The Transrectus Sheath Pre-peritoneal (TREPP) Technique for Strangulated Inguinal Hernia: a Case-series

n the Sint Jansdal Hospital in Harderwijk, the Netherlands, the TREPP technique is the standard operating procedure for patients with inguinal hernia. Starting from 2006, this procedure has also been used on patients that presented with an acute strangulated inguinal hernia in the emergency department, instead of the more common Lichtenstein technique. The goal of this retrospective case series is to assess the feasibility of the TREPP technique in case of an acute strangulated inguinal hernia. Patient records from 2006 until 2016 will be used to search for patients treated for acute inguinal hernia in that period. After applying the in- and exclusion criteria, patients who are eligible for inclusion will be contacted by telephone. They will be asked if they are willing to visit the surgical outpatient department once and fill out two questionnaires. The data of these questionnaires will be analyzed and published.

Study Overview

• Status: Completed
• Conditions: Strangulated Inguinal Hernia
• Intervention / Treatment: Procedure: emergency transrectus sheath pre-peritoneal mesh repair (e-TREPP)

• Study Type: Observational
• Enrollment (Actual): 45

Contacts and Locations

Study Locations

• Netherlands
  • Gelderland
    • Harderwijk, Gelderland, Netherlands, 3844 DG
      • St Jansdal Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

From all acute inguinal hernia repairs patient records will searched for e-TREPP procedures. All patients will be asked to visit the outpatient department.

Description

Inclusion Criteria:

• Emergency surgery for suspected strangulated inguinal hernia (within 6 hours after admission)
• e-TREPP performed

Exclusion Criteria:

• No emergency surgery (for instance, surgery day after admission or later).
• No e-TREPP performed

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Only
• Time Perspectives: Retrospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

e-TREPP; Patients with strangulated inguinal hernia treated with e-TREPP

Procedure: emergency transrectus sheath pre-peritoneal mesh repair (e-TREPP); The Trans REctussheath PrePeritoneal mesh repair (TREPP) was developed in 2006 as an open preperitoneal technique to reduce CPIP. In short: a 4-5 centimeters (cm) transverse incision is made about 1 cm above the localization of the deep inguinal ring. The anterior rectus sheath is opened. After retracting the rectus muscle medially, the preperitoneal space (PPS) is bluntly dissected and a complete overview can be achieved. All possible hernia orifices can be visualized such as: a direct, indirect, pantaloon, and/or femoral hernia. A self-expandable mesh is then positioned in the PPS. Due to the "upstream principle" no mesh fixation is necessary.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chronic postoperative inguinal pain according to Visual Analog Scale	Patients will be asked to fill out the VAS on a horizontal line of 10 millimeters long. Patients will be asked to mark the point that indicated the amount of pain they experience. The distance from the left marker will be measured, with increasing distance at greater pain intensity.	From surgery date up to 12 years postoperatively
Recurrence rate	Patient electronic records will be searched for re-operations for recurrent inguinal hernia. Also, patients will be asked in the outpatient department if they received recurrence surgery or suffer new complaints.	From surgery date up to 12 years postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Short-term complications	Short term complications included: hematoma, wound infection, re-admission rate, medical complications and death. These complications will be retrospectively analyzed via the electronic patient files. They will be verified at the outpatient department.	Complications occuring from the start of the operation up to 30 days postoperative
Sexual complaints related to e-TREPP	All patients will be asked if they experienced any sexual problems related to the e-TREPP surgery.	Between >30 days postoperatively and through study completion, average 6 years

Collaborators and Investigators

• Sponsor: University Medical Center Groningen
• Collaborators: St Jansdal Hospital

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2019
• Primary Completion (Actual): July 1, 2019
• Study Completion (Actual): July 12, 2019

Study Registration Dates

• First Submitted: April 29, 2019
• First Submitted That Met QC Criteria: May 1, 2019
• First Posted (Actual): May 2, 2019

Study Record Updates

• Last Update Posted (Actual): March 26, 2020
• Last Update Submitted That Met QC Criteria: March 25, 2020
• Last Verified: March 1, 2020

More Information

Terms related to this study

• Keywords: Inguinal hernia; TREPP; Strangulated; Transrectus sheath pre-peritoneal
• Additional Relevant MeSH Terms: Pathological Conditions, Anatomical; Hernia, Abdominal; Hernia; Hernia, Inguinal
• Other Study ID Numbers: 201900143

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No