First Evaluation of the TREPP Procedure for Inguinoscrotal Hernia Repair: A Step-Up Study.

Abstract

<h4>Background</h4>Inguinoscrotal hernias, classified as large indirect hernias (L3) within the European Hernia Society classification, pose unique surgical challenges. The TransREctus sheath Pre-Peritoneal (TREPP) repair is an extraperitoneal approach that may offer advantages over conventional techniques, such as reduced intra-abdominal complications and the potential to avoid general anesthesia. However, its use in inguinoscrotal hernia repair was to date not explored.<h4>Methods</h4>This retrospective study analyzed consecutive patients who underwent TREPP repair for scrotal hernia between January 2021 and December 2023. Patient data were extracted from an electronic hospital database, and follow-up was conducted via patient records and the PINQ-PHONE questionnaire. Primary outcomes included recurrence rates, postoperative pain, and surgical complications.<h4>Results</h4>A total of 33 primary scrotal hernia cases were analyzed. The majority of procedures (87.9%) were performed under spinal anesthesia, with a median operative time of 23 min for unilateral cases. No recurrences were observed within the follow-up period of at least 1 year. One patient (3.0%) reported persistent postoperative pain, successfully managed with local anesthetic and corticosteroid injections. Two patients (6.1%) developed infections, treated conservatively with antibiotics. Other minor complications included postoperative hematoma (9.1%), seroma (9.1%) or urinary retention (6.1%), all managed without surgical intervention.<h4>Conclusion</h4>The TREPP procedure in experienced hands appears to be a feasible and safe alternative for scrotal hernia repair, demonstrating low complication rates requiring reintervention and no recurrences in this cohort. Despite the study's retrospective design and small sample size, this first results step-up study support further investigation into the role of TREPP repair in inguinoscrotal hernia management. Larger, prospective studies are needed to confirm its long-term efficacy.