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The Gilmore Groin and Hernia Clinic
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Second Opinion and Third Party Surgery

With over 40 years experience of groin disruption amongst the surgical team we are delighted to assist patients with a second or even third opinion on a diagnosis for groin disruption/sportsman’s groin that they may have received elsewhere or even to assist with re-investigation and assessment if surgery at another centre has failed to relieve the symptoms.

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With over 40 years experience of groin disruption amongst the surgical team we are delighted to assist patients with a second or even third opinion on a diagnosis for groin disruption/sportsman’s groin that they may have received elsewhere or even to assist with re-investigation and assessment if surgery at another centre has failed to relieve the symptoms.

Most people find that their symptoms get better after appropriate surgery for groin disruption. A small number, unfortunately, may have further problems afterwards. These people tend to fall into two main groups. In the first group, following recovery and a return to normal activity, the symptoms come back. This is most commonly due to a strain in the groin rather than another tear. A small number of people do tear their groin twice. A combination of examination and scanning, with a combination of MRI scans and high frequency ultrasound scans, can usually sort out whether a further tear has occurred, which may need another operation, or whether there is only a strain, which will usually settle with rest, non steroidal pain killers (such as ibuprofen) and then the reintroduction of core stability exercises, building back up to normal over a few weeks.

The second main group of people find that the surgery they have had makes no difference to their pain at all. In these cases, either the diagnosis of the cause of the pain has been wrong, or if the diagnosis was correct, the wrong operation may have been done.

We will occasionally see people who seem to have hip and groin problems and it can be quite difficult to work out how much of the pain is coming from the hip and how much is actually from the groin. In these cases, following the imaging tests, the usual management is to repair the groin first and see how much of the discomfort persists. In most cases the groin has, indeed, been the main cause of trouble and the symptoms settle. In a small number problems persists and then it may be necessary to investigate any hip problems in more detail. Sometimes back problems can also cause pain that affect the groin. This is why, in our opinion, it is so important to have an experienced orthopaedic surgeon as part of the “groin team”.

A problem we are seeing increasingly frequently is of people who have had groin surgery elsewhere and the operation has made no difference to their pain. What tends to happen is that these people (nearly always young, fit, athletic men) have developed groin pain, been referred to a surgeon who diagnoses a hernia and does a hernia repair operation.

Now, to understand why there may be problems in these cases it is necessary to go back over the difference between a hernia and a groin disruption (Gilmore’s Groin).

The muscles of the wall of the abdomen may be pictured in 3 layers.  The outer layer (the external oblique) runs at about 45 degrees downwards and inwards. The middle layer (the internal oblique) runs at 45 degrees upwards and inwards (at right angles to the outer layer). The inner layer (the transversus abdominus) runs straight across. Towards the middle all these muscle fuse together into a common tendon (the conjoined tendon) and are fixed to the pelvis in the middle. They also become fused with the muscles of the leg at the top of the groin.

In men the external oblique has an archway in it through which the blood vessels and nerves go down into the testicle, along with the vas deferens. When the groin is torn this archway opens up and becomes much wider. There are also tears in the muscle around the archway. The internal oblique is pulled up and away from the pelvis, allowing the unsupported transversus abdominus to become loose and floppy.

Although Gilmore’s Groin is often also called a sportsman’s hernia there is actually no hernia present. In a hernia there is a hole in the muscle wall that allows the abdominal contents (bowel, or fat) to poke through. Gilmore’s Groin is a complex musculoskeletal disruption.

In summary, a hernia is a hole and a Gilmore’s Groin might be thought of as a muscle dislocation.

Many groin hernias are now repaired using a plastic mesh. This is simply placed over the hole to seal it off. The mesh can be placed “on the outside” (the traditional repair, with a scar in the groin) or “on the inside” using a laparoscopic (telescopic) technique. The effect is the same: the mesh is placed over the muscle and seals the hole, stopping the hernia.

Now, imagine that someone with a Gilmore’s Groin is diagnosed as having a hernia and has a hernia operation. In this case the plastic mesh will be placed over “dislocated” muscles. This has two main effects. Firstly it means that the muscles remain out of place and secondly, because they are covered by a rigid mesh, even if they have been replaced, they cannot function normally because the mesh stops them from contracting properly. In these cases the pain will persist because the operation has not corrected the cause.

As more people take on groin problems this is something we are seeing increasingly frequently. People come along for a second opinion having had a hernia repair which has not helped their pain. Often it is very easy to discover that there probably wasn’t a hernia in the first place; there was never a lump and the symptoms were consistent with a Gilmore’s Groin. A high frequency ultrasound scan will often show the signs of a persistent groin disruption.

There are, of course, potential problems with operating on a groin that has already had surgery. Even in cases where a groin disruption has recurred after being repaired correctly there may be scar tissue making the muscle layers difficult to define. If a mesh has been placed over the top of a groin disruption the scar tissue can be even thicker, making the re-operation even more difficult. The mesh can be removed, usually revealing the muscle disruption underneath, and the disruption repaired.
Successful “re-do” surgery depends making the correct diagnosis and having a detailed knowledge of the correct anatomy of the groin muscles.  As previously mentioned the surgeons at The Gilmore Groin and Hernia Clinic have a joint experience of over 40 years in diagnosing and treating groin disruption and recurrent groin problems. In addition they are part of an experienced team of experts, including radiologists, orthopaedic surgeons, anaesthetists and sports and exercise physicians, which means that all groin, and recurrent groin, problems are fully assessed before any treatment is undertaken. 

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