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Specialist clinics 17


Understanding athletes’ groins takes hernia repair ‘back to the future’


Mr Simon Marsh, consultant groin and hernia surgeon, 108 Harley Street, discusses


Inguinal hernia repair is one of the commonest operations, with around 80,000 performed in the UK every year (pre-pandemic). Despite that, there’s still some discussion about the best tech- nique and, in particular, there’s concern over the use of meshes. So, where do the athletes come in? Bear with me. In 1980, the London surgeon


Jerry Gilmore saw three, what were then first division (and international) footballers who had been unable to play because of intractable groin pain for many months. After many opinions and multiple investigations, they feared their careers were over. Jerry Gilmore did what surgeons are all trained to do: he listened carefully to what had happened


and what symptoms each was experiencing


and then exam-


ined them. He realised there was a pattern in all three cases and following surgery on the groin, they all returned to their previous high level of sporting achieve- ment with six to eight weeks. Jerry Gilmore understood


what others hadn’t; that what he was dealing with was an injury to the muscles and tendons in the groin (the inguinal region). Te operation he performed relied on a comprehensive understanding of the structure and function of the groin so that he could restore the normal anatomy, and the syndrome of Gilmore’s groin was born. In 1991, the Gilmore Groin and Hernia Clinic was founded at 108 Harley Street and over 9,000 operations have been carried out including around 500 interna- tionals. In 2010, the surgical tech- nique was revised and improved, but still relies on a fundamental understanding of the anatomy and physiology of the normal groin. And this is where the link to hernia repair comes in. Hernia repairs, initially, relied


MR JERRY GILMORE


on exactly the same principles; an anatomical repair of the groin muscles after the hernia had been pushed back (‘reduced’). When


the world-renowned Shouldice Hospital opened in Canada in the 1940s, the anatomical ‘Shouldice repair’ became the gold standard until the 1990s. Ten the hernia mesh arrived. Tis was supposed to be an easier operation for inexperienced surgeons as no detailed anatomical knowledge was required. Initially done as an ‘open’ procedure, it was also


performed laparoscopi-


cally using a large mesh placed inside the abdomen. Now, it’s important to point out that most people who have a hernia repair, by whatever technique, have very few problems, but any tech- nique using a mesh patch now arouses concerns about chronic pain. Even the Royal College of


Surgeons expressed the


opinion that a mesh-free alter- native should be offered. But here’s the problem; finding a surgeon who understands


the


anatomy of the groin sufficiently to offer a non-mesh (Shouldice type) repair seems increas- ingly difficult in the UK as most surgeons have only been taught mesh techniques. Tis is where the expertise


built up at the Gilmore Groin and Hernia Clinic comes in. Troughout


its four decades


MR SIMON MARSH


of dealing with sportsmen and women, the clinic has maintained a team of surgeons with a fastid- ious knowledge of the normal anatomy of the groin. Tis means that it is one of the few places remaining that can offer not only ‘standard’, mesh type, inguinal


hernia repairs, but also non-mesh, Shouldice type, operations.


T: 020 7563 1234 E: info@108harleystreet.co.uk 108harleystreet.co.uk


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