DOI: http://dx.doi.org/10.18203/2349-2902.isj20221142

A clinical study of trans-rectus sheath extrapreperitoneal procedure and Gilbert’s repair in the treatment of groin hernia

Nida Shafiq, Shaukat Jeelani, Umer Mushtaq, Tauqeer A. Mir

Abstract


Background: The focus to improve surgical technique has changed from recurrence to chronic postoperative inguinal pain (CPIP). Nerve injury or stretching due to surgical approach or mesh fixation led to CPIP. Transrectus sheath preperitoneal procedure (TREPP) is a new open technique in which the mesh is placed preperitoneally via medial approach. The goal of this study was to evaluate and compare the results of TREPP with another open anterior approach- Gilbert’s repair which also doesn’t need mesh fixation; in view of operative time, duration of hospital stay, CPIP, recurrence and cost effectiveness.

Methods: Between November 2013 and October 2015, an observational clinical study of TREPP and Gilbert’s repair in the treatment of groin hernia was conducted in the department of surgery, SMHS Hospital. Patients were enrolled after detailed history, clinical examination, all baseline investigations.

Results: A total of 40 patients above 18 years of age with primary unilateral inguinal hernia were operated: 20 with TREPP and remaining 20 with Gilbert’s technique. Out of those who underwent TREPP 75% had indirect type and 25% had direct type hernia. Similarly, out of those who underwent Gilbert’s repair, 65% had indirect type and 35% had direct hernia. Operative time was significantly lower in TREPP with mean of 58.6±11.47 minutes in comparison to 68.4±9.54 minutes in Gilbert’s repair. Also, the mean hospital stay was 21.2±3.69 hours in TREPP whereas it was 31.2±6.03 hours in Gilbert’s repair.

Conclusions: TREPP is a more feasible new technique for inguinal hernia repair with better results in terms of CPIP especially. It is more promising because of the complete preperitoneal view, the short learning curve, and the stay-away-from-the-nerves principle thereby offering better outcome and patient satisfaction.

 


Keywords


Groin hernia, TREPP, Gilbert's repair, Mesh

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References


Townsend CM, Beauchamp RD, Evers BM. Mattox KL. Sabiston textbook of surgery. 19th edition. Elsevier. 2021.

Zinner MJ, Ashley SW. Maingot’s Abdominal Operations. 11th edition. McGraw-Hill Professional. 2006.

AmFam, Bax T, Sheppard BC, Cross RA. Surgical options in the management of groin hernias. Physician. 1999;59(1).

Wantz GE. Abdominal wall hernias. In: Schwartz SI, editor. Principles of surgery. 7th Edition. New York, NY: Mc Graw Hill. 1999;1585-611.

Sherman V, Macho J.R, Brunicardi F.C. Inguinal Hernias. In: Schwartz’s Principles of Surgery. 9th Edition. New York, NY: Mc Graw Hill. 2010; 1330-1.

Groin Hernias. Surgical-Tutor.Org. Available at: http;//www.surgicaltutor.org.uk/specialities/general/hernias.htm. Accessed on 15 December 2021.

Kocijan R, Sandberg S, Chan YW, Hollinsky C. Anatomical changes after inguinal hernia treatment: a reason for chronic pain and recurrent hernia? Surg Endosc. 2010;24(2):395-9.

Beattie GC, Rumar S, Nixon SJ. Laparoscopic total extraperitoneal hernia repair: mesh fixation is unnecessary. J Laparoendosc Adv Surg. 2000;10:71-3.

Kumar S, Wilson RG, Nixon SJ, Macintyre IMC. Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg. 2002;89:1476-9.

Koning GG, Andeweg CS, Keus F, Tilburg MWA, Laarhoven CJHM, Akkersdijk WL. The transrectus sheath preperitoneal mesh repair for inguinal hernia: technique, rationale. Springer. 2012;16:295-9.

Lange JFM, Lange MM. Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) for Inguinal Hernia: The First 1000 patients. World J Surg. 2014;38:1922-8.

Jenkins JT, O’Dwyer PJ. Inguinal hernias. BMJ. 2008;336(7638):269-72.

Zieren J, Hoksch B, Wenger FA, Opitz I, Müller JM. Inguinal hernia repair in the new millennium: plug and patch repair with local anesthesia. World J Surg. 2001;25(2):138-41.

Huang CS, Huang CC, Lien HH. Prolene hernia system compared with mesh plug technique: a prospective study of short- to mid-term outcomes in primary groin hernia repair. Springer. 2005;9:167-71.

Benizri EI, Rahili A. Open inguinal hernia repair by plug and patch: the value of fibrin sealant fixation. Springer. 2006;10:389-94.