title: The TREPP as alternative technique for recurrent inguinal hernia after Lichtenstein's repair: A consecutive case series.
abstract: BACKGROUND
  Recurrent inguinal hernias after initial repair with mesh are preferably treated via an alternative route (e.g. posterior after anterior). For recurrent inguinal hernias after an anterior repair such as Lichtenstein's, an endoscopic approach such as the total extraperitoneal or transabdominal preperitoneal technique (TEP or TAPP) is recommended if expertise is present. The TransREctus sheath PrePeritoneal (TREPP) technique is a promising open posterior technique and could be an alternative to endoscopic methods. This study aims to evaluate the results of the TREPP technique for recurrent inguinal hernia.
  
  
  METHODS
  Consecutive patients who underwent a TREPP repair for recurrent hernia after initial operation according to Lichtenstein were included in a retrospective manner. A minimum of one year follow-up after the TREPP repair was maintained. Data retrieved from the patient files were combined with the findings at an outpatient department visit.
  
  
  RESULTS
  Between January 2006 and December 2013 fifty-two patients were eligible for inclusion of which 38 patients were clinically evaluated. The mean follow-up of these thirty-eight patients was 65 months (range 17-108 months) in which 2 patients had developed a re-recurrence. One patient reported chronic postoperative inguinal pain (CPIP) since the TREPP and four patients experienced CPIP since the primary inguinal hernia repair. Peri-operative and <30 day complications were rare and no severe adverse events occurred.
  
  
  CONCLUSIONS
  TREPP seems to be a feasible alternative for recurrent inguinal hernia repair after an initial operation according to Lichtenstein. It may yield extra advantages compared to endoscopic repairs, such as a short learning curve, spinal anesthesia and lower costs.
authors.affiliation: Department of Surgery, Radboud University Medical Center, Geert Grootteplein Zuid 10, 6525 GA Nijmegen, The Netherlands. Electronic address: willembokkerink@gmail.com.
authors.forename: W J V Willem
authors.initials: WJ
authors.lastname: Bökkerink
authors.affiliation: Department of Surgery, St. Jansdal Hospital, Wethouder Jansenlaan 90, 3844 DG Harderwijk, The Netherlands.
authors.forename: A M Alexandra
authors.initials: AM
authors.lastname: Persoon
authors.affiliation: Department of Surgery, St. Jansdal Hospital, Wethouder Jansenlaan 90, 3844 DG Harderwijk, The Netherlands.
authors.forename: W L Willem
authors.initials: WL
authors.lastname: Akkersdijk
authors.affiliation: Department of Surgery, Radboud University Medical Center, Geert Grootteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
authors.forename: C J H M Kees
authors.initials: CJ
authors.lastname: van Laarhoven
authors.affiliation: Department of Surgery, Radboud University Medical Center, Geert Grootteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
authors.forename: G G Giel
authors.initials: GG
authors.lastname: Koning
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects
keywords: Inguinal hernia; Lichtenstein; Preperitoneal; Recurrent hernia; TREPP