# Comparison and Standardisation of Various Open Preperitoneal Techniques in Inguinal Hernia Surgery–Results of a Review and Consensus

## TL;DR

This paper compares four open preperitoneal hernia repair techniques and establishes standardized criteria to evaluate and compare them.

## Contribution

The study introduces standardized definitions and a Delphi-based consensus to compare open preperitoneal hernia repair techniques.

## Key findings

- Four open preperitoneal techniques (MOPP, TIPP, TREPP, ONSTEP) were compared using standardized criteria.
- The study identified similarities and differences in indications, procedural steps, mesh use, and complications.
- Standardization is recommended for education, training, and future comparative research.

## Abstract

Both open and laparoendoscopic preperitoneal mesh techniques are good options for the treatment of inguinal hernias. The 2023 updated HerniaSurge Guidelines recommend open preperitoneal mesh techniques as an acceptable alternative to Lichtenstein repair if a competent and experienced surgeon is available. However, although numerous open preperitoneal surgical techniques have been developed, only a few comparative studies comparing them are available. Because of the lack of scientific evidence and standardisation, the aim of this article is to define comparable standards and compare four frequently used open preperitoneal techniques.

Using a Delphi-consensus process among both the authors and experts in the field, various key steps for each procedure, indications, and outcome parameters were set to allow adequate comparison of different open preperitoneal techniques.

We present four different and frequently used open preperitoneal techniques: Minimal Open PrePeritoneal repair (MOPP), TransInguinal PrePeritoneal repair (TIPP), TransREctus sheat PrePeritoneal repair (TREPP), and Open New Simplifyed Total Extraperitoneal repair (ONSTEP). We provide a clear and comparable standard regarding the best indication, different procedural steps, the use of meshes and fixation, the learning curve involved, and possible complications and limitations. We also identify some similarities for the techniques but also specific differences on different topics.

Development, validation, and implementation of these standards for the various open preperitoneal techniques are necessary both for education and training as well as for future comparative studies.