Retroperitoneal Operations Research Articles

Ultrasound-guided quadratus lumborum block for perioperative analgesia in robot-assisted partial nephrectomy: a randomized controlled trial

BackgroundRecently, several case reports and limited randomized studies have shown that quadratus lumborum blocks (QLB) are effective in providing pain relief after intra-abdominal and retroperitoneal operations. Additionally, robot-assisted partial nephrectomy (RAPN) has been proposed as a promising operative treatment for renal carcinoma because it enables early recovery and ambulation. Therefore, we aimed to evaluate the analgesic and opioid-sparing effects of a single-injection QLB in patients undergoing RAPN to determine its role in an early recovery program.MethodsFifty-six patients undergoing elective RAPN under general anesthesia were randomized to two equally sized groups. Patients were randomly allocated to receive either a unilateral QLB (n = 28) with 0.375% bupivacaine 0.5 mL/kg (QLB group) or a conventional scheme (n = 28) (control group). The QLB technique, termed QLB2, was performed as first described by Blanco. The primary outcome was visual analog scale (VAS) scores with movement at 6 h postoperatively. The secondary endpoints were morphine consumption at different time periods after surgery, morphine-related side effects, and assessment of postoperative rehabilitation.ResultsBoth the VAS pain scores and cumulative opioid consumption were significantly lower in the QLB group at 6 h after surgery as compared with results in the control group (all P < 0.05). There were significant differences in pain scores at all time points except at 4 h with movement and 48 h at rest. However, at 12–24 h no significant differences between the two groups were observed in cumulative opioid consumption or in the duration of PACU and hospital stays. The patient recovery scores were significantly higher in the QLB group.ConclusionsSingle-injection pre-emptive QLB applied to RAPN was effective and provided satisfactory analgesia and opioid-sparing effects in combination with typical patient-controlled analgesia. In addition, it may provide an effective technique for early recovery in the perioperative period for RAPN.

Improvement Effect of Comfort Nursing on Pain and Psychological Stress of Patients Undergoing Retroperitoneal Laparoscopic Operation in Urology Department

Improvement Effect of Comfort Nursing on Pain and Psychological Stress of Patients Undergoing Retroperitoneal Laparoscopic Operation in Urology Department

Application of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for patients with multiple renal tumors

Objective To explore the feasibility and safety of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for the patients with multiple renal tumors and solitary kidney or contralateral kidney insufficiency. Methods Seven patients who have undergone retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping between October 2010 and October 2016 were retrospectively analyzed, and clinical materials and parameters during and after the operation were summarized, including operation time, clamping time of segmental renal artery, blood loss during the operation, complications and renal function after the operation. Results Fifteen tumors were resected in 7 patients and the operations were all successful. The operation time ranged from 100 to 180 minutes with the average of 125 minutes; clamping time of segmental renal artery was 10-30 minutes with the average of 23 minutes; the amount of blood loss during the operation was 120-330 ml with the average of 190 ml; hospital stay after the operation is 3-6 d with the average of 5 d. There was no complication during the perioperative period, and the pathology diagnosis after the surgery showed that there were 4 renal clear cell carcinomas, 1 papillary carcinoma and 2 perivascular epithelioid cell tumors and the margins were all negative. All patients were followed up for 3-60 months, and no local recurrence or metastasis was detected, and the creatinine was 102-187 μmol/L at 3 months after operation. Conclusions For the patients with multiple renal tumors and solitary kidney or contralateral kidney insufficiency, retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping was feasible and safe, which minimized the hot ischemia injury to the kidney and preserved the renal function effectively. Key words: Kidney neoplasms; Retroperitoneal laparoscopic operation; Partial nephrectomy; Segmental renal artery; Sequential clamping

Bilateral adrenalectomy: a review of 10 years' experience.

INTRODUCTION The 2012 British Association of Endocrine and Thyroid Surgeons audit report showed that only 86 of 1359 patients who underwent adrenalectomy had a bilateral operation; thus the experience with this procedure remains limited. METHODS Retrospective review of patients undergoing bilateral adrenalectomy in a tertiary referral centre. RESULTS Between November 2005 and January 2016, bilateral adrenalectomy was performed in 23 patients (6 male, 17 female, age 43 ± 4 years) diagnosed with Cushing's disease (n = 13), hereditary phaeochromocytomas (n = 6), adrenocortical cancer (n = 2), colorectal metastatic disease (n = 1) and adrenocortical adenomas (n = 1). A laparoscopic transperitoneal approach was used in 17 patients, with one conversion to open. Three patients had open adrenalectomies for adrenocortical cancer and for simultaneous phaeochromocytomas and pancreatic neuroendocrine tumours in a patient with Von Hippel-Lindau syndrome. Three patients with Cushing's had a bilateral retroperitoneoscopic operation. The mean operating time was 195 ± 16 minutes for laparoscopic operations (n = 16), 243 ± 44 minutes for open adrenalectomies (n = 4) and 151 ± 12 minutes for retroperitoneal operations. It was significantly shorter for Cushing's disease than for phaeochromocytomas (162 ± 8 vs. 257 ± 39 minutes, P < 0.01). Median length of hospital stay was 5 days. Postoperative complications (Clavien-Dindo classification) included one chest infection (level 2), one postoperative haemorrhage and two chest drains for pneumothorax (level 3), two postoperative cardiac arrests (level 4) and one late cancer death from complications related to uncontrolled hypercortisolism (level 5). DISCUSSION Synchronous bilateral adrenalectomy remains an infrequent operation. The laparoscopic approach is feasible in the majority of patients. It is likely that the retroperitoneoscopic adrenalectomy will become the standard approach for bilateral operations.

Unusual variant of infrarenal duplication of inferior vena cava

Infrarenal inferior vena cava (IVC) duplication is a rare anomaly. Most of the cases are asymptomatic and are detected incidentally. Prior knowledge of the anomaly is essential for safe procedure by intervention radiologist, retroperitoneal operation, and multi-visceral recovery operation from deceased donor by surgeon. We report a case of infrarenal IVC duplication detected incidentally during contrast-enhanced computed tomography examination of abdomen of a patient presenting with viral hepatitis and mild obstructive jaundice.

A Case of Successful Extracorporeal Membrane Oxygenation Support for Cardiac Arrest Associated with Nonocclusive Mesenteric Ischemia

Background: We report a case of successful extracorporeal membrane oxygenation (ECMO) support for cardiac arrest associated with nonocclusive mesenteric ischemia (NOMI). Case presentation: A 34-year-old previously healthy woman in the sixth week of her second pregnancy was carried to our hospital for abdominal pain and vomiting. She had apparent peritoneal irritation signs with marked hyperglycemia and metabolic acidosis and developed refractory shock. Since portal venous gas and intestinal dilatation without enhancement in contrast-enhanced computed tomography (CT) were observed, a subtotal resection of the small intestine and right hemicolectomy against widespread intestinal necrosis were performed as an emergency operation. The patient returned to the intensive care unit (ICU) with open abdominal management. Severe respiratory failure gradually developed during the operation, and veno-venous (V-V) ECMO was prepared to start in the ICU after the operation. However, cardiac arrest occurred abruptly during the cannulation for ECMO. Therefore, veno-arterial (V-A) ECMO was implemented and hemodynamic status gradually improved. V-A ECMO was switched to V-V ECMO on Day 4 because of persistent respiratory failure. Colostomy was performed on Day 5, abdominal wall was closed on Day 8, and ECMO was successfully weaned off on Day 9. Furthermore, several surgical interventions including gauze packing for retroperitoneal bleeding and operation for intestinal dehiscence, and right lower extremity amputation were needed. She was free from the ICU on Day 78. Finally, closure of the colostomy and anastomosis of the residual duodenum and colon were performed, and the patient was discharged from the hospital without any neurologic impairment on Day 262. Conclusion: Successful surgical interventions and appropriate ECMO support contributed to the patient’s survival.

Lateroconal fascia suspension for management of peritoneal tear and "curtain" effect during retroperitoneal laparoscopic operations.

To describe the method of lateroconal fascia suspension for the management of peritoneal tear and curtain effect during retroperitoneal laparoscopic operations. Between May 2013 and October 2014, we performed lateroconal fascia suspension in 30 cases of retroperitoneal laparoscopic operations. Peritoneal tear occurred and retroperitoneal space collapsed in 18 cases of them during the operation, and free edge of the lateroconal fascia caused curtain effect and sheltered the field of view in another 12 cases after the lateroconal fascia was incised longitudinally. The curtain effect of lateroconal fascia was eliminated successfully, and the sheltered field of view got normal in all the 12 cases. The collapsed retroperitoneal space due to peritoneal tear got enlarged effectively and was sufficient for the following operations in 15 patients of the overall 18 cases, while the collapsed retroperitoneal space did not get enlarged significantly in the other three cases. After the insertion of an extra 5-mm trocar into peritoneal space, the collapsed retroperitoneal space got enlarged eventually. Finally, retroperitoneal laparoscopic operations were continued and completed successfully in all these 30 patients. It took 4min to complete the suspension procedure, and no related complications occurred during the whole suspension process. Lateroconal fascia suspension method could manage most peritoneal tears and curtain effect effectively during retroperitoneal laparoscopic operations.

Comparison of curative effect of three kinds of operation method for varicocele

Objective To evaluate clinical application value and curative effect of laparoscopic,retroperitoneal open operation and microscopical treatment of varicocele.Method 85 cases of varicocele who were treated with three kinds of operation method in our hospital from 2005 to 2013 were randomly selected.Results All patients selected had fast recovery after surgery,without recurrence and atrophy of testis.Sperm quality in 77 patients improved in varying degrees after surgery.Sperm count and activity rate after operation were significantly higher than those before operation,with statistically significant difference (P ＜ 0.01).Postoperative pregnancy rate was 25％.Spermiogenesis function in 8 patients did not improve obviously after surgery,whose preoperative sperm count was ＜ 10 × 106/ml.Conclusions Regardless of the degree of varicocele,once bad semen quality is found,and other causes ruled out,operation should be taken as soon as possible.There is no difference between three kinds of operation method for side varicocele,laparoscopic surgery is more appropriate for recurrent and bilateral varicocele. Key words: Varicocele; Three kinds of operation method; Male infertility

Effect of retroperitoneal laparoscopic operation on immune function and neuroendocrine function in patients with renal cell carcinoma

Objective To explore the effect of retroperitoneal laparoscopic operation on immune function and neuroendocrine function in patients with renal cell carcinoma,and to evaluate clinical efficacy of retroperitoneal laparoscopic operation in treatment of renal cell carcinoma.Methods The clinical data of 36 patients subject to laparoscopic radical nephrectomy (LRN) and 27 patients with open radical nephrectomy (ORN) for renal cell carcinoma in our department from January 2010 to January 2013 were analyzed retrospectively.The renal cell carcinoma was diagnosed by preoperative ultra-sound,CT or MRI,and postoperative pathological examination.The clinical stage was T1-T2,and N0M0 in all patients.The diameter of tumors ranged 2.3-9.8 cm (5.6 cm on average),and tumor was solitary.The efficacy was evaluated by the duration of operative time,blood loss during operation and postoperative hospital stay between two groups.The changes of immune function (CD3+,CD4+,CD8+,CD4+/CD8+) and neuroendocrine function [β-endorphin,Adrenocorticotrophin (ACTH),cortisol] in patients with renal cell carcinoma before and after surgical operation were examined.Results The 63 patients were operated successfully,and there were no severe perioperative complications.Blood loss during operation was (95.0 ± 29.5) ml in LRN group and (112.8 ±31.3) ml in ORN group (P ＜0.05).The mean postoperative hospital stay was (7.1 ± 1.3) days in LRN group and (8.7 ± 1.7) days in ORN group (P＜0.05).No significant difference in operative time was noted between two groups (P ＞ 0.05).After surgical operation,the proportion of CD3 +,CD4+ and CD4 +/CD8 + in LRN group was significantly higher than in ORN group (P ＜0.05),and the levels of β-endorphin,ACTH and cortisol in LRN group were significantly lower than those in control group (P ＜0.05).Average postoperative follow-up duration was 14 months (range 3-33) in 61 patients.Imaging examinations showed no recurrence or metastasis in all patients,and no patients had longterm complication.Conclusion Retroperitoneal laparoscopic operation has advantages of clearer vision,less trauma,less blood loss,faster postoperative recovery,and shorter hospital stay.In the treatment of localized renal cell carcinoma,LRN has more advantages than ORN because LRN can protect immune function better and reduce stress response better. Key words: Renal cell carcinoma ; Laparoscopic operation ; Radical nephrectomy ; Immune function

Measures to prevent ureteric injury in rectal cancer surgery

The majority of ureteric injury is iatrogenic during surgical procedures especially pelvic and retroperitoneal operations. Approximately 10% of ureteric injury is associated with colorectal procedures. The major cause is anatomical anomaly. The types of injuries mainly include contusion, clamp injury, ligation injury, cautery, cut injury and distorted traction to an acute angle. The injuries are mainly located in the lower segment of the ureter. An accurate evaluation of the risk of ureteric injury before rectal cancer operation, a better understanding of anatomy in both normal and abnormal conditions, and ureteral stent placement, are important methods to prevent ureteric injury. Primary repair is the best treatment option.

Three important components in the regeneration of the cavernous nerve: brain-derived neurotrophic factor, vascular endothelial growth factor and the JAK/STAT signaling pathway

Retroperitoneal operations, such as radical prostatectomy, often damage the cavernous nerve, resulting in a high incidence of erectile dysfunction. Although improved nerve-sparing techniques have reduced the incidence of nerve injury, and the administration of phosphodiesterase type 5 inhibitors has revolutionized the treatment of erectile dysfunction, this problem remains a considerable challenge. In recent years, scientists have focused on brain-derived neurotrophic factor and vascular endothelial growth factor in the treatment of cavernous nerve injury in rat models. Results showed that both compounds were capable of enhancing the regeneration of the cavernous nerve and that activation of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway played a major role in the process.

To explore treatment of neurogenic tumors of the peripheral nerve

To discuss the clinical features and surgical tactics of neurogenic tumors external spinal canal. The investigators retrospectively analyzed the clinical data of 56 cases with neurogenic tumors external spinal canal as confirmed by pathology at our department from January 2000 to June 2010. And the follow-up results were tracked. Among the patients, 51 cases underwent microsurgery and 5 cases routine retro-peritoneal operation. Fifty cases received total resection and 5 cases subtotal resection. Partial tumor removal was performed in 1 case with multiple Schwannoma only because nerve roots were densely distributed around the tumor. Postoperative complications included declining myodynamia (n = 3), extremity pain (n = 2), topical sensory disturbance (n = 7), hoarseness (n = 5), ipsilateral facioplegia & hypophysis (n = 1) and Horner's syndrome (n = 2). Thirty-six cases had a follow-up period of 0.5 year to 10 years. No in situ recurrence was found in 34 cases. Two cases with in situ recurrence were re-operated. There was no operative death. The surgery of neurogenic tumors external spinal canal can improve the symptoms and quality of life for the patients. A better outcome is based on anatomic familiarity and skilled micromanipulation. The key aspects of tumor resection are a maximal protection of proximal important vessels and nerves and thorough tumor dissection.

Retroperitoneal laparoscopic operation of stones diverticulum stones :a report of 4 cases

Objective To evaluate the therapeutic efficacy of retroperitoneal laparoscopic operation of stones diverticulum calculi.Methods The clinical data of 4 patients(3 men and 1 woman) who received retroperitoneal laparoscnpic operation of stones diverticulum calculi from February 2004 to February 2008 were reviewed retrospectively.The patient age ranged from 23 to 64 years (mean,43.5 years).The stones divertieular calculi were found on the fight side in 1 case,left side in 3.Among them there were 1 cases at the upper pole of the kidney,1 at the middle and 2 in the lower pole.2 cases had experienced unsuccessful extracorporeal chock wave lithotfipey,and 1 failed with minimally invasive percutaneous nephrolithotomy,Results The procedure was successful in all the 4 cases.The operative time ranged from 90 to 240 min (mean,115 min).The intraoperative blood loss ranged from 50 to 120ml (mean,7Oral).The hospital stay was 7～10 days (mean,8 days).Double J tube drainage was 4～6 weeks.During the.follow-up (3～24 months),KUB and IVU showed no residual stones and stones diverticulum.Conclusions Retroperitoneal laparoscopic treatment is minimally invasive approach for stones diverticulum stones and represents management of the stones diverticulum simultaneously and is worth generalizing in clinic. Key words: Laparoscopes; Stones diverticulum; Stones; Surgical therapy

Cirugía retroperitoneal laparoscópica: Experiencia del Hospital Universitario La Paz

With the popularisation of laparoscopic radical prostatectomy, the above technique has once again taken on an important role in the work of urology departments. Our extensive experience in laparoscopy means that we are performing increasingly more interventions using this approach. In the context of minimally invasive surgical procedures, this is probably bringing clearer benefits to retroperitoneal surgery than to prostatic surgery. In this article, we describe our series over nearly 4 years.The period analysed covers June 2004 to March 2008, during which time 288 retroperitoneal operations were performed (184 nephrectomies, 113 other procedures). In the majority of cases, the route of approach was transperitoneal.The mean hospital stay was 3.6 days for the nephrectomies and 3 days for the other procedures. The transfusion rate for the nephrectomies was 5% and there was a conversion rate of in 2%. In the other types of surgery, the transfusion rate was 6% and there were no conversions.The expansion of laparoscopy in Urology has to be accompanied good patient selection and the progressive acquiring of experience on the part of the surgeon. Certain interventions should only be tackled in cases where there is extensive experience.

Hand-Assisted Laparoscopic Approach to Renal Harvest for Autotransplantation

To describe a laparoscopic hand-assisted approach to renal autotransplantation that allows both harvest and transplant through the same incision. Three patients underwent renal autotransplantation from May 2003 to April 2004, two for loin pain-hematuria syndrome and one for severe ureteral-stricture disease. Two patients underwent autotransplantation on the left and one on the right. Hand-assisted laparoscopy was planned such that inferomedial extension of the hand-port incision would provide adequate exposure of the iliac vessels for autotransplantation. The average operative time was 240 minutes, the warm ischemia time was 2 minutes 43 seconds, and the hospital stay was 3 days. All three patients had successful graft function by postoperative renal scan with a mean follow-up of 7.1 months. Hand-assisted laparoscopic renal harvest for autotransplantation can be completed with placement of the hand port such that transplantation can be accomplished through the same incision. As many of these patients have had multiple prior retroperitoneal operations, the intracorporeal hand can greatly facilitate these potentially difficult dissections with no added morbidity.

Retroperitoneal laparoscopic management of primary aldosteronism with report of 130 cases

To evaluate retroperitoneal laparoscopic partial or total adrenalectomy for primary aldosteronism. From February 2000 to September 2003, 130 patients (76 women and 54 men) with a confirmed diagnosis of primary aldosteronism underwent retroperitoneal laparoscopic operation. Of the 130 cases, there were 119 cases with Aldosterone-producing Adenoma and 11 cases with Idiopathic Adrenal Hyperplasia (unilateral of 2 cases). Eleven cases with Idiopathic Adrenal Hyperplasia underwent unilateral adrenalectomy. Of the 119 cases with Aldosterone-producing Adenoma, 61 cases underwent total adrenalectomy, and 58 cases underwent partial adrenalectomy. All cases were with preoperatively high plasma aldosterone, low plasma rennin and hypokalemia and arterial hypertension. Operations were successfully performed in all cases. The operative time ranged from 15 to 225 min (mean 52 +/- 40 min, Md = 43 min) and the operative bleeding ranged from 0 to 200 ml (mean 23 +/- 34 ml, Md = 20 ml, zero bleeding means that less than 5 ml) without blood transfusion. The hospital length of stay was ranged from 3 to 9 d (mean 5.1 +/- 1.3 d). No major complication occurred. Kalemia was normalized within one month and aldosterone/PRA ratio was decreased obviously in all cases. Postoperatively blood pressure was normalized within 2 month in 88 cases without using any drug. It is safe and practical to perform retroperitoneal laparoscopic partial on total adrenalectomy on the patients with primary aldosteronism.

Major postoperative complications secondary to use of the Bookwalter self-retaining retractor

Objectives To report on five serious intraoperative damages to nonprocedure-related organs during 10 years of experience with the Bookwalter device. Self-retaining retractors are helpful devices, particularly during major transperitoneal and retroperitoneal operations. Various retractors are available and allow the use of all combinations of blades to maintain exposure during each step of an operation. Furthermore, by using these devices, most operations can be performed by two surgeons only. Methods With the help of the operation protocols, more than 4000 applications of the Bookwalter device between January 1992 and December 2001 were retrospectively reviewed. Four cases with damage to the large bowel and one of femoral neuropathy were documented. Results In one transperitoneal and three retroperitoneal approaches, serious damage to the large bowel occurred. None was recognized before postoperative days 2 and 7. One femoral neuropathy was noted. Conclusions The Bookwalter self-retaining retractor is a helpful and safe device in exposing the intraoperative situs. However, care must be taken in patients with risk factors, such as immunosuppression and diverticulitis, and particularly in retroperitoneal operations when tightening the blades. When the intra-abdominal cavity is not exposed, damage to other organs may not be directly noted, which could explain the delay of several days to the onset of symptoms.

Primary and postoperative retroperitoneal fibrosis—experience with 18 cases

Objectives Retroperitoneal fibrosis (RPF) is an uncommon disease complicated by ureteral entrapment. Its etiology includes several medications, periaortic inflammation, abdominal and retroperitoneal operations, radiotherapy, and malignancy. We present 18 patients, 14 of whom developed RPF after surgery and radiotherapy. Methods During the past 12 years, we treated 7 women and 11 men. The diagnosis was based on intravenous urography, retrograde pyelography, and computed tomography features. Computed tomography-guided or intraoperative biopsies were taken to differentiate benign from malignant fibrosis. In all patients, percutaneous stent nephrostomies or internal stents were inserted before surgery. The operation included ureterolysis with an omental flap or ureteral reimplantation. Follow-up included renal function tests, intravenous urography, and computed tomography. Results The mean patient age was 57.3 years (range 36 to 85). Fourteen patients developed RPF after abdominal or retroperitoneal surgery. Three had primary RPF and one malignant RPF due to metastatic disease. Six patients also underwent radiotherapy. The mean time between the insults to the diagnosis of RPF was 18.6 months (range 1 to 96). Ten patients had bilateral obstruction. Fourteen patients underwent surgery and four were treated with stenting only. Of the 14 patients who underwent surgery, 10 had a normal intravenous urogram postoperatively and 4 had decreased function of the formerly obstructed kidney. In 1 patient, re-entrapment of the ureter appeared owing to pelvic recurrence of tumor. At last follow-up, 1 patient waits with stents. The mean follow-up time was 22 months (range 4 to 52). Conclusions The etiology of RPF varies. The unique feature of our series was the high incidence of patients who developed RPF after surgery and radiotherapy to the retroperitoneum. Nephrostomy drainage and ureteral stenting facilitated surgery. Ureterolysis combined with wrapping the ureter with an omental flap or re-implantation ensured good anatomic and functional results.

Microsurgical subinguinal varicocelectomy.

Varicocele is the most frequently observed surgically correctable cause of male infertility. Traditional approaches to the surgical repair of varicocele include retroperitoneal and inguinal operations. The incidence of persistent or recurrent varicocele following surgical repair in adults varies from 5 to 45%. Attempts at decreasing the complication and recurrence rates following varicocelectomy have included microsurgical approaches. These methods have the advantage that the testicular artery and lymphatics can be identified and preserved. The use of some microsurgical methods can also decrease the incidence of hydrocele formation and testicular artery injury. We describe our microscopic procedure and report the results obtained with this method.

Controlled balloon dilatation for laparoscopic extraperitoneal bladder neck suspension in patients with previous abdominal surgery.

The balloon dilator is used in a variety of minimally invasive preperitoneal and retroperitoneal operations. In this study, we compared the ability to create an extraperitoneal cavity using a balloon spacer in patients with and without previous abdominal surgery undergoing laparoscopic bladder neck suspension. This prospective study included 38 patients in total, 15 of whom had had previous abdominal wall surgery and 23 who had not. A balloon spacer technique was used to develop the extraperitoneal space. In 80% of the patients with previous surgery, the introduction of the balloon spacer was recorded as simple; in 20%, it was considered difficult. In 78% of the patients without previous surgery, the introduction of the balloon spacer was recorded as simple, in 17% it was difficult, and in 4% it failed. In 80% of the patients with previous surgery, the extraperitoneal view was good or acceptable, in 20% it was poor, and in 13% it failed. In 92% of the patients without previous surgery, the extraperitoneal view was good or acceptable, in 4% it was poor, and in 4% dilatation failed. Morbidity was equally divided between the groups. Previous abdominal surgery is not a contraindication to laparoscopic extraperitoneal surgery using a balloon spacer. The approach carries low morbidity, similar to that in patients without previous abdominal surgery.