title: Teaching the transrectus sheath preperiotneal mesh repair: TREPP in 9 steps.
abstract: BACKGROUND
  The preperitoneal mesh position seems preferable to reduce the number of patients with postoperative chronic pain after inguinal hernia surgery. The transrectus sheath preperitoneal mesh repair (TREPP) is gaining popularity. Teaching a new technique requires a standardized approach to achieve an optimal learning curve. The aim of this paper was to provide a step-by-step teaching module for hernia surgeons learning the TREPP.
  
  
  METHODS
  Literature was critically reviewed and the forthcoming nine surgical steps of the new TREPP technique and its rationale are described in this article. The TREPP hernia repair technique is illustrated with an online education video and three photos of the anatomical landmarks and the proposed mesh position of TREPP.
  
  
  RESULTS
  The nine steps of TREPP are described extensively and the critical steps are presented in a standardized way for surgical educational purposes. Also the rationale and technical considerations of inguinal hernia experts are presented.
  
  
  CONCLUSIONS
  TREPP may be a promising technique for groin hernia surgery. To date there have been no major complications with the TREPP repair which is currently the subject of a RCT. The learning curve of TREPP is being investigated and teaching of this technique requires standardization for trainee surgeons.
  
  
  CONCLUSIONS
  TREPP potentially merges the advantages of a preperitoneal positioned mesh with an open technique. Initial results are promising and TREPP seems to be applicable in different hospitals in the Netherlands. Since the start of an active teaching program, TREPP has been introduced and accepted well by dedicated hernia surgeons in other hospitals in the Netherlands and Europe.
authors.affiliation: Depts. of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands. Electronic address: wl.akkersdijk@stjansdal.nl.
authors.forename: W L
authors.initials: WL
authors.lastname: Akkersdijk
authors.affiliation: Depts. of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands.
authors.forename: C S
authors.initials: CS
authors.lastname: Andeweg
authors.affiliation: Depts. of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: W J V
authors.initials: WJ
authors.lastname: Bökkerink
authors.affiliation: Depts. of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: J F
authors.initials: JF
authors.lastname: Lange
authors.affiliation: Depts. of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: C J H M
authors.initials: CJ
authors.lastname: van Laarhoven
authors.affiliation: Depts. of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: G G
authors.initials: GG
authors.lastname: Koning
mesh_terms: D000328:Adult; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D017568:Rectus Abdominis / Q000601:surgery*; D013526:Surgical Mesh
keywords: Abdominal wall; Extraperitoneal; Groin; Hernia; Inguinal; Open; Posterior; Preperitoneal; Rectus sheath; Repair; Surgery; TAPP; TEP; TIPP; TREPP