The Marsh Modification for

Groin Reconstruction

Gilmore’s Groin updated

Simon Marsh MA MD FRCS Eng FRCS Gen-Surg

Surgical Director 108 Harley Street

New and Improved

• Rehabilitation

• Anaesthesia and pain control

• Surgical technique

RehabilitationRehabilitation

Traditional 4 week program

Week 1: walk 4 x day

Week 2: jog --- running adductor exercises

Week 3: start sprinting cycling

Week 4: kicking twist & turn

Week 5: play

PLAY

RehabilitationRehabilitation

4 Stages:

Summary:

Stage 1: MobilityStage 2: FlexibilityStage 3: StrengthStage 4: Sport Specific

Different requirements for amateurs and professionals

Stage 1Stage 1

Mobility

Straight line activitiesAvoid abdominal straining

Treadmill jogging/runningFront crawl swimmingCross training

Stage 2Stage 2

Flexibility

Body weight movements

LungesSide lungesPartial squatsHip flexion and extensionBegin ball work

Stage 3Stage 3

Strength

Increase intensity of core stability workChange of direction at speed

Box drills Cutting drillsFigure of eight routines

Stage 4Stage 4

Sport specific training

RehabilitationRehabilitation

Professional: 3-4 weeks

Amateur: 6-8 weeks

Accurate Ultrasound Accurate Ultrasound GuidedGuidedIlioinguinal nerve blockIlioinguinal nerve block

Pubic bone Stress InjuryPubic bone Stress Injury

Aka: Osteitis Pubis

Wound without sutures

Graph of wound strength against time

Wound without sutures

Graph of wound strength against time

Wound with

Dissolvable sutures

Wound without sutures

Graph of wound strength against time

Wound with

Dissolvable sutures

Wound withPermanent sutures

Surgical TechniqueSurgical Technique

• Inguinal ligament tenolysis

• Plication of posterior wall

• Resuturing conjoint tendon to inguinal ligament

• 2/0 prolene darn (permanent)

• Closure of Scarpa’s fascia

Groin ReconstructionGroin Reconstruction

• Marsh Modification

– Builds on traditional repair

– Incorporates the best from around the world

– Includes inguinal ligament tenolysis and less tissue trauma

– Specific anaesthesia– Individualised

rehabilitation

• Traditional repair

– Based on established anatomical

and physiological principles

– 30 years experience

– Established success

http://www.108harleystreet.co.uk/