Indikationen zur laparoskopischen Versorgung gro?er Narbenhernien

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• 作者：Prof. Dr. Dr. U.A. Dietz ; A. Wiegering ; C.-T. Germer
• 关键词：Hernienchirurgie ; Laparoskopie ; Komplikationen ; Risikoprofil ; Rezidivrate ; Hernia surgery ; Laparoscopy ; Complications ; Risk profile ; Recurrence rate
• 刊名：Der Chirurg
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：86
• 期：4
• 页码：338-345
• 全文大小：595 KB
• 参考文献：1.Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13:545-54View Article PubMed
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  9.Wiegering A, Schlegel N, Isbert C et al (2013) Lessons and challenges during a 5-year follow-up of 21 Composix Kugel implantations. Hernia 17:435-43View Article PubMed
  10.Dietz UA, Winkler MS, H?rtel RW et al (2012) Importance of recurrence rating, morphology, hernial gap size, and risk factors in ventral and incisional hernia classification. Hernia (Epub ahead of print)
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• 作者单位：Prof. Dr. Dr. U.A. Dietz (1)
  A. Wiegering (1) (2)
  C.-T. Germer (1)
  
  1. Klinik und Poliklinik für Allgemein-, Viszeral-, Gef??- und Kinderchirurgie, Universit?tsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
  2. Institut für Biochemie und Molekularbiologie, Universit?t Würzburg, Würzburg, Deutschland
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Cardiac Surgery
  Pediatric Surgery
  Plastic Surgery
  Traumatic Surgery
  Vascular Surgery
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1433-0385

文摘

Hernia surgeons and patients have learned to appreciate the advantages of minimally invasive laparoscopic procedures. After overcoming the early learning curve phase, smaller wound surface areas, shorter operation times and briefer hospital stays have become routine. Severe surgery-related complications are rare. Patients with poor risk profiles (e.g. age >-0 years, BMI >-0 and nicotine consumption) profit especially from these advantages. This positive picture is clouded, however, by the need for an intraperitoneal mesh and specifically by the unchanged recurrence rate. The latter is not significantly lowered even by laparoscopic intraperitoneal on-lay mesh (laparoscopic IPOM) procedures. The current literature shows that irrespective of surgical technique, e.g. retromuscular mesh or laparoscopic IPOM, the risk profile and size of the hernia defect are independent factors that determine the prognosis for recurrence. While a cure of incisional hernia is no longer the only goal, the new indication scenario has two main goals: (a) for young patients at low risk or in patients for whom functional and morphological reconstruction of the abdominal wall are of primary importance, an open retromuscular mesh procedure is indicated (despite the higher morbidity) and (b) for older patients and chiefly for patients with a complex risk profile for whom treatment of the ventral hernia symptoms is paramount, laparoscopic procedures are indicated (due to the lower morbidity). This algorithm assumes that the treating surgeons have the requisite expertise and is discussed using the examples of four complex case reports.