The third way to treat groin hernia, “the Minimal Open Pre Peritoneal approach ”“ MOPP ” M. Soler

1. The third way to treat groin hernia, “the Minimal Open Pre Peritoneal approach”“MOPP”M. Soler J. H Alexandre, described in 1984 a trans inguinal preperitoneal approach, with an regular inguinal incision, an a parietalisation of the cord. In 1995 F. Ugahary described the Grid iron technique, to treat even complex and difficult hernias with a minimal access, and minimally invasive approach.  The main difficulty of the Grid Iron technique, was to unrolled the prosthesis in the pre peritoneal space, J. H. Alexandre through a 3.5 cm incision.   In 2005, E Pelissier imagines a new self expandable mesh to facilitate the   positioning of the mesh in the preperitoneal space.This prosthesis makes easier the grid iron technique, and a new TIPP technique is now developed, by J.F Gillion, J.M. Chollet, (France) S de Gendt, F. Berrevoet (Belgium). F. Ugahary With all these new techniques “MOPP” it is now possible to treat almost the groin hernia, even the biggest ones, with an open, but a minimal access and minimal invasive posterior approach.        Methods The author operated 1800 hernias (2001-2012), using the Grid- Iron hernioplasty (Ugaharytechnique), and the TIPP technique. E. Pelissier Using for the 1200 first hernias a regular flat mesh or a lightweight mesh. Results The 300 first hernias have been analyzed (2001-2004) (2) The mean follow-up time was 18 months. The rate of follow up was 85%. N= 300; 263 patients. 223 men;   40 women                                                        Primary: 284; Secondary: 16 Anesthesia: General: 9 (3.4%); Spinal: 172 (63.4%); Ilio inguinal block: 82 (32.2%) Hospital stay: Day surgery: 128 (48.3%); Less than 48hours: 123 (46.6%); More than 48hours: 14 (5%) Complication: superficial Hematomas: 12; Infection: 0 PAIN: Discomfort: 8; Odd sensation: 15; Severe pain: 1, Pain during effort: 1 Grid Iron Technique Recurrence: 7 (2.3%)  200 hernias (2009-2011) have been operated using a self expandable prosthesis (=186), other flat mesh (N= 16); N= 200; 183 patients. 175 men;   8 women The mean follow-up time was 18 months Rate of follow-up: 87% Primary: 184; Secondary: 16 CLASSIFICATION: Lateral hernia: 129 (64, 5%); Medial: 45 (22,5%), Lateral and Medial: 22, (11%), Femoral: 4, (2%) ANESTHESIA: General: 0 (0%); Spinal: 97 (48, 5%); Ilio inguinal block: 103 (51.5%) HOSPITAL STAY: Day surgery: 182 (91%); One night or more: 18 (9%) COMPLICATION: Superficial hematoma, or seroma 9; Infection: 0; bladder retention: 2 PAIN: Discomfort: 24; with normal activity 23; difficulty with sport 1 Moderate pain: 5; with normal activity: 3; difficulty with sport 1; necessity to stop hard work: 1  Severe pain: 1 (but normal activity, professional and sport) Necessity to have pain killer: 0 VAS and rest: VAS: 164; VAS1: 2; VAS2: 1; VAS3: 3 VAS during daily activity: VAS: 150; VAS1; 7; VAS2: 1; VAS3: 5; VAS4: 3; VAS5: 3; VAS7: 1; VAS8: 1 For the patients VAS 4-8: post op pain is always less than preoperative ones, except for one patient (VAS 4) For these patients the result is: good: 6; Medium: 1; Bad: 1 RECURRENCE: 2 (1%), small asymptomatic hernia sac For the last 100 hernias of these data, (2011-2012) the author used a new semi rigid mesh, with the TIPP technique, with the same results and no recurrence but the follow up is only 6 months. CONCLUSION: This Minimal Open Pre Peritoneal, (Alexandre, Ugahary, TIPP, (MOPP)) approach, allows a minimal invasive, tension free, and suture less procedure, with protection for the nerves. The use of the new self expandable, and semi expandable prosthesis, makes easier the technique and secures the good position of the mesh, especially for the big medial hernia. The recurrence rate is lower with the new meshes. The specific result of the study is the low rate of severe chronic pain. 1 Clinique saint jean, Cagnes sur Mer, France. 2 e-mémoires de l'Académie Nationale de Chirurgie, 2004, 3 (3) : 28-33 TIPP Technique