or with surgery. Purpose: The aim of this study is to report the surgical treatment carried out on patients suffering from HS in the perianal area and the gluteus. Layout: This is a descriptive, retrospective and multicentre study. Place: This study was carried out in the Hospital Santa María Magdalena, Magdalena, in the 1 Hospital HIGA San Martín, La Plata and in private practice. Patients and Methods: The results of the surgical treatment carried out on 7 patients who suffered from HS in the perianal area and the gluteus during the years 2001 and 2011 are analyzed. Those patients were 23-56 years old on average 35.4. Marsupialization and drainage was carried out on 4 patients who were in Hurley stage II. Surgical excisions and skin grafts stage III with the patients own skin and lyophilized pigskin that speeded the time of regeneration were done to 3 patients. Results: Crohns Disease or squamous cell carcinoma was not observed. 2 of the 4 patients who were treated with marsupialization recovered favorably and they were monitored during 3 and 6 years. The rest of the patients had recurrences within a period of 4 and 8 months. Only 1 patient has still been monitored for the last three years. The 3 patients who had excisions and skin grafts are monitored at present and they do not show alterations within a period of evolution of 5,3 and 2 years. No colostomy was perfonned. Conclusion: The traditional methods do not show useful results when the HS in the perianal area and the gluteus is extensive...(AU)