Surgical Endoscopy

, Volume 28, Issue 2, pp 439–446 | Cite as

Health-related quality of life after TAPP repair for the sportsmen’s groin

  • Gerwin A. Bernhardt
  • Gerald Gruber
  • Benjamin S. Molderings
  • Herwig Cerwenka
  • Mathias Glehr
  • Christian Giessauf
  • Peter Kornprat
  • Andreas Leithner
  • Hans-Jörg Mischinger



Sportsmen’s groin (SG) is a clinical diagnosis of chronic, painful musculotendinous injury to the medial inguinal floor in the absence of a groin hernia. Long-term results for laparoscopic inguinal hernia repair, especially data on health-related quality of life (HRQOL), are scant and there are no available data whatsoever on HRQOL after SG. The main goal of this study was to compare postoperative QOL data in the long term after transabdominal preperitoneal hernioplasty (TAPP) in groin hernia and SG patients with QOL data of a normal population.


This study included all patients (n = 559) who underwent TAPP repair between 2000 and 2005. Forty seven patients (8.4 %) were operated on for SG. We sent out the Short Form 36 Health Survey (SF-36) questionnaire for QOL evaluation. QOL data were compared with data from an age- and sex-matched normal population.


Ultimately, 383 completed questionnaires were available for evaluation (69 % response rate). The mean follow-up time was 94 ± 20 months. In the SG group there were statistically significant differences in three subscales of the SF-36 and the mental component summary measure, showing better results for the SG group compared to the sex- and age-matched normal group data. There were no statistically significant differences between groin hernia patients and the sex- and age-matched normal population.


TAPP repair for SG as well as groin hernia results in good HRQOL in the long term. Results for SG patients are comparable with QOL data of a normal population or even better.


Sportsmen’s groin Sports hernia Groin hernia Chronic groin pain TAPP Quality of life SF-36 



We thank the chief of the Surgical Department at the District Hospital of Weiz, Dr. Roland Fegerl, and the hospital’s former director Dr. Karl Gruber for providing us with the patient data. Many thanks to Eugenia Lamont for language editing.


Drs. Gerwin A. Bernhardt, Gerald Gruber, Benjamin S. Molderings, Herwig Cerwenka, Mathias Glehr, Christian Giessauf, Peter Kornprat, Andreas Leithner, and Hans-Jörg Mischinger have no conflicts of interest or financial ties to disclose.


  1. 1.
    Bernhardt GA, Kornprat P, Cerwenka H, El-Shabrawi A, Mischinger HJ (2009) Do we follow evidence-based medicine recommendations during inguinal hernia surgery? Results of a survey covering 2441 hernia repairs in 2007. World J Surg 33:2050–2055PubMedCrossRefGoogle Scholar
  2. 2.
    Morales-Conde S, Socas M, Fingerhut A (2012) Endoscopic surgeons’ preferences for inguinal hernia repair: TEP, TAPP, or OPEN. Surg Endosc 26:2639–2643PubMedCrossRefGoogle Scholar
  3. 3.
    McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, Vale L, Grant A (2005) Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess 9:1–203PubMedGoogle Scholar
  4. 4.
    van Hanswijck de Jonge P, Lloyd A, Horsfall L, Tan R, O’Dwyer PJ (2008) The measurement of chronic pain and health-related quality of life following inguinal hernia repair: a review of the literature. Hernia 12:561–569PubMedCrossRefGoogle Scholar
  5. 5.
    Gholghesaei M, Langeveld HR, Veldkamp R, Bonjer HJ (2005) Costs and quality of life after endoscopic repair of inguinal hernia vs open tension-free repair: a review. Surg Endosc 19:816–821PubMedCrossRefGoogle Scholar
  6. 6.
    Singh AN, Bansal VK, Misra MC, Kumar S, Rajeshwari S, Kumar A, Sagar R, Kumar A (2012) Testicular functions, chronic groin pain, and quality of life after laparoscopic and open mesh repair of inguinal hernia: a prospective randomized controlled trial. Surg Endosc 26:1304–1317PubMedCrossRefGoogle Scholar
  7. 7.
    Abbas AE, Abd Ellatif ME, Noaman N, Negm A, El-Morsy G, Amin M, Moatamed A (2012) Patient-perspective quality of life after laparoscopic and open hernia repair: a controlled randomized trial. Surg Endosc 26:2465–2470PubMedCrossRefGoogle Scholar
  8. 8.
    Siddiqui MR, Kovzel M, Brennan S, Priest OH, Preston SR, Soon Y (2012) A literature review on the role of totally extraperitoneal repairs for groin pain in athletes. Int Surg 97:327–334PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Gilmore OJA (1991) Gilmore’s groin: ten years experience of groin disruption – a previously unsolved problem in sportsmen. Sports Med Soft Tissue Trauma 3:12–14Google Scholar
  10. 10.
    Fon LJ, Spence RA (2000) Sportsman’s hernia. Br J Surg 87:545–552PubMedCrossRefGoogle Scholar
  11. 11.
    van Veen RN, de Baat P, Heijboer MP, Kazemier G, Punt BJ, Dwarkasing RS, Bonjer HJ, van Eijck CH (2007) Successful endoscopic treatment of chronic groin pain in athletes. Surg Endosc 21:189–193PubMedCrossRefGoogle Scholar
  12. 12.
    Nam A, Brody F (2008) Management and therapy for sports hernia. J Am Coll Surg 206:154–164PubMedCrossRefGoogle Scholar
  13. 13.
    Swan KG Jr, Wolcott M (2007) The athletic hernia: a systematic review. Clin Orthop Relat Res 455:78–87PubMedCrossRefGoogle Scholar
  14. 14.
    Campanelli G (2010) Pubic inguinal pain syndrome: the so-called sports hernia. Hernia 14:1–4PubMedCrossRefGoogle Scholar
  15. 15.
    Akita K, Niga S, Yamato Y, Muneta T, Sato T (1999) Anatomic basis of chronic groin pain with special reference to sports hernia. Surg Radiol Anat 21:1–5PubMedCrossRefGoogle Scholar
  16. 16.
    Holzheimer RG (2005) Inguinal hernia: classification, diagnosis and treatment: classic, traumatic and Sportsman’s hernia. Eur J Med Res 10:121–134PubMedGoogle Scholar
  17. 17.
    Caudill P, Nyland J, Smith C, Yerasimides J, Lach J (2008) Sports hernias: a systematic literature review. Br J Sports Med 42:954–964PubMedCrossRefGoogle Scholar
  18. 18.
    Bittner R, Schwarz J (2012) Inguinal hernia repair: current surgical techniques. Langenbecks Arch Surg 397:271–282PubMedCrossRefGoogle Scholar
  19. 19.
    Gruber G, Zacherl M, Giessauf C, Glehr M, Fuerst F, Liebmann W, Gruber K, Bernhardt GA (2010) Quality of life after volar plate fixation of articular fractures of the distal part of the radius. J Bone Joint Surg Am 92:1170–1178PubMedCrossRefGoogle Scholar
  20. 20.
    Ware JE Jr, Kosinski M, Gandek B (1993, 2000, 2005) SF-36 health survey: manual and interpretation guide. Lincoln, RI: QualityMetricGoogle Scholar
  21. 21.
    Stewart AL, Hays RD, Ware GE (1988) The MOS short form General Health Survey: reliability and validity in a patient population. Med Care 26:724–735PubMedCrossRefGoogle Scholar
  22. 22.
    Fredberg U, Kissmeyer-Nielsen P (1996) The sportsman’s hernia: fact or fiction? Scand J Med Sci Sports 6:201–204PubMedCrossRefGoogle Scholar
  23. 23.
    Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry EJ, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg JS, Sauerland S, Schug-Paß C, Singh K, Timoney M, Weyhe D, Chowbey P (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25:2773–2843PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Messaoudi N, Jans C, Pauli S, Van Riet R, Declercq G, Van Cleemput M (2012) Surgical management of sportsman’s hernia in professional soccer players. Orthopedics 35:e1371–e1375PubMedCrossRefGoogle Scholar
  25. 25.
    Muschaweck U, Berger L (2010) Minimal repair technique of sportsmen’s groin: an innovative open-suture repair to treat chronic inguinal pain. Hernia 14:27–33PubMedCrossRefGoogle Scholar
  26. 26.
    Edelman DS, Selesnick H (2006) “Sports” hernia: treatment with biologic mesh (Surgisis): a preliminary study. Surg Endosc 20:971–973PubMedCrossRefGoogle Scholar
  27. 27.
    Kluin J, den Hoed PT, van Linschoten R, IJzerman JC, van Steensel CJ (2004) Endoscopic evaluation and treatment of groin pain in the athlete. Am J Sports Med 32:944–949PubMedCrossRefGoogle Scholar
  28. 28.
    Preskitt JT (2011) Sports hernia: the experience of Baylor University Medical Center at Dallas. Proc (Bayl Univ Med Cent) 24:89–91Google Scholar
  29. 29.
    Ingoldby CJH (1997) Laparoscopic and conventional repair of groin disruption in sportsmen. Br J Surg 84:213–215PubMedCrossRefGoogle Scholar
  30. 30.
    Paajanen H, Brinck T, Hermunen H, Airo I (2011) Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman’s hernia (athletic pubalgia). Surgery 150:99–107PubMedCrossRefGoogle Scholar
  31. 31.
    Genitsaris M, Goulimaris I, Sikas N (2004) Laparoscopic repair of groin pain in athletes. Am J Sports Med 32:1238–1242PubMedCrossRefGoogle Scholar
  32. 32.
    Langenbach MR, Schmidt J, Ubrig B, Zirngibl H (2008) Sixty-month follow-up after endoscopic inguinal hernia repair with three types of mesh: a prospective randomized trial. Surg Endosc 22:1790–1797PubMedCrossRefGoogle Scholar
  33. 33.
    Lawrence K, McWhinnie D, Jenkinson C, Coulter A (1997) Quality of life in patients undergoing inguinal hernia repair. Ann R Coll Surg Engl 79:40–45PubMedCentralPubMedGoogle Scholar
  34. 34.
    Fortelny RH, Petter-Puchner AH, May C, Jaksch W, Benesch T, Khakpour Z, Redl H, Glaser KS (2012) The impact of atraumatic fibrin sealant vs. staple mesh fixation in TAPP hernia repair on chronic pain and quality of life: results of a randomized controlled study. Surg Endosc 26:249–254PubMedCrossRefGoogle Scholar
  35. 35.
    Barkun JS, Wexler MJ, Hinchey EJ, Thibeault D, Meakins JL (1995) Laparoscopic versus open inguinal herniorrhaphy: preliminary results of a randomized controlled trial. Surgery 118(4):703–709PubMedCrossRefGoogle Scholar
  36. 36.
    Liem MS, Halsema JA, van der Graaf Y, Schrijvers AJ, van Vroonhoven TJ (1997) Cost-effectiveness of extraperitoneal laparoscopic inguinal hernia repair: a randomized comparison with conventional herniorrhaphy. Coala trial group. Ann Surg 226:668–675PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Lawrence K, McWhinnie D, Goodwin A, Doll H, Gordon A, Gray A, Britton J, Collin J (1995) Randomised controlled trial of laparoscopic versus open repair of inguinal hernia: early results. BMJ 311:981–985PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Myers E, Browne KM, Kavanagh D, Hurley M (2010) Laparoscopic (TEP) versus Lichtenstein inguinal hernia repair: a comparison of quality-of-life outcomes. World J Surg 34:3059–3064PubMedCrossRefGoogle Scholar
  39. 39.
    Hammoud A, Gago A, Diamond MP (2004) Adhesions in patients with chronic pelvic pain: a role for adhesiolysis? Fertil Steril 82:1483–1491PubMedCrossRefGoogle Scholar
  40. 40.
    Kehlet H, Bay-Nielsen M, Danish Hernia Database Collaboration (2008) Nationwide quality improvement of groin hernia repair from the Danish Hernia Database of 87,840 patients from 1998 to 2005. Hernia 12:1–7PubMedCrossRefGoogle Scholar
  41. 41.
    Stechemesser B, Jacob DA, Schug-Paß C, Köckerling F (2012) Herniamed: an internet-based registry for outcome research in hernia surgery. Hernia 16:269–276PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Gerwin A. Bernhardt
    • 1
    • 2
  • Gerald Gruber
    • 2
    • 3
  • Benjamin S. Molderings
    • 1
  • Herwig Cerwenka
    • 1
  • Mathias Glehr
    • 2
  • Christian Giessauf
    • 3
    • 4
  • Peter Kornprat
    • 1
  • Andreas Leithner
    • 2
  • Hans-Jörg Mischinger
    • 1
  1. 1.Division of General Surgery, Department of SurgeryMedical University of GrazGrazAustria
  2. 2.Department of Orthopaedic SurgeryMedical University of GrazGrazAustria
  3. 3.Department of SurgeryDistrict Hospital of WeizWeizAustria
  4. 4.Orthopaedic ClinicSchwarzachGermany

Personalised recommendations