Open New Simplified Totally Extraperitoneal (ONSTEP) Technique for Inguinal Hernia Repair

  • Jacob RosenbergEmail author
  • Kristoffer Andresen


The ONSTEP technique for inguinal hernia repair was developed by two surgeons from Portugal, Lorenzo and da Costa [1]. For several years there has been a trend toward placing the mesh in the preperitoneal space rather than below the external aponeurosis as in the Lichtenstein repair. The reason for this has been reports of reduced pain after surgery, especially levels of chronic pain, with the preperitoneal mesh replacement as in laparoscopic repair [2].


  1. 1.
    Lourenço A, da Costa RS. The ONSTEP inguinal hernia repair technique: initial clinical experience of 693 patients, in two institutions. Hernia. 2013;17:357–64.CrossRefPubMedGoogle Scholar
  2. 2.
    Sevonius D, Montgomery A, Smedberg S, Sandblom G. Chronic groin pain, discomfort and physical disability after recurrent groin hernia repair: impact of anterior and posterior mesh repair. Hernia. 2016;20:43–53.CrossRefPubMedGoogle Scholar
  3. 3.
    Pélissier EP, Ngo P, Gayet B. Transinguinal preperitoneal patch (TIPP) under local anesthesia with sedation. Am Surg. 2011;77:1681–4.PubMedGoogle Scholar
  4. 4.
    Lange JF, Lange MM, Voropai DA, et al. Trans rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia: the first 1,000 patients. World J Surg. 2014;38:1922–8.PubMedGoogle Scholar
  5. 5.
    Andresen K, Burcharth J, Rosenberg J. Lichtenstein versus Onstep for inguinal hernia repair: protocol for a double-blinded randomised trial. Dan Med J. 2013;60:A4729.PubMedGoogle Scholar
  6. 6.
    Andresen K, Burcharth J, Rosenberg J. Onstep versus laparoscopy for inguinal hernia repair. A protocol for a randomized clinical trial. Dan Med J. 2015;62:A5169.PubMedGoogle Scholar
  7. 7.
    Öberg S, Andresen K, Hauge D, Rosenberg J. Recurrence mechanisms after inguinal hernia repair by the Onstep technique—a case series. Hernia. 2016;20(5):681–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Öberg S, Andresen K, Rosenberg J. How to surgically remove the permanent mesh ring after the Onstep procedure for alleviation of chronic pain following inguinal hernia repair. Case Rep Surg. 2016;2016. article ID 5209095.Google Scholar
  9. 9.
    Andresen K, Burcharth J, Rosenberg J. The initial experience of introducing the Onstep technique for inguinal hernia repair in a general surgical department. Scand J Surg. 2015;104:61–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Marinis A, Psimitis I. The open new simplified totally extra-peritoneal (ONSTEP) inguinal hernia repair: initial experience with a novel technique. Hell Cheirourgike. 2014;86:362–7.Google Scholar
  11. 11.
    Kohoutek L, Musil J, Plechâcovâ P, Gryga A. Operace tfïselné kyly technikou ONTEP [The ONSTEP inguinal hernia repair technique]. Rozhl Chir. 2015;94:152–5.PubMedGoogle Scholar
  12. 12.
    World Health Organization. International Clinical Trials Registry Platform. Accessed 21 Dec 2015.
  13. 13.
    Andresen K, Burcharth J, Fonnes S, et al. Short-term outcome after Onstep versus Lichtenstein technique for inguinal hernia repair: results from a randomized clinical trial. Hernia. 2015;19:871–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Andresen K, Burcharth J, Fonnes S, et al. Sexual dysfunction after inguinal hernia repair with Onstep versus Lichtenstein technique: a randomized clinical trial. Hernia. 2016;161(6):1690–5.Google Scholar
  15. 15.
    Rosenberg J, Andresen K, Laursen J. Team training (training at own facility) versus individual surgeon’s training (training at trainer’s facility) when implementing a new surgical technique: example from the ONSTEP inguinal hernia repair. Surg Res Pract. 2014;2014:762761.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Andresen K, Laursen J, Rosenberg J. Difficulties and problematic steps in teaching the Onstep technique for inguinal hernia repair - results from a focus group interview. Surg Res Pract. 2016;2016:4787648.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Medical Research Council Laparoscopic Groin Hernia Trial Group. Cost-utility analysis of open versus laparoscopic groin hernia repair: results from a multicentre randomized clinical trial. Br J Surg. 2001;88:653–61.CrossRefGoogle Scholar
  18. 18.
    Rosenberg J, Bisgaard T, Kehlet H, et al. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull. 2011;58:C4243.PubMedGoogle Scholar
  19. 19.
    Miserez M, Peeters E, Aufenacker T, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2014;18:151–63.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryHerlev HospitalHerlevDenmark

Personalised recommendations