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Balloon dissection versus telescopic dissection during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair: a systematic review, meta-analysis, and trial sequential analysis

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Abstract

Objectives

To compare the outcomes of balloon dissection and telescopic dissection in patients undergoing laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.

Methods

A systematic review in accordance with PRISMA statement standards was conducted. A search of electronic information sources was conducted to identify all studies comparing the outcomes of balloon dissection and telescopic dissection in patients undergoing laparoscopic TEP inguinal hernia repair. Random effects modelling was applied to calculate pooled outcome data.

Results

A total of 936 patients from eight studies were included. The included population in both groups were comparable in terms of baseline characteristics. There was no difference between the two techniques in terms of operation time (MD: − 4.14 min, P = 0.05), conversion to another technique (RD: − 0.02, P = 0.29), recurrence (RD: − 0.00, P = 0.84), haematoma (OR: 1.34, P = 0.61), seroma (OR: 0.63, P = 0.56), surgical site infection (RD: 0.00, P = 1.00), urinary retention (OR: 0.92, P = 0.86), postoperative pain score on day 1 (MD: − 0.16, P = 0.69) and day 7 (MD: − 0.16, P = 0.61). Trial sequential analysis of randomised trials suggested that evidence for operative time and conversion to other technique is subject to type 1 and type 2 error.

Conclusions

Balloon dissection and telescopic dissection during TEP inguinal hernia repair are comparable in terms of operative and postoperative outcomes. The available evidence for operative time and conversion to other technique is subject to type 1 and type 2 error. In presence of comparative clinical outcomes, the cost-effectiveness analysis in future studies may play an important role in determining the dissection technique of choice.

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Data availability statement

The information about the data presented in this article will be accessible on request.

References

  1. Hajibandeh S, Hajibandeh S, Evans L, Havard T, Naguib NN, Helmy AH (2022) Meta-analysis of the outcomes of trans rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia. Author’s reply. Hernia 26(4):1197–1198

    Article  CAS  PubMed  Google Scholar 

  2. Bullen NL, Massey LH, Antoniou SA, Smart NJ, Fortelny RH (2019) Open versus laparoscopic mesh repair of primary unilateral uncomplicated inguinal hernia: a systematic review with meta-analysis and trial sequential analysis. Hernia 23(3):461–472

    Article  CAS  PubMed  Google Scholar 

  3. Aiolfi A, Cavalli M, Del Ferraro S, Manfredini L, Lombardo F, Bonitta G et al (2021) Total extraperitoneal (TEP) versus laparoscopic transabdominal preperitoneal (TAPP) hernioplasty: systematic review and trial sequential analysis of randomized controlled trials. Hernia 25(5):1147–1157

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hajibandeh S, Hajibandeh S, Mobarak S, Bhattacharya P, Mobarak D, Satyadas T (2020) Meta-analysis of spinal anesthesia versus general anesthesia during laparoscopic total extraperitoneal repair of inguinal hernia. Surg Laparosc Endosc Percutan Tech 30(4):371–380

    Article  PubMed  Google Scholar 

  5. Kieturakis MJ, Nguyen DT, Vargas H, Fogarty TJ, Klein SR (1994) Balloon dissection facilitated laparoscopic extraperitoneal hernioplasty. Am J Surg 168(6):603–7 (discussion 607–8)

    Article  CAS  PubMed  Google Scholar 

  6. McKernan JB (1994) Prosthetic inguinal hernia repair using a laparoscopic extraperitoneal approach. Semin Laparosc Surg 1(2):116–122

    CAS  PubMed  Google Scholar 

  7. Chu HC, Hu SW, Wu WL, Tam KW (2023) Comparison of balloon dissection and telescopic dissection of the preperitoneal space in laparoscopic totally extraperitoneal hernia repair: a systematic review and meta-analysis. Langenbecks Arch Surg 408(1):15

    Article  PubMed  Google Scholar 

  8. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  PubMed  PubMed Central  Google Scholar 

  9. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) (2019) 2nd edn. Wiley, Chichester

    Google Scholar 

  10. Schünemann H, Brożek J, Guyatt G, Oxman A, editors (2013) GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group. Available at GRADE handbook (gradepro.org). Accessed 22 Nov 2022

  11. Higgins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC (2020) Chapter 8: assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (Eds) Cochrane handbook for systematic reviews of interventions version 6.1 (updated September 2020). Cochrane. www.training.cochrane.org/handbook. Accessed 28 Nov 2020

  12. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919

    Article  PubMed  PubMed Central  Google Scholar 

  13. Akin E, Bas E, Firat N, Ozdemir K, Capoglu R, Altintoprak F (2021) Comparison of balloon trocar versus telescopic dissection method for TEP inguinal hernia repair. J Coll Physicians Surg Pak 30(6):623–626

    PubMed  Google Scholar 

  14. Birol S, Ofluoglu HV (2021) The comparison of balloon and camera dissection of the preperitoneal space in totally extraperitoneal repair hernia repair. Our initial experience! Surg Innov 28(6):695–699

    Article  PubMed  Google Scholar 

  15. Tastaldi L, Bencsath K, Alaedeen D, Rosenblatt S, Alkhatib H, Tu C et al (2019) Telescopic dissection versus balloon dissection for laparoscopic totally extraperitoneal inguinal hernia repair (TEP): a registry-based randomized controlled trial. Hernia 23(6):1105–1113

    Article  CAS  PubMed  Google Scholar 

  16. Tran H, Tran K, Turingan I, Zajkowska M, Lam V, Hawthorne W (2015) Single-incision laparoscopic inguinal herniorraphy with telescopic extraperitoneal dissection: technical aspects and potential benefits. Hernia 19(3):407–416

    Article  CAS  PubMed  Google Scholar 

  17. Misra MC, Kumar S, Bansal VK (2008) Total extraperitoneal (TEP) mesh repair of inguinal hernia in the developing world: comparison of low-cost indigenous balloon dissection versus direct telescopic dissection: a prospective randomized controlled study. Surg Endosc 22(9):1947–1958

    Article  PubMed  Google Scholar 

  18. Bringman S, Ek A, Haglind E, Heikkinen T, Kald A, Kylberg F et al (2001) Is a dissection balloon beneficial in totally extraperitoneal endoscopic hernioplasty (TEP)? A randomized prospective multicenter study. Surg Endosc 15(3):266–270

    Article  CAS  PubMed  Google Scholar 

  19. Bringman S, Ek A, Haglind E, Heikkinen TJ, Kald A, Kylberg F et al (2001) Is a dissection balloon beneficial in bilateral, totally extraperitoneal, endoscopic hernioplasty? A randomized, prospective, multicenter study. Surg Laparosc Endosc Percutan Tech 11(5):322–326

    Article  CAS  PubMed  Google Scholar 

  20. Farinas LP, Griffen FD (2000) Cost containment and totally extraperitoneal laparoscopic herniorrhaphy. Surg Endosc 14(1):37–40

    Article  CAS  PubMed  Google Scholar 

  21. Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ et al (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25(9):2773–2843

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of General Surgery, Prince Charles Hospital, Merthyr Tydfil, UK

    V. Satish Kolli

  2. Department of Surgery, Royal Sussex County Hospital, Brighton, UK

    K. Kumar

  3. Department of General Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK

    S. Hajibandeh

  4. Department of General Surgery, University Hospital of Wales, Cardiff & Vale NHS Trust, Cardiff, UK

    S. Hajibandeh

Authors
  1. V. Satish Kolli
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  2. K. Kumar
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  3. S. Hajibandeh
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  4. S. Hajibandeh
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Contributions

Conception and design: SH. Data collection: SVK, KK. Analysis and interpretation: SH, SH. Writing the article: All authors. Critical revision of the article: All authors. Final approval of the article: All authors.

Corresponding author

Correspondence to S. Hajibandeh.

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Conflict of interest

All authors included in this work declare no conflict of interest.

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Human and animal rights and Informed consent

This study is a systematic review with meta-analysis of outcomes which does not include research directly involving human or animal participation.

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Appendix

Appendix

Search No

Search strategy†

#1

inguinal near 2 hernia: TI,AB,KW

#2

MeSH descriptor: [inguinal hernia] explode all trees

#3

#1 OR #2

#4

balloon: TI,AB,KW

#5

camera: TI,AB,KW

#6

telescop*: TI,AB,KW

#7

#5 OR #6

#8

#3 AND #4 AND #7

† This search strategy was adopted for following databases: CINAHL, EMBASE, MEDLINE, CENTRAL, and Scopus.

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Kolli, V.S., Kumar, K., Hajibandeh, S. et al. Balloon dissection versus telescopic dissection during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair: a systematic review, meta-analysis, and trial sequential analysis. Hernia 27, 527–539 (2023). https://doi.org/10.1007/s10029-023-02793-0

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  • DOI: https://doi.org/10.1007/s10029-023-02793-0

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