The transrectus sheath preperitoneal mesh repair for inguinal hernia: technique, rationale, and results of the first 50 cases

Abstract

IntroductionLaparoscopic and endoscopic hernia repair popularized the preperitoneal mesh position due to promising results concerning less chronic pain. However, considerable proportions of severe adverse events, learning curves, or added costs have to be taken into account. Therefore, open preperitoneal mesh techniques may have more advantages. The open approach to the preperitoneal space (PPS) according to transrectus sheath preperitoneal (TREPP) mesh repair is through the sheath of the rectus abdominus muscle. This technique provides an excellent view of the PPS and facilitates elective or acute hernia reduction and mesh positioning under direct vision. In concordance with the promising transinguinal preperitoneal inguinal hernia repair experiences in the literature, we investigated the feasibility of TREPP.MethodsA rationale description of the surgical technique, available level of evidence for thoughts behind technical considerations. Furthermore, a descriptive report of the clinical outcomes of our pilot case series including 50 patients undergoing the TREPP mesh repair.ResultsA consecutive group of our first 50 patients were operated with the TREPP technique. No technical problems were experienced during the development of this technique. No conversions to Lichtenstein repair were necessary. No recurrences and no chronic pain after a mean follow-up of 2 years were notable findings.ConclusionThis description of the technique shows that the TREPP mesh repair might be a promising method because of the complete preperitoneal view, the short learning curve, and the stay-away-from-the-nerves principle. The rationale of the TREPP repair is discussed in detail.

Transabdominal pre-peritoneal inguinal hernioplasty (TAPP) without mesh fixation. Initial experience in the short term.

“…La fijación atraumática omite el proceso de grapado y evita el mecanismo de lesión nerviosa directa, por lo que disminuye el riesgo de dolor posoperatorio [3][4][5][6] . Esta posibilidad ya ha sido valorada en la literatura con resultados positivos [15][16][17][18][19][20] . La segunda opción -la total ausencia de fijación-es actualmente una posibilidad muy controvertida.…”

A randomized controlled study of transinguinal pre peritoneal repair vs Lichtenstein repair for inguinal hernia

“…It can be applied to all types of primary inguinal hernia. 8,9 In TPT the average operating time is slightly longer than the Lichtenstein procedure which can be attributed to preperitoneal dissection as well as proper placement of the mesh. Complications like peritoneal breach are easily avoided by meticulous technique.…”

Study protocol for a randomized controlled trial for anterior inguinal hernia repair: transrectus sheath preperitoneal mesh repair compared to transinguinal preperitoneal procedure

“…The TREPP technique has been described [12]. To reach the preperitoneal space (PPS), a 5 cm transverse incision is made approximately 1 cm cranial to the pubic bone.…”

“…Description of the technique and results of the first 50 TREPP cases have been reported [12]. This pilot study showed promising results for TREPP.…”