Leistenhernienversorgung: Laparoskopisch oder konventionell?

Zusammenfassung

Hintergrund: Netzverfahren dominieren die Versorgung von Leistenhernien. Es stellt sich jedoch weiterhin die Frage, ob offene oder laparoskopische Verfahren bevorzugt werden sollten. Methode: Anhand von Meta-Analysen und großen prospektiven Studien werden die laparoskopischen und die offenen Operationsverfahren mit Netz hinsichtlich Rezidivrate, der Rate an chronischen Schmerzen, Rekonvaleszenz, Komplikationen und Kosten miteinander verglichen. Ergebnisse: Während zwischen offenen und laparoskopischen Netzverfahren kein Unterschied in der Rezidivrate besteht, zeigen die laparoskopischen Verfahren Vorteile in der Morbidität, der Rekonvaleszenz und besonders in dem selteneren Auftreten chronischer Leistenschmerzen. Die offenen Netzverfahren zeigen Vorteile hinsichtlich der seltenen schweren intraabdominellen Komplikationen und der besseren Kosteneffektivität. Schlussfolgerung: Sowohl laparoskopische als auch offene Netzverfahren sind in der Versorgung von Leistenhernien sicher und effektiv. Jedes Verfahren ist mit Vor- und Nachteilen behaftet, sodass die Datenlage es nicht zulässt, eines der aktuellen Verfahren als Gold-Standard zu definieren.

Abstract

Background: Today, mesh repair is the preferred technique in surgery of inguinal hernia. Whether the mesh should be placed laparoscopically or by open techniques is still controversial. Methods: A comparison of open mesh and laparoscopic techniques was made with the help of meta-analyses and prospective trials. Outcome variables analysed were recurrence, chronic pain, recovery, morbidity and costs. Results: With regard to recurrence rates, both techniques gave comparable results. The laparoscopic technique shows advantages in terms of morbidity, recovery and especially a lower rate of chronic pain. Open mesh repair has the advantage of a lower risk of some rare severe intra-abdominal complications and seems to be more cost-effective. Conclusion: Both techniques of inguinal hernia repair are effective and safe. Each technique has its advantages and disadvantages. Therefore, today no single technique can be recommended as a gold standard.

Leistenhernien - Netz - Laparoskopie - Chirurgie

inguinal hernia - groin hernia - mesh - laparoscopy - surgery

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