Skip to main content
SpringerLink
Log in

Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) for Inguinal Hernia: The First 1,000 Patients

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Introduction

After the introduction of mesh in inguinal hernia repair, the focus to improve surgical technique has changed from recurrence to chronic postoperative inguinal pain. At present, the most common surgical techniques are the Lichtenstein hernioplasty and total extraperitoneal procedure. Both techniques have their own specific disadvantages, with regard to potential nerve damage and the necessity of general anesthesia, respectively.

Objective

The goal of this study was to evaluate the results of a new technique in which the inguinal nerves are not at risk, and in which general anesthesia is not needed: trans rectus sheath extraperitoneal procedure (TREPP).

Material and methods

Between 2006 and 2010, a total of 1,000 patients were treated for inguinal hernia with TREPP. A questionnaire concerning pain, sensibility changes, patient satisfaction, and recurrence was sent to all patients.

Results

The questionnaire was completed by 932 patients. Almost 90 % of patients had not experienced any pain since the surgical procedure; 8 % of patients reported experiencing some pain, but less than preoperatively; and 2 % of patients reported an increase in pain postoperatively. Recurrence occurred in 1 and 3 % were unsure about this. Reduced sensibility of the scar, scrotum, and upper leg was reported by 12.4, 1.4, and 1.5 %, respectively. Overall, 97.4 % of patients were satisfied with the results of the surgical procedure. The time period in which TREPP was performed was not associated with any of the outcome measures.

Conclusion

TREPP has proven to be a feasible new technique for inguinal hernia repair, with excellent results, justifying a randomized controlled trial in which TREPP should be compared with standard techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jenkins JT, O’Dwyer PJ (2008) Inguinal hernias. BMJ 336(7638):269–272

    Article  PubMed Central  PubMed  Google Scholar 

  2. Eklund AS, Montgomery AK, Rasmussen IC et al (2009) Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicentre trial with 5 year follow up. Ann Surg 249(1):33–38

    Article  PubMed  Google Scholar 

  3. McCormack K, Scott NW, Go PM et al (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev (1): CD001785

  4. Takata MC, Duh QY (2008) Laparoscopic inguinal hernia repair. Surg Clin North Am 88(1):157–178

    Article  PubMed  Google Scholar 

  5. Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM (2002) Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev (4): CD002197

  6. Kehlet H (2008) Chronic pain after groin hernia repair. Br J Surg 95:135–136

    Article  CAS  PubMed  Google Scholar 

  7. Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54

    Article  PubMed  Google Scholar 

  8. Wijsmuller AR, Lange JF, van Geldere D, Simons MP, Kleinrensink GJ, Hop WC, Jeekel J, Lange JF (2007) Surgical techniques preventing chronic pain after Lichtenstein hernia repair: state-of-the-art vs daily practice in the Netherlands. Hernia 11(2):147–151

    Article  CAS  PubMed  Google Scholar 

  9. Aasvang EK, Kehlet H (2009) The effect of mesh removal and selective neurectomy on persistent postherniotomy pain. Ann Surg 249(2):327–334

    Article  PubMed  Google Scholar 

  10. Kato Y, Yamataka A, Miyano G et al (2005) Tissue adhesives for repairing inguinal hernia: a preliminary study. J Laparoendosc Adv Surg Tech A 15(4):424–428

    Article  PubMed  Google Scholar 

  11. Hallen M, Bergenfelz A, Westerdahl J (2008) Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: long-term follow-up of a randomized controlled trial. Surgery 143(3):313–317

    Article  PubMed  Google Scholar 

  12. Tantia O, Jain M, Khanna S et al (2009) Laparoscopic repair of recurrent groin hernia: results of a prospective study. Surg Endosc 23(4):734–738

    Article  PubMed  Google Scholar 

  13. Kuhry E, van Veen RN, Langeveld HR, Steyerberg EW, Jeekel J, Bonjer HJ (2007) Open or endoscopic extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 21:161–166

    Article  CAS  PubMed  Google Scholar 

  14. Horeyseck G, Roland F, Rolfes N (1996) TAPP versus Lichtenstein. Chirurg 67(10):1036–1040

    Article  CAS  PubMed  Google Scholar 

  15. Edwards CC II, Bailey RW (2000) Laparoscopic hernia repair: the learning curve. Surg Laparosc Endosc Percutan Tech 10:15–149

    Google Scholar 

  16. Kugel RD (2003) The Kugel repair for groin hernias. Surg Clin North Am 83(5):1119–1139

    Article  PubMed  Google Scholar 

  17. Ugahary F, Simmermacher RKJ (1998) Groin hernia repair via a grid-iron incision: an alternative technique for preperitoneal mesh insertion. Hernia 2:123–125

    Article  Google Scholar 

  18. Wantz GE (1993) The technique of giant prosthetic reinforcement of the visceral sac performed through an anterior groin incision. Surg Gynecol Obstet 176(5):497–500

    CAS  PubMed  Google Scholar 

  19. Pelissier EP (2006) Inguinal hernia: preperitoneal placement of memory-ring patch by anterior approach. Hernia 10(3):248–252

    Article  CAS  PubMed  Google Scholar 

  20. Melzack R (2005) The McGill pain questionnaire; from description to measurement. Anesthesiology 103(1):199–202

    Article  PubMed  Google Scholar 

  21. Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95(1):69–76

    Article  CAS  PubMed  Google Scholar 

  22. Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WCS (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88:1122–1126

    Article  CAS  PubMed  Google Scholar 

  23. Nienhuijs SW, Boelens O, Strobbe LJA (2005) Pain after anterior hernia repair. J Am Coll Surg 200:885–889

    Article  PubMed  Google Scholar 

  24. Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Callesen T, Bech K, Kehlet H (1999) Prospective study of chronic pain after groin hernia repair. Br J Surg 86:1528–1531

    Article  CAS  PubMed  Google Scholar 

  26. Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA (1996) Cooperative hernia study: pain in the postrepair patient. Ann Surg 224:598–602

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Courtney CA, Duffy K, Serpell MG, O’Dwyer PJ (2002) Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg 89:1310–1314

    Article  CAS  PubMed  Google Scholar 

  28. Liem MSL, van der Graaf Y, van Steensel C, Boelhouwer RU, Clevers G-J, Meijer WS, Stassen LPS, Vente JP, Weidema WF, Schrijvers AJP, van Vroonhoven TJMV (1997) Comparison of conventional anterior surgery and laparoscopic surgery for inguinal hernia repair. N Engl J Med 336:1541–1547

    Article  CAS  PubMed  Google Scholar 

  29. Neumayer L, Giobbie-Hurder A, Jonasson O et al (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827

    Article  CAS  PubMed  Google Scholar 

  30. Grant AM, Scott NW, O’Dwyer PJ, on behalf of the MRC Laparoscopic Groin Hernia Trial Group (2004) Five year follow-up of a randomised trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91:1570–1574

    Article  CAS  PubMed  Google Scholar 

  31. Amid PK (2004) Lichtenstein tension-free hernioplasty: its inception, evolution and principles. Hernia 8(1):1–7

    Article  PubMed  Google Scholar 

  32. Lange JF, Wijsmuller AR, van Geldere D, Simons MP, Swart R, Oomen J, Kleinrensink GJ, Jeekel J, Lange JF (2009) Feasibillity study of three-nerve-recognizing Lichtenstein procedure for inguinal hernia. Br J Surg 96(10):1210–1214

    Article  CAS  PubMed  Google Scholar 

  33. Loos MJ, Roumen RM, Scheltinga MR (2007) Chronic sequelae of common elective groin hernia repair. Hernia 11:169–173

    Article  CAS  PubMed  Google Scholar 

  34. Ali SM, Zendejas B, Hernandez-Irrizari RC, Lohse CM, Farley DR (2013) Predictors of chronic groin discomfort after laparoscopic totally extraperitoneal inguinal hernia repair. J Am Coll Surg 217(1):27–28

    Article  Google Scholar 

  35. Vos PM, Simons MP, Luitse JS, van Geldere D, Koelemaij MJ, Obertop H (1998) Follow-up after inguinal hernia repair. Questionnaire compared with physical examination; a prospective study in 299 patients. Eur J Surg 164(7):533–536

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands

    J. F. M. Lange & R. J. Ploeg

  2. Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands

    M. M. Lange

  3. Department of Surgery, St. Jansdal Hospital, Harderwijk, The Netherlands

    D. A. Voropai, M. W. A. van Tilburg & W. L. Akkersdijk

  4. Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands

    J. P. E. N. Pierie

  5. Postgraduate School of Medicine, University Medical Centre Groningen, University Groningen, Groningen, The Netherlands

    J. P. E. N. Pierie

  6. Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK

    R. J. Ploeg

Authors
  1. J. F. M. Lange
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. M. Lange
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. A. Voropai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. W. A. van Tilburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. P. E. N. Pierie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. J. Ploeg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. W. L. Akkersdijk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. F. M. Lange.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lange, J.F.M., Lange, M.M., Voropai, D.A. et al. Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) for Inguinal Hernia: The First 1,000 Patients. World J Surg 38, 1922–1928 (2014). https://doi.org/10.1007/s00268-014-2475-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2475-5

Keywords

Search

Navigation