The Marsh Modification of the Gilmore Technique Simon Marsh MA MD FRCS Surgical Director.
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The Marsh Modification of the Gilmore Technique Simon Marsh MA MD FRCS Surgical Director
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Transcript of The Marsh Modification of the Gilmore Technique Simon Marsh MA MD FRCS Surgical Director.
The Marsh Modificationof the
Gilmore Technique
Simon Marsh MA MD FRCS
Surgical Director
Challenges
•Maintain high success rate
•Single operation
•Get back and stay back
•Rapid return to full activity
Surgery
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
• Skin closure
Groin 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
Rehabilitation
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
Rehabilitation
4 Stages:
Summary:
Stage 1: MobilityStage 2: FlexibilityStage 3: StrengthStage 4: Sport Specific
Different requirements for amateurs and professionals
Stage 1: MobilityStraight line activities
Avoid abdominal straining
Treadmill jogging/runningTreadmill jogging/running
Front crawl swimmingFront crawl swimming
Cross trainingCross training
Stage 2: FlexibilityBody weight movements
LungesLunges
Side lungesSide lunges
Partial squatsPartial squats Hip flexion and extensionHip flexion and extension
Stage 3: StrengthIncrease intensity of core stability work
Change of direction at speed
Box drillsBox drillsCutting drillsCutting drills
Figure of eight routines
Stage 4: Sport specific training
Rehabilitation
Professional: 3-4 weeks
Amateur: 6-8 weeks
The Team:
Patient
Surgeon Anaesthetist
Sports and Exercise Physician
PhysiotherapistSpecialist Nurses
Orthopaedic Surgeon
Some PhysiologySome Physiology
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
Definitely NOT a herniaDefinitely NOT a hernia(and re-operations)(and re-operations)
