Achieving the Preperitoneal Space in Totally Extraperitoneal Inguinal Hernia Repair: Dissection with or without a Balloon Dissector

ABSTRACT

PURPOSE: A balloon dissector is widely used to achieve the preperitoneal space in totally extraperitoneal (TEP) inguinal hernia repair. The aim of this study was to compare the operative results of TEP cases performed with (the balloon dissection group) or without (the plain dissection group) a balloon dissector. METHODS: A retrospective analysis was conducted with a consecutive series of inguinal hernia repairs performed by a single surgeon in OOO Hospital between April 2008 and April 2012. All 128 patients with full-length video recordings were included. The distribution of the operation method was altered during the study period, from dissection with a balloon dissector to without it. RESULTS: Of 128 cases, 57 belonged to the balloon dissection group and the other 71 belonged to the plain dissection group. The demographic features and clinical characteristics were similar in both groups. Mean operation time (57.7 vs. 45.6 min, p<0.001) and laparoscopic recording time (31.6 vs. 25.0 min, p=0.004) were significantly shorter in the plain dissection group without differences in the degree of bloodstaining and the frequency of peritoneal tearing. Postoperative complications did not differ between the two groups. CONCLUSION: Plain dissection may be a safe and feasible alternative method of achieving the preperitoneal space in TEP by an experienced surgeon.