Scrotal Hernia Repair: New Evidence for the MOPP/TIPP Approach

Scrotal hernia repair remains a challenging area of groin hernia surgery. Two recent scientific publications provide new evidence on Open Preperitoneal Procedures (OPPs), including the MOPP/TIPP approach, for scrotal hernia repair.

What Are OPPs?

OPPs (Open Preperitoneal Procedures) is a generic term for minimally invasive open preperitoneal techniques used in groin hernia repair. It includes techniques such as TIPP (Trans-Inguinal Pre-Peritoneal), MOPP (Minimal Open Pre-Peritoneal) and TREPP (Trans-Rectus Extra-Peritoneal). These approaches share the principle of placing the mesh in the preperitoneal space through an open, limited-access route.

1. MOPP/TIPP for Scrotal Hernia Repair: Our Clinical Experience

Our first publication specifically examined whether large scrotal hernias could be treated using the Minimal Open Pre-Peritoneal (MOPP) technique. This work, conducted with Jean-François Gillion, evaluates the feasibility and outcomes of an open preperitoneal approach for these complex hernias.

The study showed that the MOPP approach can be used successfully for selected large scrotal hernias. Despite the complexity of these cases, the open preperitoneal route offers the possibility of repairing the hernia through a limited groin incision while placing the mesh in the preperitoneal space. These findings support MOPP as an additional surgical option for appropriately selected patients with scrotal hernias.

Scientific publication: Are “European” Scrotal Hernias Repairable With the Minimal Open Pre-Peritoneal Technique? https://doi.org/10.3389/jaws.2025.13863

2. Comparing MOPP/TIPP With Other Techniques for Scrotal Hernia Repair

Our second publication provides a broader comparison using data from the French Club Hernie Registry. It analyzed 3,043 scrotal hernia repairs and compared the trans-inguinal preperitoneal (TIPP/MOPP) approach with laparoscopic techniques and the Lichtenstein repair. This large registry-based study provides important real-world evidence on the different surgical options available for scrotal hernia repair.

Scientific publication: Three-Arm Registry-Based Comparison of Trans-Inguinal-Pre-Peritoneal, Laparoscopic, and Lichtenstein Techniques for Scrotal Hernia Repair https://doi.org/10.3389/jaws.2025.13993

The results showed that all three approaches can be used for scrotal hernia repair, with different profiles and indications. The TIPP/MOPP group included 395 repairs. The study found no significant difference in severe complications between the three approaches. Recurrence rates were also low. These findings support open preperitoneal repair as a valuable option alongside laparoscopic and Lichtenstein techniques, with the choice of procedure adapted to the patient, the hernia and the surgeon’s expertise. 

What Do These Results Mean for Patients?

For patients with a large scrotal hernia, there is no single surgical technique that is appropriate for every situation. The choice of repair depends on the size and characteristics of the hernia, the patient’s medical condition, previous surgery, and the surgeon’s experience. These publications show that open preperitoneal techniques such as MOPP/TIPP can be considered among the surgical options for selected patients, alongside laparoscopic and Lichtenstein repairs.

Conclusion

Scrotal hernia repair remains a demanding field of groin hernia surgery. These two recent publications contribute new clinical evidence on the role of open preperitoneal techniques in the management of these complex hernias. They also support the importance of tailoring the surgical approach to each patient rather than applying a single technique to every case.

Marc Soler, MD — Cagnes-sur-Mer, France