Chronic inguinal pain in children

Abstract

PURPOSE: To present our experience in the management of chronic groin pain in children.

METHODS: We report 4 patients (age range 0-18 years old) who presented with history of chronic groin pain (April 2010 January 2017). After failure of all conservative treatments they underwent surgical management as ultima ratio.

RESULTS: Currently, there is no consensus on treatment of ‘Sportsman’s Hernia’ and literature on paediatric population is still poor. There are no appropriate randomised controlled trials supporting a standardized management of chronic groin pain. Initial approach should be conservative [Physical Medicine and Rehabilitation (PM&R) follow-up for 3-6 months] and surgical treatment proposed after failure of conservative therapies. It is advisable to consider surgery at least months after clinical onset. More recently, some studies suggested surgery as a first line treatment. Most of surgical cases manage to recover to full activity without pain, as reported in our experience. Surgical approach to the groin can be anterior (open) or posterior (laparoscopic), both these procedures have shown good results. Surgeons having different opinions on the aetiology of ‘Sportsman’s Hernia’ may sustain the suitability of different surgical techniques. In our experience, pain was localized at the pubic tubercle therefore we preferred the ‘open’ approach ensuring a successful release of ilioinguinal and genitofemoral nerves.

CONCLUSIONS: Children with chronic groin pain can benefit of surgical treatment. In our experience, surgery always proved to be successful for treating chronic groin pain in paediatric age. Further multicentric studies are needed to support these results.