Belastbarkeit nach abdominellen Eingriffen – Ergebnisse einer Patientenbefragung

Zusammenfassung

Einleitung Narbenhernien (NH) sind häufige Komplikationen nach abdominalchirurgischen Eingriffen und beeinflussen die postoperative Phase der Schonung, indem eine frühe Belastung mit traditionell einem erhöhten NH-Risiko in Verbindung gebracht wird. Evidenz hierzu fehlt jedoch. Einen Zusammenhang zwischen der postoperativen körperlichen Aktivität nach abdominellen Operationen und der Entwicklung von NH untersucht diese Studie.

Material und Methoden Patienten, die 2009 – 2016 eine Laparoskopie (LS) oder Laparotomie (LT) aufgrund einer viszeralchirurgischen Indikation erhielten, wurden mittels eines Fragebogens zur Belastung, zu Beschwerden und zum Auftreten von NH sowie zur Lebensqualität postoperativ befragt. Komplizierte Verläufe (Clavien-Dindo > III), Laparostomaanlagen und Eingriffe im Zusammenhang mit Hernienrekonstruktionen wurden ausgeschlossen.

Ergebnisse 393 Patienten beantworteten den Fragebogen (43,6%) vollständig, dabei waren 274 LS und 128 LT. Die NH-Inzidenz betrug 5,2% (LS) und 18,0% (LT, p = 0,001). NH-Patienten waren jünger und häufiger Männer. Patienten mit NH erreichten in 30,5% postoperativ keine Vollbelastung. Die Verwendung einer Abdominalbandage hatte keinen Einfluss auf die NH-Rate. Die Lebensqualität war für die NH-Gruppe eingeschränkt, sowohl auf psychischer als auch physischer Ebene.

Schlussfolgerung Die frühe schmerzadaptierte Belastung nach abdominalchirurgischen Eingriffen stellt in dieser Studie keinen Risikofaktor für die Entwicklung von Narbenhernien dar. Die prospektive Evaluation liberaler postoperativer Aufbelastungsregime ist notwendig.

Abstract

Introduction Incision hernias are common complications after abdominal surgery and affect the recommendations on postoperative physical strain, as it is thought that excessively early strain causes incisional hernias. However, there is no evidence to justify this. This study evaluates the effect of postoperative strain on the risk of incisional hernia.

Materials and Methods Patients with a laparoscopy (LS) or laparotomy (LT) were asked to complete a questionnaire on postoperative strain, complaints and quality of life. Patients with hernia surgery, or open abdomen therapy for complicated courses (Clavien-Dindo > III) were excluded.

Results 393 patients completed the questionnaire (43.6%). 274 were LS and 128 LT. The incidence of incisional hernias was 5.2% (LS) and 18.0% (LT, p = 0.001). Incisional hernia patients were younger and more commonly males. 30.5% of incisional hernia patients did not return to normal physical strain postoperatively. Abdominal binders did not affect the hernia rate. The incisional hernia patients showed decreased quality of life scores in both mental and physical domains.

Conclusion Early postoperative physical strain was not a risk factor for incisional hernia development in this study. However, prospective studies are needed to create necessary evidence to recommend earlier postoperative return to normal physical strain.

Schlüsselwörter

Narbenhernie - Arbeitsfähigkeit - individuelle Vollbelastung - Laparoskopie - Laparotomie - Viszeralchirurgie

Key words

incisional hernia - return to work - physical strain - laparoscopic surgery - laparotomy - abdominal surgery

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