目的：建立腹膜前间隙的安全性在腹腔镜完全腹膜外（TEP）疝修补术中至关重要。在这篇系统综述和荟萃分析中，我们比较了接受TEP疝修补术的腹股沟疝或股疝患者的球囊剥离术和伸缩式剥离术的结局.
方法：我们搜索了PubMed，Embase,WebofScience,和Cochrane数据库的随机对照试验（RCT）以及从开始到2022年7月发表的前瞻性和回顾性研究。采用随机效应模型进行Meta分析。使用手术时间测量治疗结果，术中出血的发生率，腹膜裂伤,转换为其他方法，手术部位感染（SSI），血肿,血清瘤形成，疝气复发,和术后疼痛。
结果：五个RCT，一项前瞻性研究，和两项回顾性研究(总共，936名患者）被包括在内。两组间手术时间无显著差异,SSI,血肿,血清肿,复发率,术后第1天和第7天疼痛。球囊组的转换率明显低于伸缩组（比值比，0.34；95%置信区间，0.15-0.81）。
结论：在腹腔镜TEP疝修补术中，球囊剥离术和伸缩式剥离术都是创造腹膜前间隙的可行技术，手术时间相似，并发症发生率,和术后疼痛。然而，接受球囊剥离术的患者的转换率低于接受伸缩式剥离术的患者。
OBJECTIVE: Safety in creating a preperitoneal space is crucial in laparoscopic totally extraperitoneal (TEP) hernia repairs. In this systematic
review and meta-analysis, we compared the outcomes of balloon dissection and telescopic dissection in patients with inguinal or femoral hernias who underwent TEP hernia repair.
METHODS: We searched PubMed, Embase, Web of Science, and Cochrane databases for randomized controlled trials (RCTs) and prospective and retrospective studies published from inception to July 2022. Meta-analysis was performed using a random-effects model. The treatment outcome was measured using operation time, incidence of intraoperative hemorrhage, peritoneal laceration, conversion to other approaches, surgical site infection (SSI), hematoma, seroma formation, hernia recurrence, and postoperative pain.
RESULTS: Five RCTs, one prospective study, and two retrospective studies (in total, 936 patients) were included. No significant between-group differences were noted in operation time, SSI, hematoma, seroma, recurrence rate, and postoperative pain on days 1 and 7. The conversion rate was significantly lower in the balloon group than in the telescopic group (odds ratio, 0.34; 95% confidence interval, 0.15-0.81).
CONCLUSIONS: Both balloon dissection and telescopic dissection are viable techniques for creating preperitoneal space in laparoscopic TEP hernia repair and have similar operation time, complication rate, and postoperative pain. Nevertheless, the conversion rate was lower in patients undergoing balloon dissection than in those undergoing telescopic dissection.
