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

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Abstract

Objectives

To evaluate the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) in patients undergoing elective inguinal hernia repair.

Methods

In compliance with PRISMA statement standards, electronic databases were searched to identify all studies reporting the outcomes of TREPP in patients undergoing elective inguinal hernia repair. The outcomes of interest included recurrence, chronic pain, haematoma, and wound infection. Proportion meta-analysis model was constructed to quantify the risk of postoperative complications and direct comparison meta-analysis model was constructed to compare the outcomes of TREPP and other open techniques. Random-effects modelling was applied to calculate pooled outcome data.

Results

Seven studies enrolling 1891 patients undergoing TREPP were included. The mean operative time was 26 min (95% CI 15–36). Pooled analyses showed that TREPP was associated with 3.00% (95% CI 1.00–6.00%) risk of recurrence, 3.00% (95% CI 2.00–6.00%) risk of chronic pain, 8.00% (95% CI 0.00–20.00%) risk of haematoma, and 3.00% (95% CI 0.00–6.00%) risk of wound infection. The results remained consistent through subgroup analysis of patients with primary hernias and those with recurrent hernias. Analysis of a limited number of comparative studies showed no difference between TREPP and Lichtenstein technique in terms of recurrence (OR 1.57, P = 0.26) and chronic pain (OR 1.16, P = 0.59).

Conclusions

The best available evidence suggests that TREPP may be a promising technique for elective repair of inguinal hernias as indicated by low risks of recurrence, chronic pain, haematoma, and wound infection. The available evidence is limited to studies from a same country conducted by almost the same research group which may affect generalisability of the findings. Moreover, there is a lack of comparative evidence on outcomes of TREPP versus other techniques highlighting a need for high-quality randomised controlled trials for definite conclusions. Although the available evidence is not adequate for definite conclusions, the results of current study can be used for sample size calculation and power analysis in future trials.

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Authors and Affiliations

Authors

Contributions

Conception and design: SH, AH; data collection: SH, SH, LE; analysis and interpretation: all authors; writing the article: all authors; critical revision of the article: all authors; final approval of the article: all authors; statistical analysis: SH, SH.

Corresponding author

Correspondence to S. Hajibandeh.

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Conflict of interest

All authors declare no conflict of interest.

Ethical approval

Considering the nature of this study, ethical approval was not required.

Human and animal rights

This study is a systematic review with meta-analysis of outcomes which does not include research directly involving human or animal participation.

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Considering the nature of this study, informed consent was not required.

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Supplementary file1 (DOCX 98 KB)

Appendix 1

Appendix 1

Search No

Search strategy

#1

Ingoinal hernia: TI,AB,KW

#2

MeSH descriptor: [inguinal hernia] explode all trees

#3

#1 OR #2

#4

TREPP: TI,AB,KW

#5

Trans rectus: TI,AB,KW

#6

Trans-rectus: TI,AB,KW

#7

Extra-peritoneal: TI,AB,KW

#8

Extra peritoneal: TI,AB,KW

#9

Trans rectus sheath extra-peritoneal procedure: TI,AB,KW

#10

#4 OR #5 OR #6 OR #7 OR #8 OR #9

#11

#3 AND #10

  1. † This search strategy was adopted for following databases: CINAHL, EMBASE, MEDLINE, CENTRAL, and Scopus.

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Hajibandeh, S., Hajibandeh, S., Evans, L.A. et al. Meta-analysis of the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) for inguinal hernia. Hernia 26, 989–997 (2022). https://doi.org/10.1007/s10029-021-02554-x

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