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À votre disposition pour toute informations complémentaires sur ces nouvelles techniques qui sont enfin maintenant largement diffusées dans le monde entier. Toutes les dernières publications ont montré de très bons résultats, et elles sont moins invasives par rapport à beaucoup d'autres techniques actuellement répandues. Elles donnent également moins de douleurs chroniques que des techniques plus anciennes.
Je vous transcris ici le résumé.
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Excellente lecture
Marc Soler
Original Article
The minimal open preperitoneal (MOPP) approach for treating
groin hernias: technique, indications, and results
Marc Soler^
Abdominal Wall Surgery Center, Polyclinique Saint Jean, Cagnes-sur-Mer, France
Correspondence to: Marc Soler, MD. Abdominal Wall Surgery Center, Polyclinique Saint Jean, 53 Avenue des Alpes, Cagnes-Sur-Mer, France.
Email: soler.marc2@wanadoo.fr.
Background: Over recent decades, surgical treatments for groin hernias have been largely categorized into the endoscopic posterior approach and the classic Liechtenstein-type anterior approach. A newer third approach, termed the open preperitoneal, has emerged. Numerous studies over the years have highlighted its benefits and efficacy. Here, we provide a detailed step-by-step description of the minimal open preperitoneal (MOPP) technique, a variant of these approaches. This method involves the placement of a large mesh in
the preperitoneal space through a minor incision. It represents a fusion of the transinguinal preperitoneal technique (TIPP) and the Ugahary technique.
Methods: The primary innovation of this paper is the meticulous delineation of surgical anatomy,
focusing on the fascia transversalis that envelops the deep inguinal orifice and forms the internal spermatic fascia. This precision enables clear definition of crucial steps in the technique, facilitating its teachability and reproducibility. Another significant contribution of this work is the presentation of results based on a large patient cohort, monitored over a two-year period. All consecutive MOPP procedures performed by the author during the study timeframe were registered in the Hernia club registry. Data points included demographics, baseline pain status, perioperative details, hospital stay, early outcomes up to day 30, followups,
long-term outcomes, and patient-related outcomes measures (PROM).
Results: Between September 2011 and April 2019, the author performed surgeries on 1,616 groin hernias. Out of these 1,401 hernias (spanning 1,146 patients) were treated using the MOPP procedure. A total of 1,316 patients were treated on an outpatient (93.4%), 77 cases (5.51%) of post-operative complications were noted classified under Dindo-Clavien grades I and II. No reoperation was necessary. On the thirtieth postoperative day 1,228 patients were checked, 915 patients had a Visual Analog Scale (VAS) equal to 0 (74.51%), VAS 1–3 for 260 patients (21.17%), VAS 4–6 for 43 patients (3.50 %), VAS 7–10 for 10 patients (0.81%). At 3 months 56 patients reported a VAS score greater than 0 for 20 patients the pain was greater than the preoperative pain. The overall rate of chronic pain was therefore 1.43%. Two recurrences were noted.
Conclusions: The MOPP technique, a minimally invasive open preperitoneal procedure, offers a sutureless and tension-free total groin hernia repair. It gives an excellent outcome, characterized by minimal chronic pain, recurrence, and complication rates.
Keywords: Prosthesis; open preperitoneal; minimal open preperitoneal (MOPP); groin hernias
Received: 13 July 2023; Accepted: 04 December 2023; Published online: 15 January 2024.
doi: 10.21037/ales-23-37
View this article at: https://dx.doi.org/10.21037/ales-23-37
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