TREPP – a relatively new preperitoneal mesh repair method

[Good intentions]

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.

Why is Dr. Reinhorn never mentioned on this forum?

[Good intentions]

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]

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).
…”

[Watchful]

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.

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