TransREctus Sheath PrePeritoneal Procedure (TREPP) for Inguinal Hernia Repair

NCT07618884 | Recruiting

• 1 other identifier: RF-1-6-2025
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

Inguinal hernia repair remains one of the most commonly performed surgical procedures worldwide. Tension-free repair with mesh augmentation is the predominant treatment option, either achieved by preperitoneal laparoscopic hernioplasty or Lichtenstein procedure (LP). As the recurrence rate is reduced to less than 5 % after mesh repair, nowadays, long-term morbidity associated with open inguinal hernia repair is mainly related to chronic postoperative inguinal pain (CPIP). Despite many hypotheses about the possible causes for CPIP, there is now consensus that involvement of inguinal nerves plays a major role. The trans rectus sheath extra-peritoneal procedure (TREPP) is a minimally invasive open approach utilizing the rectus sheath to access the preperitoneal space. It has shown promise in providing effective repair with potential advantages in cosmesis, postoperative pain, and recurrence rates. It is a medial approach avoiding the interference with the course of all (three) inguinal nerves through lateral abdominal wall.

Conditions

Inguinal Hernia; Inguinal Hernia Repair

Keywords

Inguinal hernia; Chronic postoperative inguinal pain; Trans rectus sheath extra-peritoneal procedure

Outcome Measures

Primary Outcomes (1)

• Recurrence rate

  Number and percentage of patients with recurrence of hernia after surgery

  through study completion, an average of 1 year

Secondary Outcomes (1)

• Incidence of chronic postoperative inguinal pain

  3 months after surgery

Study Arms (1)

TREPP group

EXPERIMENTAL

Patients undergoing TransREctus Sheath PrePeritoneal Procedure (TREPP) for inguinal hernia repair

Procedure: trans rectus sheath extra-peritoneal procedure (TREPP)

Interventions

trans rectus sheath extra-peritoneal procedure (TREPP) PROCEDURE

The TREPP technique, a minimally invasive open approach utilizing the rectus sheath to access the preperitoneal space

TREPP group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adults with primary unilateral or bilateral inguinal hernia

You may not qualify if:

• Strangulated hernias.
• Severe comorbidities precluding surgery ((ASA Class IV,V)

Sponsors & Collaborators

• Assiut University: lead

Study Sites (1)

Faculty of Medicine-Assiut University -Assiut-Egypt

Asyut, Asyut Governorate, 71515, Egypt

RECRUITING

Related Publications (5)

• Faessen JL, Stoot JHMB, Broos PPHL, Vijgen GHEJ, Reisinger KW, Bouvy ND, van Vugt R. Trans rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia repair under local anesthesia with sedation in the outpatient clinic: a feasibility study. Langenbecks Arch Surg. 2024 Jun 19;409(1):188. doi: 10.1007/s00423-024-03383-z.

  PMID: 38896330 BACKGROUND

• Bokkerink WJ, Persoon AM, Akkersdijk WL, van Laarhoven CJ, Koning GG. The TREPP as alternative technique for recurrent inguinal hernia after Lichtenstein's repair: A consecutive case series. Int J Surg. 2017 Apr;40:73-77. doi: 10.1016/j.ijsu.2017.02.022. Epub 2017 Feb 20.

  PMID: 28219816 BACKGROUND

• Faessen JL, Stoot JHMB, van Vugt R. Safety and efficacy in inguinal hernia repair: a retrospective study comparing TREPP, TEP and Lichtenstein (SETTLE). Hernia. 2021 Oct;25(5):1309-1315. doi: 10.1007/s10029-020-02361-w. Epub 2021 Jan 5.

  PMID: 33400030 BACKGROUND

• Bokkerink WJV, Koning GG, Vriens PWHE, Mollen RMHG, Harker MJR, Noordhof RK, Akkersdijk WL, van Laarhoven CJHM. Open Preperitoneal Inguinal Hernia Repair, TREPP Versus TIPP in a Randomized Clinical Trial. Ann Surg. 2021 Nov 1;274(5):698-704. doi: 10.1097/SLA.0000000000005130.

  PMID: 34342299 BACKGROUND

• Eklund AS, Montgomery AK, Rasmussen IC, Sandbue RP, Bergkvist LA, Rudberg CR. Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg. 2009 Jan;249(1):33-8. doi: 10.1097/SLA.0b013e31819255d0.

  PMID: 19106673 BACKGROUND

MeSH Terms

Conditions

Hernia, Inguinal

Condition Hierarchy (Ancestors)

Hernia, Abdominal; Hernia; Pathological Conditions, Anatomical; Pathological Conditions, Signs and Symptoms

Central Study Contacts

Mohamad Raafat, MD

CONTACT

0201067877622; mohamad_raafat10@yahoo.com

Faculty of Medicine-Assiut University

CONTACT

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Lecturer at General surgery department

Study Record Dates

• First Submitted: May 23, 2026
• First Posted: June 1, 2026
• Study Start: April 15, 2025
• Primary Completion: June 1, 2026
• Study Completion (Estimated): September 1, 2026
• Last Updated: June 1, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

EG (1)