Prakash (name changed), a 23-year-old medical student presented with groin and upper inner thigh pain of five months duration. He was suspected to have a testicular torsion when seen first by his family physician. Scans did not confirm this diagnosis. He was treated for several weeks with painkillers and antibiotics and saw little relief. During the subsequent five months, he continued to suffer constant pain with exacerbations of shooting pain in the groin and inner thighs which made even walking, straining at motion, or coughing extremely painful. He required injectable painkillers frequently for pain relief. He was seen by Dr. Srikanth Gadiyaram, at Sahasra Hospital when a history of ‘high-intensity abdominal excesses history was forthcoming on detailed inquiry. Prakash was suspected to have a ‘Gilmore hernia’ and investigations were performed including a dynamic ultrasound of the groin region and an MRI of lower abdomen. Conservative measures in the preceding months had failed and he was advised a laparoscopic procedure akin to groin hernia repair. His hospital stay was 24 hours and he started seeing relief from his pain from the day after surgery. Physiotherapy to strengthen his core muscles and inner thigh muscles were initiated post surgery with advice to continue same in the long term. Ten days after the keyhole procedure he is totally pain free, fully ambulance, active and back to his medical school. He has been advised to avoid strenuous physical activity for a period of six weeks.
Best hernia treatment in Bangalore
Gilmore hernia OR sportsman hernia is seen in young males and athletes. The problem results from injury to the muscles in the groin and upper inner thigh muscles. The extent of injury could be variable. This injury is seen in athletes playing cricket, football, hockey, hurdle races, rugby, skiing etc. It is seen less commonly in sports like basket ball, tennis, cycling and swimming. For those who are habituated to a more sedentary life style, a high intensity exercise programme might be important cause for a Gilmore hernia. Apart from pain in the groin and inner thigh during regular activities like walking, patients tend to have exacerbation and excruciating pain during coughing, sneezing, climbing stairs, lifting objects, driving, straining at motion, etc. Essentially any activity which engages core muscles that increases intraabdominal pressure would put a strain on the groin (inguinal) and inner thigh (adductor group of muscles) and therefore results in pain.
Once suspected on history and clinical examination, abdominal scans may provide supportive evidence. The essential components of treatment would be rest, physiotherapy to strengthen core and inner thigh muscles along with anti-inflammatory medications. Patients who have failed conservative measures for several weeks merit consideration for surgery. This can be achieved through keyhole surgery.
When to suspect Gilmore hernia?
Sharp shooting pain in the groin and inner thigh following sports activity or high-intensity excercise. It is important to recognize that the diagnosis is on clinical suspicion, particularly because scans may not help to diagnose in more than a third of patients.
How to avoid a sportsman hernia?
For sedentary individuals embarking on a high-intensity exercise program, it is mandatory to do this under the supervision of a trainer. Strengthening of core muscles by appropriate exercises might help prevent this injury.
What should be the treatment plan?
Resting the sore muscles, anti-inflammatory medications, and physiotherapy are essential initial steps to manage the problem. After several weeks of core and inner thigh muscle strengthening fails to relieve symptoms surgery is considered.
How is the surgery performed and what is the duration of recovery?
In the two decades following Gilmore’s initial description of the condition, open surgical repair was advocated. In the last decade, the superiority of laparoscopic (keyhole) repair for these hernias is established. The procedure takes about 45 minutes and typically requires a 24-hour stay. Physiotherapy is commenced post-surgery and continued for several weeks.
Dr. Srikanth Gadiyaram is a renowned surgical gastroenterologist in Bangalore. He is an advanced laparoscopic and robotic surgeon with over two decades of experience and over 12,000 surgeries. He has done pioneering work in fluorescence guidance gallbladder surgery and has related publications in international peer-reviewed journals. Looking for the best hernia treatment in Bangalore? Then visit us today as we provide the best hernia treatment in Bangalore.
Dr. SrikanthGadiyaram is currently the Director and Chief surgical gastroenterologist at Sahasra Hospitals, Jayanagar, Bangalore
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