Meta-analysis of the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) for inguinal hernia

Hajibandeh, Shahab; Evans, Louis; Havard, Timothy; Naguib, Nader; Helmy, Ahmed

doi:10.1007/s10029-021-02554-x

Cited by 4 publications

(1 citation statement)

References 17 publications

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“…Studies evaluating TREPP/OPP have thus far been limited, but some single-institution observational studies have shown promising outcomes [10][11][12][13]. Comparisons of TREPP to MIS TEP and open Lichtenstein approaches demonstrate no significant differences in recurrence rates, postoperative complications, or postoperative pain [5,14], and a recent meta-analysis on TREPP demonstrated low risk of recurrence, chronic pain, hematoma, and wound infection [15]. While evaluation of the quality of hernia repair has traditionally involved comparison of recurrence rates, patients themselves also measure the success of their surgery by their quality of life in recovery.…”

Section: Introductionmentioning

confidence: 99%

Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches

Reinhorn

Fullington

Agarwal

et al. 2022

Hernia

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Purpose International guidelines suggest the use of lapro-endoscopic technique for primary unilateral inguinal hernia (IHR) because of lower postoperative pain and reduction in chronic pain. It is unclear if the primary benefit is due to the minimally invasive approach, the posterior mesh position or both. Further research evaluating posterior mesh placement using open preperitoneal techniques is recommended. A potential benefit of open preperitoneal repair is the avoidance of general anesthesia, as these repairs can be performed under local anesthesia. This study compares clinical and patient-reported outcomes after unilateral laparo-endoscopic, robotic, and open posterior mesh IHRs. Methods We performed a propensity score matched analysis of patients undergoing IHR between 2012 and 2021 in the Abdominal Core Health Quality Collaborative registry. 10,409 patients underwent a unilateral IHR via a posterior approach. Hernia repairs were performed via minimally invasive surgery (MIS) which includes laparoscopic and robotic transabdominal preperitoneal (TAPP), laparoscopic totally extraperitoneal (TEP), or open transrectus preperitoneal/open preperitoneal (TREPP/OPP) approaches. Propensity score matching (PSM) utilizing nearest neighbor matching accounted for differences in baseline characteristics and possible confounding variables between groups. We matched 816 patients in the MIS cohort with 816 patients in the TREPP/OPP group. Outcomes included patient reported quality of life, hernia recurrence, and postoperative opioid use. Results Improvement was seen after TREPP/OPP as compared to MIS IHR in EuraHS at 30 days (Median(IQR) 7.0 (2.0–16.64) vs 10 (2.0–24.0); OR 0.69 [0.55–0.85]; p = 0.001) and 6 months (1.0 (0.0–4.0) vs 2.0 (0.0–4.0); OR 0.63 [0.46–85]; p = 0.002), patient-reported opioid use at 30-day follow-up (18% vs 45% OR 0.26 [0.19–0.35]; p < 0.001), and rates of surgical site occurrences (0.8% vs 4.9% OR 0.16 [0.06–0.35]; p < 0.001). There were no differences in EuraHS scores and recurrences at 1 year. Conclusions This study demonstrates a potential benefit of open posterior mesh placement over MIS repair in short-term quality of life and seroma formation with equivalent rates of hernia recurrence. Further study is needed to better understand these differences and determine the reproducibility of these findings outside of high-volume specialty centers.

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