title: Is a dissection balloon beneficial in totally extraperitoneal endoscopic hernioplasty (TEP)? A randomized prospective multicenter study.
abstract: BACKGROUND
  Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to facilitate the creation of the initial working space in totally extraperitoneal endoscopic hernioplasty (TEP), but their use adds to the cost of the operation.
  
  
  METHODS
  A total of 322 men with unilateral, primary, or recurrent inguinal hernias were randomized to undergo TEP with or without a dissection balloon.
  
  
  RESULTS
  In the group with the balloon, three of 161 patients (2.5%) required conversion to transabdominal preperitoneal hernioplasty (TAPP), or open herniorraphy, whereas 17 of 161 patients (10.6%) were converted to TAPP or open herniorraphy in the group without the balloon (p = 0.002). The mean operation time was 55 min in the group with the balloon and 63 min in the group without the balloon (p = 0.004). There was no difference between them in postoperative morbidity, and there were no major complications in either group. The recurrence rate was 3.1% in the group with the balloon and 3.7 % in the group without the balloon (p = 0.8).
  
  
  CONCLUSIONS
  The use of a dissection balloon in TEP reduces the conversion rate and may be especially beneficial early in the learning curve.
authors.affiliation: Department of Surgery, Karolinska Institute, Huddinge University Hospital, S-141 86 Stockholm, Sweden. sven.bringman@gastro.hs.sll.se
authors.forename: S
authors.initials: S
authors.lastname: Bringman
authors.forename: A
authors.initials: A
authors.lastname: Ek
authors.forename: E
authors.initials: E
authors.lastname: Haglind
authors.forename: T
authors.initials: T
authors.lastname: Heikkinen
authors.forename: A
authors.initials: A
authors.lastname: Kald
authors.forename: F
authors.initials: F
authors.lastname: Kylberg
authors.forename: S
authors.initials: S
authors.lastname: Ramel
authors.forename: C
authors.initials: C
authors.lastname: Wallon
authors.forename: B
authors.initials: B
authors.lastname: Anderberg
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013523:Surgical Equipment / Q000706:statistics & numerical data; D016896:Treatment Outcome