Purpose Results of the most commonly used inguinal hernia repair techniques often originate from expert centers or from randomized controlled studies. In this study, we portray daily-practice results of a high-volume, regional surgical group in the Netherlands, comparing TREPP (open (posterior) transrectus sheath pre-peritoneal) with Lichtenstein (open anterior) and TEP (endoscopic (posterior) totally extraperitoneal). We hypothesize that the TREPP shows more favorable outcome compared to the current gold standard procedures: TEP and Lichtenstein. Methods Between January 2016 and December 2018, 3285 consecutive patients underwent surgical treatment and were included for analysis. The outcome measures were postoperative pain, recurrence rate and other surgical complications. Propensity-score matching was used to address potential selection bias. Results After propensity-score matching, there was no statistically significant difference in postoperative pain in the TREPP group compared to the Lichtenstein group (TREPP 7.3% versus Lichtenstein 6.3%; p = 0.67) nor in TREPP compared to TEP (TREPP 7.4% versus TEP 4.1%; p = 0.064). There was no statistically significant difference in recurrences in the TREPP group compared to Lichtenstein (3.8% vs 2.5%; p = 0.42), nor in the TREPP versus TEP comparison (3.9% vs 2.8%; p = 0.55) Conclusion This study compares TREPP with Lichtenstein and TEP in the presence of postoperative pain, recurrences and other adverse outcomes. After propensity-score matching, no statistically significant difference in postoperative pain or recurrences remained between either TREPP compared to Lichtenstein, or TREPP compared to TEP. Based on these results, TREPP, Lichtenstein and TEP showed comparable results in postoperative pain, recurrences and other surgical site complications.

Duodenal diverticula are relatively frequent but complications are uncommon. The mortality rate of perforated duodenal diverticulitis is high, and its management is controversial. We report three patients with a perforated duodenal diverticulitis who were successfully treated with conservative antibiotic therapy. The clinical presentation in all three patients was acute onset of pain in the upper abdomen. In all cases, ultrasound showed no abnormalities, but computed tomography revealed the correct diagnosis. All three were treated with broad-spectrum antibiotics and total parenteral nutrition. They recovered clinically and laboratory findings normalized. During follow-up visit, all patients were asymptomatic. This study contributes another three patients to the small number of successful conservatively treated cases of perforated duodenal diverticulitis described in literature. We suggest that in patients in good condition with no septic signs, conservative treatment with close clinical follow-up should be the treatment of choice.