{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T16:45:47Z","timestamp":1757609147021,"version":"3.44.0"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["J. Abdom. Wall Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Inguinoscrotal hernias, classified as large indirect hernias (L3) within the European Hernia Society classification, pose unique surgical challenges. The TransREctus sheath Pre-Peritoneal (TREPP) repair is an extraperitoneal approach that may offer advantages over conventional techniques, such as reduced intra-abdominal complications and the potential to avoid general anesthesia. However, its use in inguinoscrotal hernia repair was to date not explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study analyzed consecutive patients who underwent TREPP repair for scrotal hernia between January 2021 and December 2023. Patient data were extracted from an electronic hospital database, and follow-up was conducted via patient records and the PINQ-PHONE questionnaire. Primary outcomes included recurrence rates, postoperative pain, and surgical complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 33 primary scrotal hernia cases were analyzed. The majority of procedures (87.9%) were performed under spinal anesthesia, with a median operative time of 23\u00a0min for unilateral cases. No recurrences were observed within the follow-up period of at least 1\u00a0year. One patient (3.0%) reported persistent postoperative pain, successfully managed with local anesthetic and corticosteroid injections. Two patients (6.1%) developed infections, treated conservatively with antibiotics. Other minor complications included postoperative hematoma (9.1%), seroma (9.1%) or urinary retention (6.1%), all managed without surgical intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The TREPP procedure in experienced hands appears to be a feasible and safe alternative for scrotal hernia repair, demonstrating low complication rates requiring reintervention and no recurrences in this cohort. Despite the study\u2019s retrospective design and small sample size, this first results step-up study support further investigation into the role of TREPP repair in inguinoscrotal hernia management. Larger, prospective studies are needed to confirm its long-term efficacy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/jaws.2025.15098","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T08:38:38Z","timestamp":1756888718000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["First Evaluation of the TREPP Procedure for Inguinoscrotal Hernia Repair: A Step-Up Study"],"prefix":"10.3389","volume":"4","author":[{"given":"T. L. R.","family":"Zwols","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. J. W.","family":"M\u00f6llers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. J. G. M.","family":"Veeger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. H.","family":"Eker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. G.","family":"Koning","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. P. E. N.","family":"Pierie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1007\/s10029-007-0198-3","article-title":"The European Hernia Society Groin Hernia Classication: Simple and Easy to Remember","volume":"11","author":"Miserez","year":"2007","journal-title":"Hernia"},{"key":"B2","doi-asserted-by":"publisher","first-page":"11195","DOI":"10.3389\/jaws.2023.11195","article-title":"Systematic Review and Guidelines for Management of Scrotal Inguinal Hernias","volume":"2","author":"Tran","year":"2023","journal-title":"J Abdom Wall Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1007\/s10029-025-03352-5","article-title":"Comment To: A New Groin Hernia Classification with Clinical Relevance","volume":"29","author":"Koning","year":"2025","journal-title":"Hernia"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10029-017-1668-x","article-title":"International Guidelines for Groin Hernia Management","volume":"22","author":"Group","year":"2018","journal-title":"Hernia"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1007\/s10029-020-02281-9","article-title":"Differences in the Outcomes of Scrotal Vs. Lateral Vs. Medial Inguinal Hernias: A Multivariable Analysis of Registry Data","volume":"25","author":"K\u00f6ckerling","year":"2021","journal-title":"Hernia"},{"key":"B6","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.ijsu.2016.04.037","article-title":"Teaching the Transrectus Sheath Preperiotneal Mesh Repair: TREPP in 9 Steps","volume":"30","author":"Akkersdijk","year":"2016","journal-title":"Int J Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1007\/s10029-020-02291-7","article-title":"Transrectus Sheath Pre-Peritoneal (TREPP) Procedure Versus Totally Extraperitoneal (TEP) Procedure and Lichtenstein Technique: A Propensity-Score-MATCHED Analysis in Dutch High-Volume Regional Hospitals","volume":"25","author":"Zwols","year":"2021","journal-title":"Hernia"},{"key":"B8","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1097\/SLA.0000000000005130","article-title":"Open Preperitoneal Inguinal Hernia Repair, TREPP Versus TIPP in a Randomized Clinical Trial","volume":"274","author":"B\u00f6kkerink","year":"2021","journal-title":"Ann Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1922","DOI":"10.1007\/s00268-014-2475-5","article-title":"Trans Rectus Sheath Extra-PERITONEAL Procedure (TREPP) for Inguinal Hernia: The First 1,000 Patients","volume":"38","author":"Lange","year":"2014","journal-title":"World J Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s10029-011-0893-y","article-title":"The Transrectus Sheath Preperitoneal Mesh Repair for Inguinal Hernia: Technique, Rationale, and Results of the First 50 Cases","volume":"16","author":"Koning","year":"2012","journal-title":"Hernia"},{"key":"B11","doi-asserted-by":"publisher","first-page":"3292","DOI":"10.1007\/s00464-015-4080-6","article-title":"Follow-Up After Laparoscopic Inguinal Hernia Repair, Can It Be Done by Phone? A Prospective Study in 300 Patients, the PINQ-PHONE","volume":"29","author":"van den Heuvel","year":"2015","journal-title":"Surg Endosc"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"12","author":"von Elm","year":"2014","journal-title":"Int J Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"13863","DOI":"10.3389\/jaws.2025.13863","article-title":"Are \u201cEuropean\u201d Scrotal Hernias Repairable with the Minimal Open Pre-Peritoneal Technique?","volume":"4","author":"Soler","year":"2025","journal-title":"J Abdom Wall Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1177\/1553350612468959","article-title":"Stages and Evaluation of Surgical Innovation","volume":"20","author":"Heikens","year":"2013","journal-title":"Surg Innov"},{"key":"B15","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/1471-2288-10-90","article-title":"Evidence at a Glance: Error Matrix Approach for Overviewing Available Evidence","volume":"10","author":"Keus","year":"2010","journal-title":"BMC Med Res Methodol"}],"container-title":["Journal of Abdominal Wall Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/jaws.2025.15098\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T08:38:39Z","timestamp":1756888719000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/jaws.2025.15098\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,3]]},"references-count":15,"alternative-id":["10.3389\/jaws.2025.15098"],"URL":"https:\/\/doi.org\/10.3389\/jaws.2025.15098","relation":{},"ISSN":["2813-2092"],"issn-type":[{"type":"electronic","value":"2813-2092"}],"subject":[],"published":{"date-parts":[[2025,9,3]]},"article-number":"15098"}}