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Open Preperitoneal Inguinal Hernia Repair, TREPP Versus TIPP in a Randomized Clinical Trial
Willem J V Bökkerink1, Giel G Koning2, Patrick W H E Vriens3
1Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
Annals of Surgery
|August 3, 2021
Summary
Both TransREctus Sheath PrePeritoneal (TREPP) and TransInguinal PrePeritoneal Technique (TIPP) offer low chronic postoperative inguinal pain (CPIP) rates after hernia repair. TREPP may be suitable with expertise, though its learning curve requires further study.
Area of Science:
- Surgical innovation in hernia repair.
- Comparative analysis of surgical techniques.
Background:
- Preperitoneal mesh placement in inguinal hernia repair is linked to reduced chronic postoperative inguinal pain (CPIP) and low recurrence.
- Two open preperitoneal techniques, TREPP and TIPP, were compared to assess CPIP incidence.
Purpose of the Study:
- To compare chronic postoperative inguinal pain (CPIP) in patients undergoing inguinal hernia repair using the TransREctus Sheath PrePeritoneal (TREPP) versus the TransInguinal PrePeritoneal Technique (TIPP).
Main Methods:
- A randomized clinical trial involving adult patients with primary unilateral inguinal hernias across four hospitals.
- Patients were randomized to either TREPP or TIPP, with outcomes including CPIP at 1 year, recurrence rates, adverse events, and quality of life.
- Follow-up assessments were conducted at 2 weeks, 6 months, and 1 year post-surgery.
Main Results:
- While pain was less frequent at 2 weeks and 6 months post-TREPP, 1-year CPIP rates at rest were comparable (1.9% for TREPP vs. 1.4% for TIPP).
- The overall recurrence rate was higher in the TREPP group (8.9%) compared to TIPP (4.6%), but this difference was not significant after accounting for a learning curve (TREPP 5.7% vs. TIPP 4.8%).
Conclusions:
- Both TREPP and TIPP demonstrate low incidences of CPIP after one year.
- The TREPP technique is a viable option for inguinal hernia repair, contingent upon surgeon expertise.
- Further evaluation of the learning curve associated with TREPP is recommended.
