Open preperitoneal mesh repair for inguinal hernia – new evidence, old arguments

In the recent updated guidelines for inguinal hernias by the European Hernia Society, the open preperitoneal mesh techniques are considered to achieve comparable results in terms of recurrence rate compared to the Lichtenstein technique. On the other hand there is almost no evidence to compare results between various open preperitoneal techniques. Regarding the surgical procedure favourable results have been observed in terms of operating time, acute and chronic postoperative pain and return to work compared to the Lichtenstein repair. Again, very limited evidence compares open and laparoscopic preperitoneal approaches.

Open techniques like the Transinguinal preperitoneal approach (TIPP) or the transrectus extraperitoneal approach (TREPP) are scarcely described in the current literature, while benefits seem clear for those surgeons that regularly use them. Especially, longterm follow-up data, the use of this technique for recurrent inguinal hernias and the experience with recurrences after these types of procedures are limited and fuel the discussion about the pros and cons of these procedures.

Submission topics include the following:

- Results after open preperitoneal mesh repair
- Results after open versus laparoscopic preperitoneal repair
- Comparative studies between different open preperitoneal mesh techniques
- Benefits of the TIPP repair
- Downsides for open preperitoneal repairs
- How to perform a good TREPP or TIPP repair
- Chronic pain after open preperitoneal mesh repair
- TIPP for females: a good idea?
- Registry data Herniamed
- Longterm outcome after open preperitoneal mesh repairs
- Patient perspectives and QoL after open preperitoneal mesh repairs
- How to approach a recurrent hernia after TIPP or after TREPP?
- Open preperitoneal mesh repair for scrotal hernias
- Open preperitoneal mesh repair for recurrent inguinal hernia’s after Lichtenstein or laparoscopic repair

Keywords: preperitoneal, inguinal hernia, open surgery, mesh, transrectus approach, transinguinal approach