BALLOON DISSECTION FACILITATED LAPAROSCOPIC EXTRAPERITONEAL HERNIOPLASTY

BACKGROUND: With the goals of minimizing perioperative morbidity and o btaining direct inguinal access without transgressing the peritoneal c avity, we developed a balloon dissection device to facilitate laparosc opic extraperitoneal hernioplasty. PATIENTS AND METHODS: me have perfo rmed balloon facilitated dissection on 113 patients (105 males) on an outpatient basis, Some patients were repaired under regional anesthesi a. A total of 150 hernias have been repaired: 72 indirect, 10 direct, 3 scrotal, 2 sliding, 2 spigelian, and 1 femoral. RESULTS: Mean operat ing time was 60 minutes. All patients were ambulatory on discharge. Ha lf reported minimal or no immediate postoperative pain. Over 80% had o nly minimal irritation or discomfort on the third postoperative day. N early 60% returned to work within 2 weeks. None required hospital read mission for an immediate complication of hernioplasty. With a mean fol low-up of 6.3 months, only three recurrences are reported. Except for one persistent neuropathy which resolved after staple removal, there w ere no significant complications. CONCLUSIONS: We conclude that balloo n dissection facilitates laparoscopic extraperitoneal hernioplasty and obviates the need for general anesthesia. Our approach minimizes peri operative pain. It can be done on an outpatient basis and permits prom pt return to full activity including physical work.