1. The Marsh Modification for Groin Reconstruction
Gilmore’s Groin updated
Simon Marsh MA MD FRCS Eng FRCS Gen-Surg
Surgical Director 108 Harley Street

4. New and Improved Rehabilitation Anaesthesia and pain control
Surgical technique

5. Traditional 4 week program
Rehabilitation
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

6. Rehabilitation 4 Stages: Summary: Stage 1: Mobility
Stage 2: Flexibility
Stage 3: Strength
Stage 4: Sport Specific
Different requirements for amateurs
and professionals

7. Stage 1 Mobility Straight line activities Avoid abdominal straining
Treadmill jogging/running
Front crawl swimming
Cross training

8. Stage 2 Flexibility Body weight movements Lunges Side lunges
Partial squats
Hip flexion and extension
Begin ball work

9. Stage 3 Strength Increase intensity of core stability work
Change of direction at speed
Box drills
Cutting drills
Figure of eight routines

10. Sport specific training
Stage 4
Sport specific training

11. Rehabilitation
Professional: 3-4 weeks
Amateur: weeks

12. Accurate Ultrasound
Guided
Ilioinguinal nerve block

14. Pubic bone Stress Injury
Aka: Osteitis Pubis

15. Graph of wound strength against time
Wound without
sutures
Graph of wound strength against time

16. Graph of wound strength against time
Wound without
sutures
Graph of wound strength against time
Wound with
Dissolvable sutures

17. Graph of wound strength against time
Wound with
Permanent sutures
Wound with
Dissolvable sutures
Wound without
sutures

18. Surgical Technique
Inguinal ligament tenolysis
Plication of posterior wall
Resuturing conjoint tendon to inguinal ligament
2/0 prolene darn (permanent)
Closure of Scarpa’s fascia

19. Groin Reconstruction Traditional repair Marsh Modification
Based on established anatomical
and physiological principles
30 years experience
Established success
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