Open Preperitoneal Techniques (OPPs):A Bridge Between Conventional Open and Endoscopic Groin Hernia Repair

July 15, 2026

I am pleased to announce the publication of my invited review in the international journal Mini-invasive Surgery:

Open Preperitoneal Techniques: A Bridge between Anterior Open and Posterior Endoscopic Approaches.

I would like to sincerely thank the Editors and the Reviewers for their thoughtful comments and constructive suggestions, which greatly contributed to improving this work.

This publication is particularly meaningful to me.

Unlike most of my previous articles, published in journals dedicated to abdominal wall surgery, this invited review appears in an international minimally invasive surgery journal intended for a much broader surgical audience.

Its purpose is to introduce Open Preperitoneal Techniques (OPPs) and to highlight the role they may play in contemporary groin hernia surgery.

A different way of looking at groin hernia repair

For decades, groin hernia surgery has often been presented as a choice between two major approaches:

• conventional anterior open repair (Lichtenstein);

• posterior endoscopic repair (TEP and TAPP), now complemented by robotic surgery.

However, this distinction may be overly simplistic.

The key issue is not simply the surgical access.

It is fundamentally anatomical.

What truly matters is the position of the mesh.

Open preperitoneal techniques place the mesh in the same anatomical plane as endoscopic repair while preserving the advantages of an open operation.

They therefore represent a genuine bridge between these two major approaches.

More than twenty years of commitment

I introduced the original Ugahary technique in France in 2001.

For more than twenty years, a significant part of my clinical practice, teaching, and research has been devoted to the development, scientific evaluation, and dissemination of this family of techniques.

This invited review summarizes their historical evolution, anatomical rationale, current indications, and the scientific evidence available today.

A repair philosophy

OPPs are not intended to reproduce conventional open surgery.

Their ambition is different.

They aim to provide patients with the same anatomical benefits as endoscopic or robotic repair through preperitoneal mesh placement while preserving the simplicity of an open operation.

Studies based on the French Club Hernie Registry suggest that this strategy can achieve outcomes comparable to endoscopic repair in selected patients while reducing certain aspects of the overall invasiveness of the procedure.

A promising direction

OPPs are not intended to oppose open and endoscopic surgery.

Rather, they represent a complementary approach whose objective is to provide the anatomical benefits of posterior repair while limiting, whenever possible, the overall invasiveness of the procedure.

In my opinion, they represent a promising evolution in groin hernia surgery and deserve broader recognition, further evaluation, and wider dissemination within the surgical community.

I hope this review will contribute to increasing awareness of these techniques and stimulate further education, collaboration, and scientific research.

Key Messages

✔ OPPs achieve preperitoneal mesh placement based on the same anatomical principles as endoscopic repair.

✔ They represent a genuine bridge between conventional open surgery and endoscopic or robotic repair.

✔ Their goal is to provide the anatomical benefits of posterior repair while reducing the overall invasiveness of the procedure whenever possible.

✔ They offer an additional option for a more tailored approach to groin hernia repair.

✔ This invited review summarizes their history, anatomical rationale, current indications, and the scientific evidence available today.

📖 Read the Full Article (Open Access)

Open Preperitoneal Techniques: A Bridge between Anterior Open and Posterior Endoscopic Approaches

👉 Access the full article free of charge (Open Access):https://www.oaepublish.com/articles/2574-1225.2026.25

Continue the conversation

Whether you are a patient seeking information about groin hernia treatment options, or a surgeon interested in Open Preperitoneal Techniques (OPPs), I would be pleased to answer your questions and share my experience.

Please feel free to contact me or explore the other sections of this website.