Are "European" Scrotal Hernias Repairable With the Minimal Open Pre-Peritoneal Technique?

Minimally invasive open preperitoneal techniques are an alternative in groin hernia repair. Scrotal hernias (SH) are frequently difficult to repair laparoscopically, resulting in a significant conversion rate.

The aim of this exploratory monocentric retrospective study, based on data prospectively collected in the "Club-Hernie" registry, was to assess the feasibility, effectiveness and safety of the MOPP technique in SH repair compared with non-SH repair.

All consecutive MOPP repairs performed from 11 September 2011 to 31 December 2022 were identified in which 2005 MOPP (126 SH and 1879 non-SH) met the inclusion criteria. The results were analysed "as treated" in 125 SH vs. 1879 non-SH. No statistically significant difference was observed between these two groups in terms of age, BMI, and ASA classification. Symptomatic hernias (84% vs. 73%; p < 0.001), and lateral hernias (87.80% vs. 62.81%; p < 0.0001) were more frequent in the SH group. The mean operating time was longer (58 min vs. 39 min; p < 0.0001) in the SH group. The SH procedures were performed under general anaesthesia with a laryngeal mask in 92% of cases. All postoperative complications, except one reoperation in the non-SH group, were classified as Clavien-Dindo Grade I/II. Superficial surgical site occurrences were more frequent in the SH group (14% vs. 3%; p < 0.0001). No peri-prosthetic infections were observed. The outpatient rate was 83% vs. 94% in the SH and non-SH groups, respectively. There were four rehospitalisations in the non-SH group and none in the SH group. The postoperative pain was low and similar in the two groups, except at M1, where the mean pain was lower in the SH group (p < 0.001). A total of 113 (90%) patients in the SH group vs. 1,553 (82%) in the non-SH group were followed for 1 year or more. The number of identified recurrences and reoperations was low and did not differ between the two groups studied. In total, 98% of patients in both groups assessed their surgery as excellent or good.

This exploratory study shows that the MOPP technique is feasible and safe in scrotal hernia repair, with similar results to those observed in non-scrotal hernias. Our next step will be to compare MOPP with laparoscopic and Lichtenstein techniques in scrotal hernia repair.