CC BY 4.0 · Surg J (N Y) 2020; 06(02): e62-e66
DOI: 10.1055/s-0040-1705171
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Emergency TREPP for Strangulated Inguinal Hernia Repair: A Consecutive Case Series

1   Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
2   Department of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands
,
W.L. Akkersdijk
2   Department of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands
,
2   Department of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands
3   Department of Surgery, Gelderse Vallei Hospital, The Netherlands
,
C.S. Andeweg
2   Department of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands
,
J.P.E.N. Pierie
1   Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
4   Postgraduate School of Medicine, University Medical Centre Groningen, Groningen, The Netherlands
,
G.G. Koning
5   Department of Surgery, Ikazia Hospital, Rotterdam, the Netherlands
› Author Affiliations
Funding No funding was received for this study.
Further Information

Publication History

30 September 2019

03 February 2020

Publication Date:
31 March 2020 (online)

Abstract

Background Patients with strangulated inguinal hernia (SIH) require emergency surgical treatment. International guidelines do not specify the surgical technique of preference. Frequently, an open anterior approach such as the Lichtenstein technique is used.

The TransREctus sheath Pre-Peritoneal (TREPP) technique is an alternative, open posterior approach, which has shown promising results in the elective treatment of inguinal hernias. This study aims to evaluate the feasibility and safety of the TREPP technique in the emergency setting of SIHs.

Materials and Methods After medical ethical approval was warranted, all consecutive patients, who underwent emergency TREPP (e-TREPP) at a high-volume hernia institute, were retrospectively included from 2006 up to and including 2016. Data retrieved from the electronic patient files were combined with the findings during a long-term outcome physical investigation at an outpatient department visit. e-TREPP was, prior to the start of the study, defined as TREPP performed immediately at the operation room.

Results Thirty-three patients underwent e-TREPP for SIH. Ten patients were clinically evaluated, ten patients were deceased, nine patients could not be contacted, and four patients did not or could not consent. Of the ten deceased patients, one patient died perioperatively due to massive aspiration followed by cardiac arrest. Nine patients died due to other causes. Two patients developed a recurrence after (after 13 days and 16 months respectively). Two patients were surgically treated for a wound infection (mesh removal in one). No patient reported chronic postoperative inguinal pain.

Conclusion e-TREPP in experienced hands seems feasible and safe (Level of Evidence 4) for the treatment of patients with strangulated inguinal hernia, with percentages of postoperative complications comparable to other techniques.

 
  • References

  • 1 Statline, Centraal Bureau voor de Statistiek - https://opendata.cbs.nl/statline/#/CBS/nl/dataset/80386ned/table?ts=1555317940875 , 2019/4/12 (2014).
  • 2 Mayo Clinic - Inguinal hernia - https://www.mayoclinic.org/diseases-conditions/inguinal-hernia/symptoms-causes/syc-20351547 , 2019/04/12 (2019)
  • 3 HerniaSurge Group. International guidelines for groin hernia management. Hernia 2018; 22 (01) 1-165
  • 4 Simons MP, Aufenacker T, Bay-Nielsen M. , et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009; 13 (04) 343-403
  • 5 Dahlstrand U, Wollert S, Nordin P, Sandblom G, Gunnarsson U. Emergency femoral hernia repair: a study based on a national register. Ann Surg 2009; 249 (04) 672-676
  • 6 Keus F, Wetterslev J, Gluud C, van Laarhoven CJ. Evidence at a glance: error matrix approach for overviewing available evidence. BMC Med Res Methodol 2010; 10: 90
  • 7 Akkersdijk WL, Andeweg CS, Bökkerink WJ, Lange JF, van Laarhoven CJ, Koning GG. Teaching the transrectus sheath preperitoneal mesh repair: TREPP in 9 steps. Int J Surg 2016; 30: 150-154
  • 8 Bökkerink WJ, Persoon AM, Akkersdijk WL, van Laarhoven CJ, Koning GG. The TREPP as alternative technique for recurrent inguinal hernia after Lichtenstein's repair: a consecutive case series. Int J Surg 2017; 40: 73-77
  • 9 Persoon AM, Bökkerink WJV, Akkersdijk WL, van Laarhoven CJHM, Koning GG. Case series of recurrent inguinal hernia after primary TREPP repair: re-TREPP seems feasible and safe. Int J Surg Case Rep 2018; 51: 292-295
  • 10 Heikens JT, Gooszen HG, Rovers MM, van Laarhoven CJ. Stages and evaluation of surgical innovation: a clinical example of the ileo neorectal anastomosis after ulcerative colitis and familial adenomatous polyposis. Surg Innov 2013; 20 (05) 459-465
  • 11 The Transrectus Sheath Pre-peritoneal (TREPP) Technique for Strangulated Inguinal Hernia: A Case-series - https://clinicaltrials.gov/ct2/show/NCT03935490 , 2019/5/2 (2019)
  • 12 Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 1986; 3: S1-S226
  • 13 Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler AJ, Orgill DP. ; PROCESS Group. The PROCESS 2018 statement: Updating Consensus Preferred Reporting Of CasE Series in Surgery (PROCESS) guidelines. Int J Surg 2018; 60: 279-282
  • 14 Miserez M, Alexandre JH, Campanelli G. , et al. The European Hernia Society groin hernia classification: simple and easy to remember. Hernia 2007; 11 (02) 113-116
  • 15 Pollard CA. Preliminary validity study of the pain disability index. Percept Mot Skills 1984; 59 (03) 974
  • 16 Aaronson NK, Muller M, Cohen PD. , et al. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol 1998; 51 (11) 1055-1068
  • 17 Hentati H, Dougaz W, Dziri C. Mesh repair versus non-mesh repair for strangulated inguinal hernia: systematic review with meta-analysis. World J Surg 2014; 38 (11) 2784-2790
  • 18 Bessa SS, Abdel-fattah MR, Al-Sayes IA, Korayem IT. Results of prosthetic mesh repair in the emergency management of the acutely incarcerated and/or strangulated groin hernias: a 10-year study. Hernia 2015; 19 (06) 909-914
  • 19 Tatar C, Tüzün İS, Karşıdağ T, Kızılkaya MC, Yılmaz E. Prosthetic mesh repair for incarcerated inguinal hernia. Balkan Med J 2016; 33 (04) 434-440
  • 20 Karatepe O, Adas G, Battal M. , et al. The comparison of preperitoneal and Lichtenstein repair for incarcerated groin hernias: a randomised controlled trial. Int J Surg 2008; 6 (03) 189-192
  • 21 J Liu, J Chen, Y Shen. The results of open preperitoneal prosthetic mesh repair for acutely incarcerated or strangulated inguinal hernia: a retrospective study of 146 cases. Surg Endosc 2020; 34 (01) 47-52