Endoscopic Totally Extraperitoneal Release and Reinforce (TEP-RRT) With Structured Rehabilitation Program for Sportsman’s Hernia and Athletic Pubalgia: Surgical Technique and 9-Year Clinical Series of 461 Athletes

OBJECTIVE: To describe a refined endoscopic Totally Extraperitoneal Release & Reinforce (TEP-RRT) technique for sportsman's hernia and athletic pubalgia (SH/AP) with structured rehabilitation program and to present descriptive long-term results from a nine-year clinical series. METHODS: Between January 2016 and April 2024, a consecutive series of 461 athletes with chronic SH/AP grade 4 to 5 underwent bilateral TEP-RRT by a single surgeon after failure of conservative treatment. The technique involves endoscopic extraperitoneal access, meticulous release of pubic bone (PB) complex adhesions and inflamed inguinal ligament (IL) responsible for neural entrapment, followed by pre-peritoneal reinforcement with a mid-weight mesh. A standardized postoperative structured rehabilitation program (PSRP) was initiated seven days postoperatively. Nine years long-term outcomes were assessed retrospectively using a standardized telephone survey conducted between September 2024 and March 2025. RESULTS: All 461 athletes (447 primary cases and 14 revision cases following failed SH/AP surgery performed at other centers) completed a survey-based postoperative follow-up, ranging from 6 months to 9 years. Overall, 98.5% (454/461) returned to sports activity and remained active, 75% resumed activity within 8 weeks, including all revision cases. No recurrences were reported during the follow-up period. Complications were infrequent (1.5%). CONCLUSIONS: TEP-RRT combined with a PSRP is a feasible, safe, and durable technique for primary and revision SH/AP cases.