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. 2021 Oct;25(5):1265-1270.
doi: 10.1007/s10029-020-02291-7. Epub 2020 Oct 16.

Transrectus sheath pre-peritoneal (TREPP) procedure versus totally extraperitoneal (TEP) procedure and Lichtenstein technique: a propensity-score-matched analysis in Dutch high-volume regional hospitals

T L R Zwols  1   2 , N Slagter  3 , N J G M Veeger  4 , M J W Möllers  5 , D A Hess  6 , E Jutte  3 , H T Brandsma  6 , P H J M Veldman  7 , G G Koning  8 , H H Eker  3 , J P E N Pierie  3   9   10
Affiliations

Transrectus sheath pre-peritoneal (TREPP) procedure versus totally extraperitoneal (TEP) procedure and Lichtenstein technique: a propensity-score-matched analysis in Dutch high-volume regional hospitals

T L R Zwols et al. Hernia. 2021 Oct.

Abstract

Purpose: Results of the most commonly used inguinal hernia repair techniques often originate from expert centers or from randomized controlled studies. In this study, we portray daily-practice results of a high-volume, regional surgical group in the Netherlands, comparing TREPP (open (posterior) transrectus sheath pre-peritoneal) with Lichtenstein (open anterior) and TEP (endoscopic (posterior) totally extraperitoneal). We hypothesize that the TREPP shows more favorable outcome compared to the current gold standard procedures: TEP and Lichtenstein.

Methods: Between January 2016 and December 2018, 3285 consecutive patients underwent surgical treatment and were included for analysis. The outcome measures were postoperative pain, recurrence rate and other surgical complications. Propensity-score matching was used to address potential selection bias.

Results: After propensity-score matching, there was no statistically significant difference in postoperative pain in the TREPP group compared to the Lichtenstein group (TREPP 7.3% versus Lichtenstein 6.3%; p = 0.67) nor in TREPP compared to TEP (TREPP 7.4% versus TEP 4.1%; p = 0.064). There was no statistically significant difference in recurrences in the TREPP group compared to Lichtenstein (3.8% vs 2.5%; p = 0.42), nor in the TREPP versus TEP comparison (3.9% vs 2.8%; p = 0.55) CONCLUSION: This study compares TREPP with Lichtenstein and TEP in the presence of postoperative pain, recurrences and other adverse outcomes. After propensity-score matching, no statistically significant difference in postoperative pain or recurrences remained between either TREPP compared to Lichtenstein, or TREPP compared to TEP. Based on these results, TREPP, Lichtenstein and TEP showed comparable results in postoperative pain, recurrences and other surgical site complications.

Keywords: Groin hernia; Inguinal hernia repair; Lichtenstein; Open preperitoneal; TEP; TREPP.

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Conflict of interest statement

None of the authors have conflicts of interests.

Figures

Fig. 1
Fig. 1
Flowchart of total inguinal hernia repairs within the selected timeframe
See this image and copyright information in PMC

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References

    1. HerniaSurge Group International guidelines for groin hernia management. Hernia. 2018;22:1–165. doi: 10.1007/s10029-017-1668-x. - DOI - PMC - PubMed
    1. Statline, Centraal Bureau voor de Statistiek - https://opendata.cbs.nl/statline/#/CBS/nl/dataset/80386ned/table?ts=1555..., (2014). Accessed 12 Apr 2019
    1. Fitzgibbons RJ, Jr, Giobbie-Hurder A, Gibbs JO, Dunlop DD, Reda DJ, McCarthy M, Jr, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA. 2006;295:285–292. doi: 10.1001/jama.295.3.285. - DOI - PubMed
    1. Schroeder AD, Tubre DJ, Fitzgibbons RJ., Jr Watchful waiting for inguinal hernia. Adv Surg. 2019;53:293–303. doi: 10.1016/j.yasu.2019.04.014. - DOI - PubMed
    1. Langeveld HR, van’t Riet M, Weidema WF, Stassen LP, Steyerberg EW, Lange J, et al. Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg. 2010;251:819–824. doi: 10.1097/SLA.0b013e3181d96c32. - DOI - PubMed

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