News Feed Discussions TREPP – a relatively new preperitoneal mesh repair method

  • TREPP – a relatively new preperitoneal mesh repair method

    Posted by Good intentions on August 20, 2023 at 5:24 pm

    Dr. Reinhorn joined the forum a few days ago and talked about his use of TREPP. I had heard of it recently but did not know much about it. The rationale behind it makes sense. If the same logical thinking could be applied to mesh prosthetic development, along with research funds, many of the “mesh problems” might go away.

    This thread can be a place to collect TREPP information. It seems unlikely that there are no TREPP patients that have had the typical mesh problems. But it is possible. It seems to fit somewhere between Lichtenstein and laparoscopy. It has the advantage of local anesthesia also.

    Here is what seems to be one of the earliest TREPP studies. I will link to Dr. Reinhorn’s posts also.

    https://link.springer.com/article/10.1007/s10029-011-0893-y

    The transrectus sheath preperitoneal mesh repair for inguinal hernia: technique, rationale, and results of the first 50 cases
    Original Article
    Open Access
    Published: 01 December 2011
    volume 16, pages295–299 (2012)

    G. G. Koning, C. S. Andeweg, F. Keus, M. W. A. van Tilburg, C. J. H. M. van Laarhoven & W. L. Akkersdijk
    .
    .
    Here is a thread that Chuck started, in which Dr. Reinhorn responded. He linked to some of his publications.

    https://herniatalk.com/forums/topic/why-is-dr-reinhorn-never-mentioned-on-this-forum/#post-37761

    Good intentions replied 6 months, 2 weeks ago 2 Members · 4 Replies
  • 4 Replies
  • Watchful

    Member
    August 20, 2023 at 6:29 pm

    Isn’t there an even larger area of interface between the mesh and the spermatic cord in the preperitoneal space? That’s what I’ve been told by surgeons. Not sure about differences in the nerve anatomy between the two areas in terms of what could adhere to the mesh.

  • Good intentions

    Member
    August 20, 2023 at 5:39 pm

    Here is a study that finds no statistically valid difference between several methods and TREPP. But, a person should wonder about the ability to repair any problems that do occur. For example, as seen and described in videos and surgery reports, mesh often sticks to various nerves and arteries, like the inferiors\ epigastric artery, and the material stuck to the mesh must be sacrificed in order to remove the mesh.

    The subject of hernia repair should be expanded to include the follow-on effects of problems. Any surgery is damaging but which methods leave the best field to work on if there are problems?

    https://link.springer.com/article/10.1007/s10029-020-02291-7

    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
    Original Article
    Open Access
    Published: 16 October 2020
    volume 25, pages1265–1270 (2021)

    The paper does contain a surprising weakness, considering especially when it was published. Their definition of pain is very weak and arbitrary. Almost useless.. But the fact that they did the work shows that TREPP is becoming more common.

    “…
    Outcome measures
    Patients were scheduled for regular follow-ups at the outpatient clinic at two–six weeks postoperatively. More visits were scheduled only in case of adverse events. Every outcome that was mentioned in the electronic patient file was noted in the database. For postoperative pain specifically, patients scored a “yes” if they: visited the outpatient clinic after a regular follow-up because of inguinal pain; received pain treatment or had any further pain evaluation (e.g., ultrasonography, MR-imaging, referral to pain specialist).
    …”

  • Good intentions

    Member
    August 20, 2023 at 5:28 pm

    Somewhat like the Desarda pure tissue method, its newness means that not many surgeons use it. Of course, that is a good thing overall, the world doesn’t need surgeons jumping on every new method that pops up. But, with the rationale behind it, as the results come in, it might become more popular.

    https://link.springer.com/article/10.1007/s10029-021-02554-x

    Review
    Published: 10 January 2022
    Meta-analysis of the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) for inguinal hernia
    S. Hajibandeh, S. Hajibandeh, L. A. Evans, T. J. Havard, N. N. Naguib & A. H. Helmy
    Hernia volume 26, pages989–997 (2022)

    “…
    Conclusions
    The best available evidence suggests that TREPP may be a promising technique for elective repair of inguinal hernias as indicated by low risks of recurrence, chronic pain, haematoma, and wound infection. The available evidence is limited to studies from a same country conducted by almost the same research group which may affect generalisability of the findings.
    …”

    • Good intentions

      Member
      December 26, 2023 at 3:41 pm

      Another publication about TREPP and maybe TIPP. Pre-peritoneal both. Dr. Reinhorn is the last author on the list.

      These publications seem to have an inherent conflict between promoting the topic under study and objective reporting of results. Very strange that none of the authors see the mixed messaging.

      The title states firmly that “Open preperitoneal inguinal hernia repair has superior 1-year patient-reported outcomes compared to Shouldice non-mesh repair.”

      But the conclusion seems more reality based. “Conclusion

      Our data suggest that OPP is associated with significantly better patient-reported QoL, in the first month after surgery and up to 1 year postoperatively, especially with respect to lesser pain, when compared to the Shouldice repair.”

      Also, these authors are still blending superficial concerns in the ACHQC data reporting, aesthetics, with actual performance concerns. Pain and activity restriction. Just report the individual scores. The blending is a subjective choice and waters down what many patients are really concerned about. How can the size of the scar be anywhere near as important as the other two?

      At least they are still looking for alternatives. If they could just stop trying to “win” and/or promote what they are doing. Just do the work, report the results, and suggest improvements.

      Another pay-per-view article. “Suggest”, “may”, “encourage”. A lot of maybe here.

      https://link.springer.com/article/10.1007/s10029-023-02936-3

      Hernia

      <b data-test=”article-title” data-article-title=””>Open preperitoneal inguinal hernia repair has superior 1-year patient-reported outcomes compared to Shouldice non-mesh repair

      “…

      EuraHS scores were used to estimate QoL, and further analysis on the EuraHS domains of pain, aesthetics, and activity restriction were performed between the two cohorts.

      <b data-test=”abstract-sub-heading” style=”background-color: var(–bb-content-background-color); font-family: inherit; font-size: inherit; color: var(–bb-body-text-color);”>Conclusion

      Our data suggest that OPP is associated with significantly better patient-reported QoL, in the first month after surgery and up to 1 year postoperatively, especially with respect to lesser pain, when compared to the Shouldice repair. In specialized inguinal hernia practices, open posterior mesh repairs may lead to better outcomes than non-mesh repairs. We encourage more training in both repairs to facilitate larger prospective studies and evaluation of the generalizability of these results to all surgeons performing IHR.”

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