Voie MOPP/TIPP, nouvelles communications scientifiques! (volumineuses hernies scrotales)

Les articles scientifiques concernant la cure des hernies de l’aine selon la troisième voie dont nous faisons la promotion  se succèdent en collaboration avec d’autres spécialistes chirurgiens de la paroi abdominale.

Après les articles de base disponible en open data et cités dans nos précédents Blogs, voilà deux articles importants prouvant l’efficacité de notre technique versus les voies classiques ouvertes ( Lichtenstein like), et les voies coelioscopiques également classiques (TAPP, TEP). Ces deux articles sont consacrés aux volumineuses hernies de l’homme souvent difficiles à traiter par des non spécialistes, il s’agit des hernies scrotales ( hernie déformant  la bourse en raison de sa grande taille, voir la photo). Nous démontrons les très bons résultats des voies MOPP / TIPP.

Le premier article compare notre expérience personnelle concernant ces volumineuses hernies scrotales en comparant les résultats avec les hernies de l’aine primaire non scrotales traité par la même technique MOPP /TIPP.  L’article conclu que nos résultats pour ces hernies complexes sont comparables aux résultats pour les hernies plus simples à traiter (non scrotales). Vous pouvez lire l’article en suivant ce lien : | doi.org/10.3389/jaws.2025.13863

Le  deuxième article  est le fruit de notre  expérience  et de celle des spécialistes Français du « Club Hernie» ( https://www.club-hernie.com/fr/), qui militent également depuis des années à l’amélioration  des résultats des interventions de cure des hernies et des éventrations pariétales.

Dans cet article, tout juste publié, le résultat du  traitement des hernies scrotales par voie MOPP/TIPP est comparé aux techniques ouvertes classique (Lichtenstein like) et coelioscopiques ( TAPP/ TEP).

La encore sont vérifiés les très bons résultats de la voie MOPP/TIPP.

L’article en "open access" est maintenant disponible, voilà le lien, et le résumé !

https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2025.13993/full

Abstract

Background: Studies on minimally invasive open preperitoneal techniques for scrotal hernia repair are scarce.Methods: This comparative study analysed data collected prospectively by the ‘Club-Hernie’ registry. A scrotal hernia was defined as an inguinal hernia which had descended into and caused any distortion of the scrotum. Giant hernia were not included.Results: A total of 3043 scrotal hernia repairs, performed between 1st September 2011 and 30th April 2023, met the inclusion criteria. The late results of 395

transinguinal-preperitoneal (TIPP/) repairs were similar to those of 1038 Lichtenstein and 1610 laparoscopic totally extraperitoneal/transabdominal preperitoneal (TEP/TAPP) repairs. At a median follow-up of 2 years, no significant difference was found between the three groups regarding the rate of recurrences (0.6% vs. 0.6% vs. 0.7%, respectively; p>0.05) and the prevalence of severe chronic postoperative inguinal pain (0.6% vs. 0.4% vs. 0.7%, respectively; p>0.05). Each technique had its own benefits and drawbacks. Laparoscopic repairs, used in less complex patients (lower number of ASA 3–4 patients and/or patients on anticoagulants) and hernias (lower rate of L3/M3 defects), provided better nerve preservation (nerve resection <1%), a shorter operating time, a higher proportion of outpatients (79.4%) and less early postoperative pain than open procedures. Laparoscopic repairs had slightly

more conversions and postoperative organ space complications than open procedures, but the differences were not statistically significant. TIPP repairs had a low conversion rate (0.8%) and less nerve resection than Lichtenstein repairs (3.6% vs. 17.2%, respectively; p<0.0001 for the ilio-inguinal nerve), the lowest rate (0.3%) of serious (Clavien-Dindo ≥III) postoperative complications and a high rate of day surgery (69.9%). Most likely due to preoperative selection, the Lichtenstein group included significantly more

complex patients (ASA 3–4: 31.8%; anticoagulant therapy: 23.4%) and the most symptomatic hernias (severe preoperative pain:17.5%). Conclusion: TIPP is a feasible, safe and effective procedure for scrotal hernia repair, providing results similar to those of laparoscopic techniques. TIPP appears to be a valid alternative when the aim is to perform a preperitoneal repair using a minimally

invasive open route. Having the choice of effective techniques may help tailor the treatment of these types of inguinal hernia.

Contribution to the field

This comparative registry-based study, which includes data from 3,043 prospectively collected cases, represents the largest published research on scrotal hernia repairs. Moreover, it is the first to compare TIPP, laparoscopic, and Lichtenstein techniques in S1-scrotal hernias. This is a multicentre study in which 68 surgeons participated, evenly allocated across the techniques being investigated. The rate of missing data and the rate of lost to follow-up patients is very low. This is the first study which shows that TIPP is feasible, safe, and effective in S1-scrotal hernias.

Bonne lecture et n’ hésitez pas à commenter et à interroger.

soler.marc2@wanadoo.fr

Marc Soler