THE IMPORTANCE OF SURGICAL TECHNIQUE IN THE REPAIR OF GROIN DISRUPTION (GILMORE’S GROIN)
The technique for repairing a groin disruption was developed by Jerry Gilmore in the early 1980s. It has stood the test of time as the definitive method of surgical repair for the condition that carries his name.
It is important to understand why we still repair the groin in this way (with some recent modifications).
A groin disruption occurs when the muscles in the groin are torn away from their usual positions. The aim of the repair is to return the muscles to their normal positions. We do not advocate the use of a mesh as placing a mesh over torn muscles means the muscles are not put back and problems may persist.
We use stitches (sutures) to put the muscles back in their normal, anatomical, positions and allow the body to naturally heal itself. With the anatomy restored function can also return to normal.
We use dissolvable sutures for all the muscles and then we use one layer of a permanent stitch. This permanent layer is, we feel, vitally important in maintaining the strength of the repair but it is a layer that is often misunderstood. It is not pulled tight and it is not used to hold one muscle to another. It acts as a scaffold to give the repair immediate strength so that rehabilitation can start as soon as the wound is comfortable.
The importance of the surgical technique and especially the importance of the permanent stitch is best understood by looking at the three graphs below.
The first graph shows how a wound regains its strength if it is left to heal on its own, without any stitches. This is the equivalent of making an incision and then just leaving it. As you can see it returns to normal strength over a period of 3-4 weeks
In the next graph you can see how the strength of the wound changes if dissolvable suture are used. In this case the sutures give the wound immediate strength; but dissolvable sutures do just that, they dissolve! So after 2 weeks or so the wound strength has fallen to the same level as if there were no sutures there at all. The danger of just using dissolvable sutures is that, although it may be possible to begin exercise quickly after surgery, by two weeks the wound is quite weak and the repair may give out causing more problems.
The final graph shows what happens if a permanent stitch is used. In this case wound strength is immediately high and this strength is maintained throughout the healing process. This means that there is much less chance of any problems during the rehabilitation and also that each individual can rehabilitate at their own rate without worrying about damaging the repair.
This technique allows the body to heal naturally whilst maintaining the strength that is fundamental to allowing rapid rehabilitation. Techniques that do not use the permanent stitch risk further problems and this can occur quite early on.