Meta-analysis of the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) for inguinal hernia

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Hajibandeh S.; Evans L.A.; Havard T.J.; Naguib N.N.; Helmy A.H.

Journal: Hernia

Publisher: Springer-Verlag Italia s.r.l.

Publication Date: 10 January 2022

Volume / Issue: Volume 26 / Issue 4

Pages: 989–997

ISSN: 12654906

DOI: 10.1007/s10029-021-02554-x

Scopus: View on Scopus

PubMed: 35006472

Document Type: Review

Authors and Affiliations

Hajibandeh S., Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board, Pontyclun, United Kingdom, Hepatobiliary and Pancreatic Surgery and Liver transplant Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; Evans L.A., Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board, Pontyclun, United Kingdom; Havard T.J., Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board, Pontyclun, United Kingdom; Naguib N.N., Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board, Pontyclun, United Kingdom; Helmy A.H., Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board, Pontyclun, United Kingdom, Theodor Bilharz Research Institute, Giza, Imbaba, Egypt

Abstract

Objectives: To evaluate the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) in patients undergoing elective inguinal hernia repair. Methods: In compliance with PRISMA statement standards, electronic databases were searched to identify all studies reporting the outcomes of TREPP in patients undergoing elective inguinal hernia repair. The outcomes of interest included recurrence, chronic pain, haematoma, and wound infection. Proportion meta-analysis model was constructed to quantify the risk of postoperative complications and direct comparison meta-analysis model was constructed to compare the outcomes of TREPP and other open techniques. Random-effects modelling was applied to calculate pooled outcome data. Results: Seven studies enrolling 1891 patients undergoing TREPP were included. The mean operative time was 26 min (95% CI 15–36). Pooled analyses showed that TREPP was associated with 3.00% (95% CI 1.00–6.00%) risk of recurrence, 3.00% (95% CI 2.00–6.00%) risk of chronic pain, 8.00% (95% CI 0.00–20.00%) risk of haematoma, and 3.00% (95% CI 0.00–6.00%) risk of wound infection. The results remained consistent through subgroup analysis of patients with primary hernias and those with recurrent hernias. Analysis of a limited number of comparative studies showed no difference between TREPP and Lichtenstein technique in terms of recurrence (OR 1.57, P = 0.26) and chronic pain (OR 1.16, P = 0.59). Conclusions: The best available evidence suggests that TREPP may be a promising technique for elective repair of inguinal hernias as indicated by low risks of recurrence, chronic pain, haematoma, and wound infection. The available evidence is limited to studies from a same country conducted by almost the same research group which may affect generalisability of the findings. Moreover, there is a lack of comparative evidence on outcomes of TREPP versus other techniques highlighting a need for high-quality randomised controlled trials for definite conclusions. Although the available evidence is not adequate for definite conclusions, the results of current study can be used for sample size calculation and power analysis in future trials. © 2022, Crown.

Keywords

Hernia repair; Inguinal hernia; TREPP; Chronic Pain; Hematoma; Hernia, Inguinal; Herniorrhaphy; Humans; Pain, Postoperative; Recurrence; Surgical Mesh; Wound Infection; adult; clinical outcome; comparative effectiveness; female; hernioplasty; human; infection risk; Lichtenstein technique; male; meta analysis; open surgery; operation duration; postoperative complication; postoperative hemorrhage; postoperative pain; randomized controlled trial (topic); rectus abdominis muscle; recurrence risk; recurrent disease; Review; surgical infection; surgical technique; systematic review; trans rectus sheath extra peritoneal procedure; adverse device effect; adverse event; complication; procedures

Citation Information

Scopus Citations: 5

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