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Edelman Hybrid mesh for sports hernia repair

groin and were not able to demonstrate a definite cannula was used at the umbilicus to create a space
inguinal hernia on exam. Surgery to repair these for surgery down to the pubis in the pre-peritoneum.
hernias has been popularized in the United States by Stay sutures of 0 Vicril were placed in the fascia to hold
Dr. William C. Meyers. a 12 mm Hasson cannula in place for the 0 degree
laparoscope. Insufflation of carbon dioxide gas at a
Many approaches to the treatment of this condition 12 mmHg pressure was used for the surgery. A single,
have been described in the literature and not one 5 mm cannula was placed in the midline, 6 cm below
approach has been studied to be superior to any other. the umbilicus. A flat dissector was used at the 5 mm
The laparoscopic approach to repair inguinal hernias portal to dissect out the cord structures away from
has been demonstrated to be safe and effective. the pubis exposing the epigastric vessels, iliopubic
Using mesh or a synthetic prosthesis is commonplace. tract and both inguinal areas looking for pathology.
Despite the availability of different types of mesh, Once the dissection was complete, a 10 cm × 15 cm
no one mesh has yet to be proven applicable to all hybrid mesh was opened on the operative field and
patients or hernia repairs. Biologic mesh is designed moistened in 20 mL of bupivacaine prior to rolling it up
to leave behind a minimal amount of foreign material and introducing it into the pre-peritoneal space. The flat
and reduce the inflammatory response associated with dissector was used to position the mesh over the cord
polypropylene mesh. This has theoretical advantages structures to the lateral edge of the balloon dissection
for the athlete. Biologic mesh has been shown to be a and past the midline under the pubis. Four absorbable
safe and effective alternative to polypropylene mesh. [3] tacks were used to hold the mesh in place - superior
However, studies on incisional hernias using biologic medial, superior lateral, midline pubis and inferior into
mesh have found late recurrences and this fact has the lacunar ligament near the femoral canal. Five mL
led to incorporating an ultra-lightweight polypropylene of fibrin sealant was then sprayed on both sides of
mesh into the biologic mesh matrix. Selecting the most the mesh. The remaining bupivacaine was injected
[4]
appropriate mesh to repair and reinforce a hernia while into the pre-peritoneal space before removing all of
minimizing the failure rate but optimizing the return the CO gas. The umbilical fascia was closed with a 0
2
of the athlete to their sport is mandatory. In 2014, a Vicril suture and both skin incisions were closed with a
hybrid mesh was released having a 6 layers of porcine subcuticular, 4-0 monocryl suture followed by skin glue.
small intestine sub mucosa covering a lightweight,
macroporous, polypropylene mesh (Zenapro, COOK RESULTS
Surgical). This mesh was the basis of this study.
From April 2015 to August 2016, 16 male athletes
METHODS with a diagnosis of a sports hernia were consented for
hybrid mesh repair. Their ages ranged from 18 years to
Patients were seen and examined because of a 43 years with an average age of 22.9 years. Operative
suspected sports hernia. All patients had an magnetic times ranged from 25 min to 75 min with an average of
resonance imaging (MRI) showing signs of a rectus 42.5 min. The athletes played sports including: soccer
abdominis injury or chronic osteitis pubis that persisted (5), basketball (3), track (3), football (2), baseball (1),
after a trial of conservative therapy including rest, weight lifting (1) and ultimate frisbee (1). There were
non-steroidal anti-inflammatory medication (NSAIDs) no operative complications. Two patients (soccer)
and physical therapy. Proper informed consent was developed seromas overlying the urinary bladder
obtained on all patients. Surgery was performed on an causing intense pressure. Interventional radiology was
outpatient basis. Patients were seen 7 days to 10 days consulted for drainage of these sterile fluid collections
after surgery and started on a rigid physical therapy 2 weeks after surgery. All patients completed a post-
program over 4 weeks. They were seen at again at 4 operative therapy program and all have returned to
weeks post-op before being released to full contact. their sport without problems.
The athletes were seen for a final visit at 4 months
after surgery. DISCUSSION

A modified, double incision, total extra-peritoneal Sports hernia involves a set of injuries in the abdominal
(TEP) hernia repair was performed. Patients were wall and pelvis causing a weakness of the posterior
placed supine on the operating room table under a inguinal wall. It is a chronic, activity related groin pain
general endotracheal anesthesia. Five mL of 0.5% that is worsened by turning or twisting movements.
bupivacaine at each of the 2 skin incisions. Ten mL Athletes can usually play through the pain but by the
of bupivacaine was injected into the pre-peritoneal day following the activity, there is pain in the groin on
space at the completion of the procedure. A balloon the affected side. Rest is beneficial but resumption
32 Mini-invasive Surgery ¦ Volume 1 ¦ March 31, 2017