Is a dissection balloon beneficial in totally extraperitoneal endoscopic hernioplasty (TEP)? A randomized prospective multicenter study

Background: Laparoscopic hernioplasty has been criticized because of its te chnical 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 co st 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 balloo n. Results: In the group with the balloon, three of 161 patients (2.5%) requir ed 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 op eration time was 55 min in the group with the balloon and 63 min in the gro up without the balloon (p = 0.004). There was no difference between them in postoperative morbidity, and there were no major complications in either g roup. The recurrence rate was 3.1% in the group with the balloon and 3.7% i n the group without the balloon (p = 0.8). Conclusion: The use of a dissection balloon in TEP reduces the conversion r ate and may be especially beneficial early in the learning curve.