Endoscopic Extraperitoneal Herniorraphy Using a Preperitoneal Distention Balloon System

Hiroshi Kanamaru, Masakazu Tada*, Yoshiaki Horie, Sin Takada*

Department of Surgery, Shisei Hospital
*Second Department of Surgery, Saitama Medical Center, Saitama Medical School

The total extraperitoneal preperitoneal approach (TPP) is a new method of "laparoscopic herniorrhaphy in which the extraperitoneal space is dissected and a polypropylene mesh is placed in the preperitoneal layer to close the hernia ports of internal and external inguinal and femoral hernias. We have used TPP in treating 5 cases by the Preperitoneal Distention Balloon (PDB) System. All of them were primary cases. The patients' ages ranged from 26 to 79 years. The sex ratio (male: female) was 4:1 . Postoperative pain was minimal. None of them complained of postoperative inguinal tension. All of them were able to be discharged a few days postoperatively without complications. Dissection of the extraperitoneal space using the PDB System is easy. The disadvantages of TPP are: 1) it is difficult to ditermine the anatomy of the inguinal region and hernia port; 2) observation of the intraperitoneal organs is not possible; and 3) a more refined operative technique is necessary and therefore more time is needed for training. Since the operative field does not include the abdominal cavity, there is no need to open it. Therefore the advantages are: 1) intraabdominal adhesions from previous operations do not deter the surgeon; 2) adverse injury to intraabdominal organs is unlikely; and 3) postoperative intestinal adhesion or paresis is rare. Because of these advantages, we regard TPP as a promising main procedure for laparoscopic herniorrhaphy in the years to come.

Key words
endoscopic herniorrhaphy, total extraperitoneal preperitoneal approach, preperitoneal distention balloon system

Reprint requests
Hiroshi Kanamaru Department of Surgery, Shisei Hospital
1221 Shimookutomi, Sayama, 350-13 JAPAN

Accepted
March 8, 1995

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