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. 2025 Jul 29:4:13993.
doi: 10.3389/jaws.2025.13993. eCollection 2025.

Three-Arm Registry-Based Comparison of Trans-Inguinal-Pre-Peritoneal, Laparoscopic, and Lichtenstein Techniques for Scrotal Hernia Repair

J F Gillion  1 , M Soler  2 , A Mettoudi  3 , A Lamblin  4 , A C Couchard  1 , O Oberlin  5 , J P Cossa  6 , N Maillot  7 , F Jurczak  8 ; Club-Hernie Members
Affiliations

Three-Arm Registry-Based Comparison of Trans-Inguinal-Pre-Peritoneal, Laparoscopic, and Lichtenstein Techniques for Scrotal Hernia Repair

J F Gillion et al. J Abdom Wall Surg. .

Abstract

Background: Studies on minimal invasive open preperitoneal techniques performed in scrotal hernia repair are very scarce.

Methods: We conducted a comparative study based on the prospectively collected data of the "Club-Hernie." A scrotal hernia was defined as an inguinal hernia which has descended into and causes any distortion of the scrotum. Giant inguinal hernias were not included.

Results: A total of 3,043 scrotal hernias repairs, performed from 01/09/2011 to 30/04/2023, met the inclusion criteria. The late results of 395 Trans-Inguinal-Pre-Peritoneal (TIPP/MOPP), compared with those of 1038 Lichtenstein and those of 1610 laparoscopic (TEP/TAPP) repairs were globally similar. At a median follow-up of 2 years, no significant difference was found between the three groups regarding the rate of identified recurrences (0.6% vs. 0.6% vs. 0.7%; p=0.9191; p=0.7435) and the prevalence of severe CPIP (0.6% vs. 0.4% vs. 0.7%; p=0.6772; p=0.7300, respectively for TIPP, Lichtenstein and TEP/TAPP). Each technique, though, showed some benefits and drawbacks. Laparoscopic repairs, used in this series in less complex patients (lower number of ASA 3-4 patients and/or patients on anticoagulants) and hernias (lower rates of L3/M3 defects), provided a better nerve preservation (nerve resection /= III) postoperative complications and a high rate of day surgery (69.9%). The hernia sac was completely resected in 64% of cases without injury of the spermatic cord nor need for a unilateral orchidectomy. Probably due to preoperative tailoring, the Lichtenstein group significantly collected many of the most complex patients (ASA3-4: 31.8%; anticoagulant therapy: 23.4%) and the most symptomatic hernias (severe preoperative pain: 17.5%). Lichtenstein was not only a default technique but also a fallback procedure: Fifteen (40.5%) of the 37 conversions occurring in laparoscopic or TIPP techniques ended up in a Lichtenstein technique.

Conclusion: This study shows that TIPP is feasible, safe and effective in scrotal hernias, providing results close to those of laparoscopic techniques. Thus, TIPP appears as a valid alternative when the aim is to elect both a preperitoneal repair and a minimal invasive open route. Having the choice of effective techniques may help in tailoring the treatment of these so particular types of groin hernias.

Keywords: groin hernia repair; minimal invasive open preperitoneal repair; registry-based comparative study; scrotal hernia; transinguinal preperitoneal technique.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Prisma flowchart. TIPP: Trans-inguinal pre-peritoneal; MOPP: minimal invasive open pre-peritoneal; Lichtenstein: Lichtenstein technique; TEP: totally extraperitoneal; TAPP: trans-abdominal pre-peritoneal.
See this image and copyright information in PMC

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