הכנס האסייאתי והבינלאומי לניתוחי בקעים בג'ייפור, הודו
פרופ' דודאי מוזמן להרצות ומציג עבודות מחקר ופיתוח שלו בכנסים פרסונליים בינלאומיים.
הכנס נערך בנובמבר 2014
דר' דודאי הרצה בנושא הגישה החדשה לטיפול בבקע ספורטאים:
NEW APPROACHES TO SPORTSMAN HERNIA
Moshe Dudai MD FACS, Hernia Excellence, Ramat Aviv Medical Center, Tel Aviv
Sport Groin injuries are very common among professional Athletes but lastly become common also in sport active people. In part is treated by conservative treatment and in part by Endoscopic surgery. Making the diagnosis for selecting the right treatment it is a challenge but lastly become more feasible after publishing the new guidelines for diagnosis and treatment of Sportsman Hernia. In some of the cases there is more complexes injury that will need combined Endoscopic surgery with conservative treatments.
There are well defined two kinds of Sport Groin Injury (SGI); the Sportsman Hernia (SH) – Posterior Wall Deficiency (PWD) and the Athletes Pubalgia (AP) – Pubic Bone Stress Injury (PBSI). The different criteria for diagnosis and treatment of this two SGI were clearly described in the Guiltiness for Sportsman Hernia as part of the International Endo Hernia guidelines published in the Journal Surgical Endoscopy 2011. In general the symptoms of SH are more lateral in the groin, sharp pain radiated to the inner tight aspect with neurologic characteristic while the AP is more central , dull continues pain with inflammatory characteristic. The background pathology for SH is sport trauma causing small and irreversible tears and weakening of the posterior inguinal wall facial sheets and the adjusted tendons while in the AP there is a stress injury with edema and inflammatory process in the Symphysis Pubis, Pubic bone and ligaments including the tendons of the attached muscles; Rectus, Pyramidal and Adductors. Beside of different findings by anamnesis and physical examination, Dynamic US can demonstrate the SH pathology and MRI the AP pathology.
According to the SH guiltiness and the recent update, surgery is superior to conservative treatment for SH –Level 1A of evidence- and Endoscopic Total Extra Peritoneal (TEP) retro- pubic and posterior wall mesh placement is the recommended treatment for SH with excellent results – Level 1A of evidence-. Specific surgical maneuvers adapted for the SH have to be add to the mesh placement. On the other hand conservative treatment of Active Isometric Weight Bering Exercises (AIWBE) is recommended for AP when quit all recovered in 8-12 weeks –Level 1A of evidence-.
In our experience we found that part of the athletes presenting with findings of both types of SGI with different level of severity. SH is expressed bilateral quite in all but PBSI expressed in different level of severity; grade 1-5. We were impressed that the SH was the first injury and because the athlete continue with extreme sport activities on top of the SH injury, others PBSI be caused. We worked in cooperation with physiotherapist and sport physiologist to build up a program that is a combination of Endoscopic TEP posterior wall repair and reinforcement by mesh combined with muscles sport rehabilitation (AIWBE for peripheral muscles and core muscles strength and balance). We had found that the more effective and shorter recovery combination is starting with the surgery, repairing and giving strength to the groin that act as an anchor for the active healing process of the muscles and tendons.
Athletes suffered from SGI have to be diagnosed correctly of the subtype injury for selecting the conservative or the surgical way of treatment. Some of the athletes having both SH and AP, in these combined treatments of Endoscopy with muscles sport rehabilitation has to be tailored according to the severity of the injuries. If the right treatment is selected the results are excellent.