Zwols T L R, Möllers M J W, Veeger N J G M, Eker H H, Koning G G, Pierie J P E N
Department of Surgery, Isala Zwolle, Zwolle, Netherlands.
Postgraduate School of Medicine, University Medical Center Groningen, Groningen, Netherlands.
J Abdom Wall Surg. 2025 Sep 3;4:15098. doi: 10.3389/jaws.2025.15098. eCollection 2025.
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.
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.
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.
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.
腹股沟阴囊疝在欧洲疝学会分类中被归类为大型间接疝（L3），带来了独特的手术挑战。经腹直肌鞘前入路腹膜前修补术（TREPP）是一种腹膜外手术方式，可能比传统技术具有优势，如减少腹腔内并发症以及避免全身麻醉的可能性。然而，其在腹股沟阴囊疝修补术中的应用至今尚未得到探索。
这项回顾性研究分析了2021年1月至2023年12月期间接受TREPP修补术治疗阴囊疝的连续患者。患者数据从电子医院数据库中提取，并通过患者记录和PINQ - PHONE问卷进行随访。主要结局包括复发率、术后疼痛和手术并发症。
共分析了33例原发性阴囊疝病例。大多数手术（87.9%）在脊髓麻醉下进行，单侧病例的中位手术时间为23分钟。在至少1年的随访期内未观察到复发情况。1例患者（3.0%）报告术后持续疼痛，通过局部麻醉和皮质类固醇注射成功处理。2例患者（6.1%）发生感染，通过抗生素保守治疗。其他轻微并发症包括术后血肿（9.1%）、血清肿（9.1%）或尿潴留（6.1%），均未进行手术干预而得到处理。
对于有经验的术者，TREPP手术似乎是阴囊疝修补术的一种可行且安全的替代方法，在该队列中显示出低并发症率，无需再次干预且无复发情况。尽管该研究为回顾性设计且样本量较小，但这项初步结果的加强研究支持进一步探讨TREPP修补术在腹股沟阴囊疝治疗中的作用。需要更大规模的前瞻性研究来证实其长期疗效。
