Article Abstract

The minimal open preperitoneal (MOPP) approach to treat the groin hernias, with the history of the preperitoneal approach

Authors: Marc Soler


At the beginning was Annandale who reported for the first time the concept of the preperitoneal posterior approach. The surgeon who popularized this approach in the sixties is Llyod Nyhus Jean Rives [1965], who proposed the placement of the unilateral prosthesis by the midline pro peritoneal route. In 1967 René Stoppa proposed the first tension free and suture less hernia repair. Since our collaboration with René Stoppa, our preference is this pre-peritoneal route, with a small incision, in front of the deep inguinal ring, in ambulatory sitting. We changed the classic mesh design, giving an asymmetrical ovoid shape, to fully adapt to the wide coverage of the musculo pectineal hole. After the introduction, the prosthesis is not subject to secondary displacement, it is not fixed. Strips are set up on the skin and will be removed during the first postoperative consultation. Here is the abstract of the results: 644 hernias (534 patients) have been operated between 2011 and 2015. Mean follow up: 711 days. Day surgery: 598, (92.8%). Complications: bladder retention: 2; phlebitis: 1; superficial infection: 2; reoperation: 0. Post-operative pain—day 30, N=553; VAS: 0, 452 (81.73%); 1–3, 77 (13.92%); 4–6, 19 (3.43%); 7–8, 5 (0.9%). Chronic pain—at 3 months, N=97; VAS: 0, 77 (79.38%); 1–3, 9 (9.27%); 4–6, 10 (10.30%); 7–8, 1 (1.03%). No medication needed and no activity limitation. At 2 years, patient opinion: excellent result 212 (99.53%), medium result 1 (0.47%). No recurrence. All these patients’ data are included in the French “club hernie” data base for a long term prospective study. So, minimal open preperitoneal (MOPP) technique gives an excellent result, with a very low chronic pain, recurrence and complication rates.