Short-term follow-up of trans-rectus sheath extraperitoneal procedure versus totally extraperitoneal for the repair of unilateral inguinal hernia repair

Introduction
Inguinal hernioplasty is one of the most frequently performed surgical procedures. Laparoscopic hernia repair popularized the preperitoneal mesh position due to promising results in alleviating chronic pain. However, considerable proportions of severe adverse events, learning curves, or added costs have to be taken into account. Therefore, open preperitoneal mesh techniques may have more advantages. The trans-rectus sheath extraperitoneal procedure (TREPP) is a novel technique that was developed in 2006 combining the advantages of both the Lichtenstein technique and totally extraperitoneal (TEP). It differs from other preperitoneal techniques due to its medial approach avoiding the interference with the course of all three inguinal nerves through the lateral abdominal wall.
Patients and methods
This study recruited 100 patients, 50 were operated upon by the TREPP technique and another 50 patients were operated upon by TEP techniques. The items of comparison were conversion to another technique, postoperative pain, bleeding (intraoperative or postoperative hematoma) and surgical site infection. The late items of comparison were chronic postoperative inguinal pain and early recurrence.
Results
The mean operative time was significantly shorter for the TREPP group. Two patients among the TEP group were converted into TREPP techniques while all the patients among the TREPP group were completed successfully. There were no differences between the two groups as regards postoperative pain, hematoma, or surgical site infection. Also, chronic postoperative inguinal pain occurred in one patient out of 48 patients among the TEP group but occurred in two patients out of the 52 patients among the TREPP group. There was no single recurrence among the TREPP group (52 patients), while there were two hernia recurrences among the TEP group (two out of 48 patients, 4%).
Conclusion
There were significant advantages of TREPP over TEP: shorter operative time and significantly reduced postoperative pain with less recurrence rate. The main advantage is the ease of learning of the TREPP technique. So, we obtain better results using a simple inexpensive open technique in comparison with the laparoscopic TEP technique. The main criticism, in my mind, was the small sample size of patients and the short follow-up period.