Three-Arm Registry-Based Comparison of Trans-Inguinal-Pre-Peritoneal, Laparoscopic, and Lichtenstein Techniques for Scrotal Hernia Repair
BackgroundStudies on minimal invasive open preperitoneal techniques performed in scrotal hernia repair are very scarce.MethodsWe conducted a comparative study based on the prospectively collected data of the “Club-Hernie.” A scrotal hernia was defined as an inguinal hernia which has descended into a...
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Frontiers Media S.A.
2025-07-01
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| Series: | Journal of Abdominal Wall Surgery |
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| author | J. F. Gillion M. Soler A. Mettoudi A. Lamblin A. C. Couchard O. Oberlin J. P. Cossa N. Maillot F. Jurczak The Club-Hernie Members |
| author_facet | J. F. Gillion M. Soler A. Mettoudi A. Lamblin A. C. Couchard O. Oberlin J. P. Cossa N. Maillot F. Jurczak The Club-Hernie Members |
| author_sort | J. F. Gillion |
| collection | DOAJ |
| description | BackgroundStudies on minimal invasive open preperitoneal techniques performed in scrotal hernia repair are very scarce.MethodsWe conducted a comparative study based on the prospectively collected data of the “Club-Hernie.” A scrotal hernia was defined as an inguinal hernia which has descended into and causes any distortion of the scrotum. Giant inguinal hernias were not included.ResultsA total of 3,043 scrotal hernias repairs, performed from 01/09/2011 to 30/04/2023, met the inclusion criteria. The late results of 395 Trans-Inguinal-Pre-Peritoneal (TIPP/MOPP), compared with those of 1038 Lichtenstein and those of 1610 laparoscopic (TEP/TAPP) repairs were globally similar. At a median follow-up of 2 years, no significant difference was found between the three groups regarding the rate of identified recurrences (0.6% vs. 0.6% vs. 0.7%; p=0.9191; p=0.7435) and the prevalence of severe CPIP (0.6% vs. 0.4% vs. 0.7%; p=0.6772; p=0.7300, respectively for TIPP, Lichtenstein and TEP/TAPP). Each technique, though, showed some benefits and drawbacks. Laparoscopic repairs, used in this series in less complex patients (lower number of ASA 3-4 patients and/or patients on anticoagulants) and hernias (lower rates of L3/M3 defects), provided a better nerve preservation (nerve resection /= III) postoperative complications and a high rate of day surgery (69.9%). The hernia sac was completely resected in 64% of cases without injury of the spermatic cord nor need for a unilateral orchidectomy. Probably due to preoperative tailoring, the Lichtenstein group significantly collected many of the most complex patients (ASA3-4: 31.8%; anticoagulant therapy: 23.4%) and the most symptomatic hernias (severe preoperative pain: 17.5%). Lichtenstein was not only a default technique but also a fallback procedure: Fifteen (40.5%) of the 37 conversions occurring in laparoscopic or TIPP techniques ended up in a Lichtenstein technique.ConclusionThis study shows that TIPP is feasible, safe and effective in scrotal hernias, providing results close to those of laparoscopic techniques. Thus, TIPP appears as a valid alternative when the aim is to elect both a preperitoneal repair and a minimal invasive open route. Having the choice of effective techniques may help in tailoring the treatment of these so particular types of groin hernias. |
| format | Article |
| id | doaj-art-b65f094fa6b643bcbb31b7e096ea7832 |
| institution | Kabale University |
| issn | 2813-2092 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Journal of Abdominal Wall Surgery |
| spelling | doaj-art-b65f094fa6b643bcbb31b7e096ea78322025-08-20T03:58:41ZengFrontiers Media S.A.Journal of Abdominal Wall Surgery2813-20922025-07-01410.3389/jaws.2025.1399313993Three-Arm Registry-Based Comparison of Trans-Inguinal-Pre-Peritoneal, Laparoscopic, and Lichtenstein Techniques for Scrotal Hernia RepairJ. F. Gillion0M. Soler1A. Mettoudi2A. Lamblin3A. C. Couchard4O. Oberlin5J. P. Cossa6N. Maillot7F. Jurczak8The Club-Hernie MembersDepartment of General Surgery, Ramsay Sante Hôpital Privé d’Antony, AntonyFranceDepartment of General Surgery, Polyclinique Saint Jean, Cagnes-sur-Mer, FranceDepartment of General Surgery, Centre Hospitalo-Universitaire de Nice, Nice, FranceDepartment of General Surgery, Hôpital Privé La Louvière, Lille, FranceDepartment of General Surgery, Ramsay Sante Hôpital Privé d’Antony, AntonyFranceDepartment of General Surgery, Clinique Turin, Paris, FranceDepartment of General Surgery, CMC Bizet, Paris, FranceDepartment of General Surgery, Clinique du Parc, Cholet, FranceDepartment of General Surgery, Clinique Mutualiste, Saint Nazaire, FranceBackgroundStudies on minimal invasive open preperitoneal techniques performed in scrotal hernia repair are very scarce.MethodsWe conducted a comparative study based on the prospectively collected data of the “Club-Hernie.” A scrotal hernia was defined as an inguinal hernia which has descended into and causes any distortion of the scrotum. Giant inguinal hernias were not included.ResultsA total of 3,043 scrotal hernias repairs, performed from 01/09/2011 to 30/04/2023, met the inclusion criteria. The late results of 395 Trans-Inguinal-Pre-Peritoneal (TIPP/MOPP), compared with those of 1038 Lichtenstein and those of 1610 laparoscopic (TEP/TAPP) repairs were globally similar. At a median follow-up of 2 years, no significant difference was found between the three groups regarding the rate of identified recurrences (0.6% vs. 0.6% vs. 0.7%; p=0.9191; p=0.7435) and the prevalence of severe CPIP (0.6% vs. 0.4% vs. 0.7%; p=0.6772; p=0.7300, respectively for TIPP, Lichtenstein and TEP/TAPP). Each technique, though, showed some benefits and drawbacks. Laparoscopic repairs, used in this series in less complex patients (lower number of ASA 3-4 patients and/or patients on anticoagulants) and hernias (lower rates of L3/M3 defects), provided a better nerve preservation (nerve resection /= III) postoperative complications and a high rate of day surgery (69.9%). The hernia sac was completely resected in 64% of cases without injury of the spermatic cord nor need for a unilateral orchidectomy. Probably due to preoperative tailoring, the Lichtenstein group significantly collected many of the most complex patients (ASA3-4: 31.8%; anticoagulant therapy: 23.4%) and the most symptomatic hernias (severe preoperative pain: 17.5%). Lichtenstein was not only a default technique but also a fallback procedure: Fifteen (40.5%) of the 37 conversions occurring in laparoscopic or TIPP techniques ended up in a Lichtenstein technique.ConclusionThis study shows that TIPP is feasible, safe and effective in scrotal hernias, providing results close to those of laparoscopic techniques. Thus, TIPP appears as a valid alternative when the aim is to elect both a preperitoneal repair and a minimal invasive open route. Having the choice of effective techniques may help in tailoring the treatment of these so particular types of groin hernias.https://www.frontierspartnerships.org/articles/10.3389/jaws.2025.13993/fullgroin hernia repairminimal invasive open preperitoneal repairscrotal herniaregistry-based comparative studytransinguinal preperitoneal technique |
| spellingShingle | J. F. Gillion M. Soler A. Mettoudi A. Lamblin A. C. Couchard O. Oberlin J. P. Cossa N. Maillot F. Jurczak The Club-Hernie Members Three-Arm Registry-Based Comparison of Trans-Inguinal-Pre-Peritoneal, Laparoscopic, and Lichtenstein Techniques for Scrotal Hernia Repair Journal of Abdominal Wall Surgery groin hernia repair minimal invasive open preperitoneal repair scrotal hernia registry-based comparative study transinguinal preperitoneal technique |
| title | Three-Arm Registry-Based Comparison of Trans-Inguinal-Pre-Peritoneal, Laparoscopic, and Lichtenstein Techniques for Scrotal Hernia Repair |
| title_full | Three-Arm Registry-Based Comparison of Trans-Inguinal-Pre-Peritoneal, Laparoscopic, and Lichtenstein Techniques for Scrotal Hernia Repair |
| title_fullStr | Three-Arm Registry-Based Comparison of Trans-Inguinal-Pre-Peritoneal, Laparoscopic, and Lichtenstein Techniques for Scrotal Hernia Repair |
| title_full_unstemmed | Three-Arm Registry-Based Comparison of Trans-Inguinal-Pre-Peritoneal, Laparoscopic, and Lichtenstein Techniques for Scrotal Hernia Repair |
| title_short | Three-Arm Registry-Based Comparison of Trans-Inguinal-Pre-Peritoneal, Laparoscopic, and Lichtenstein Techniques for Scrotal Hernia Repair |
| title_sort | three arm registry based comparison of trans inguinal pre peritoneal laparoscopic and lichtenstein techniques for scrotal hernia repair |
| topic | groin hernia repair minimal invasive open preperitoneal repair scrotal hernia registry-based comparative study transinguinal preperitoneal technique |
| url | https://www.frontierspartnerships.org/articles/10.3389/jaws.2025.13993/full |
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