BALLOON DISSECTION OF THE SPACE OF BOGROS VIA THE FEMORAL CANAL FOR TOTAL EXTRAPERITONEAL LAPAROSCOPIC HERNIORRHAPHY

To obviate the need for general anesthesia or dissection of the rectus sheath, we have transferred laparoscopic herniorrhaphy back to the gr oin by first dissecting the suprainguinal parietoperitoneal space of B ogros via the femoral canal. Cadaver dissections demonstrated that the preperitoneal plane could be routinely fingered and distended with a digitally placed balloon introduced through a 1-cm incision immediatel y below the inguinal ligament. A 10-mm femoral laparoscopic port was t hen inserted and pressurized, allowing two standard 5-mm ports to be i ntroduced from above, through the lower quadrant, under vision. The pr ocedure was then carried out in the usual way, the mesh being inserted from below. Ten patients (two women), 23-73 years old, selected becau se general anesthesia was inadvisable, underwent uncomplicated prosthe tic repair of unilateral (eight) or bilateral (two) inguinal defects. Half of the peritoneal sacs were pushed up and out of the inguinal can al; 18 months later there were no recurrences (inguinal or femoral). P reliminary experience with this new technique is promising. It may pro ve applicable to retroperitoneal exposure of the distal aorta and ilia c vessels, allowing laparoscopic bypass for Leriche syndrome.