Zusammenfassung
In der Entwicklung der endoskopischen Hernienreparation konnten sich sowohl begrenzte lokale (mesh-plug) oder intraperitoneale (onlay) Techniken aufgrund ihrer fehlenden Effizienz nicht durchsetzen. Als etablierte Verfahren müssen aktuell die rein extraperitoneale (TEP) sowie die transperitoneale (TAPP) Technik betrachtet werden. Beiden Verfahren gemeinsam ist die Implantation eines flächigen Netz-Implantates, mit dem alle potenziellen Bruchlücken der Inguinalregion sicher überdeckt werden können. Aus größeren Serien lässt sich für beide technische Alternativen eine Rezidivrate von weniger als 1 % darstellen. Die Gesamtmorbidität liegt dabei zwischen 3 und 10 %, wobei als häufigste Komplikation eine lokale Serombildung beschrieben wird. Im Gegensatz zur TAPP ergeben sich für die TEP Einschränkungen im Indikationsbereich, wobei vor allem Vernarbungen im Präperitonealbereich als Hinderungsgrund angeführt werden. Die Evidenz aus den randomisierten Studien zeigt für die endoskopische Operationstechnik (TAPP/TEP) zahlreiche Vorteile im Vergleich zu den konventionellen Alternativen mit und ohne Netzimplantation.
Abstract
During the evolution of endoscopic hernia repair mesh-plug as well as intraperitoneal onlay technique were eliminated because of missing efficacy. In the opposite to that extraperitoneal TEP and transperitoneal TAPP are regarded for routine use. In both methods the preperioneal application of a flat mesh is used, which covers all potential hernia orifices in the inguinal area. The results of several large series are demonstrating a recurrence rate of less than 1 %. The total morbidity is between 3 and 10 %, whereby the most frequent complication is a local seroma. In the opposite to TAPP there are several shortcomings of TEP in the range of the various therapeutic indications. Most frequent reason for that is a preperitoneal scar tissue. The evidence from randomised studies shows numerous issues in advantage to the endoscopic repair techniques compared to the conventional alternatives with or without mesh implantation.
Schlüsselwörter
Leistenbruch - endoskopische Versorgung
Key words
Inguinal hernia repair - endoscopic procedures
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PD Dr. B. J. Leibl
Klinik für Allgemein- und Viszeralchirurgie
Marienhospital
Böheimstr. 37
Chir I
70199 Stuttgart
eMail: bernhardleibl@vinzenz.de
