Operation der beidseitigen Leistenhernie – Sequenziell oder simultan?

 

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Zusammenfassung

Einleitung: Die Chirurgie der Leistenhernie hat sich durch Einführung spannungsfreier Operationsmethoden radikal verändert. Obwohl die simultane Versorgung bilateraler Hernien zunehmend Verbreitung findet, wird das optimale Vorgehen nach wie vor kontrovers diskutiert. Ziel der vorliegenden Arbeit ist es, die aktuelle Literatur zur Versorgung bilateraler Leistenhernien zu evaluieren. Methoden: Grundlage bildete eine Literaturanalyse der „Cochrane Database of Systematic Reviews”, „Pubmed”, „Embase” und „BMJ Clinical Evidence”. Als Schlagworte dienten: „simultaneous”, „bilateral”, „inguinal” und „hernia”. Bewertet wurden: Anzahl Patienten, Rezidivrate, Komplikationen, Studientyp, Operationstechnik, Nachbeobachtungsdauer und Schlussfolgerung der Autoren. Die Durchsicht der Literatur zeigte relevante Ergebnisse in zwei systematischen Reviews der „Cochrane Database”, 4 Zusammenfassungen in „BMJ Clinical Evidence” und 17 klinischen Untersuchungen. Ergebnisse: Alle bewerteten Arbeiten zeigen keine Unterschiede bezüglich Rezidiv- und Komplikationsrate (simultane bilaterale vs. unilaterale Versorgung). Die Rezidivraten liegen zwischen 0,3 und 19 % (bilateral) und zwischen 0,7 und 15 % (unilateral). Komplikationen werden uneinheitlich angegeben und schwanken zwischen 2,5 und 26,7 % (bilateral) und 3 und 21 % (unilateral). Sämtliche Operationsverfahren (offene Naht: Shouldice; offene Netzverfahren: Lichtenstein, Stoppa; laparoskopische Verfahren: TAPP, TEP) sind zur simultanen Versorgung bilateraler Hernien geeignet. Schlussfolgerung: Die simultane Versorgung bilateraler Leistenhernien ist sicher und im Vergleich zu unilateraler Versorgung mit vergleichbaren postoperativen Schmerzen und Dauer der Rekonvaleszenz durchführbar. Postoperative Komplikationen und Rezidivrisiko sind nicht erhöht. Nur symptomatische beidseitige Leistenhernien sollten operiert werden. Liegen keine gravierenden Gründe wie Übergewicht oder eine monströse Hernie vor, sollte die Versorgung simultan erfolgen. Die Wahl der Methode richtet sich nach dem Standardverfahren des Hernienzentrums. Eine spezielle Operationsmethode für bilaterale Leistenhernien ist nicht erforderlich und gerechtfertigt. 

Abstract

Introduction: Surgery of inguinal hernia has changed dramatically with the introduction of tension-free hernia repair. There is still some controversy regarding the treatment of bilateral inguinal hernia, but simultaneous operation has gained popularity. The purpose of the present paper is to evaluate recent publications regarding treatment of bilateral inguinal hernia. Methods: For this article, the “Cochrane Database of Systematic Reviews”, “BMJ Clinical Evidence”, “Pubmed” and “Embase” were searched using the search terms “simultaneous”, “bilateral”, “inguinal” and “hernia”. Number of patients, recurrence rate, complications, study type and authors' conclusions were evaluated. Analysis of the literature showed relevant results in two reviews of the “Cochrane Database”, 4 items in “BMJ Clinical Evidence” and 17 clinical studies. Results: No study showed a difference between recurrence and complication rate (simultaneous bilateral vs. unilateral repair). Recurrence rates were from 0.3 to 19 % (bilateral) and from 0.7 to 15 % (unilateral). Complications were defined heterogeneously and were in a range from 2.5 to 26.7 % (bilateral) and from 3 to 21 % (unilateral). All operative procedures (open suture: Shouldice; open mesh: Lichtenstein, Stoppa; laparoscopic techniques: TAPP / TEP) are adequate for the repair of bilateral hernia. Conclusion: The simultaneous operation of bilateral hernia is safe and effective. Postoperative pain and length of reconvalescence are comparable to those of the unilateral operation. Only symptomatic bilateral groin hernias should be operated. If no difficulties such as obesity and giant hernia are expected, bilateral hernias should be repaired simultaneously. The choice of the operative method should be made in accordance to the centre's standard procedure. A special operation for bilateral hernias is neither necessary nor justified. 

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PD Dr. F. Pfeffer

Department of Surgery · University of Bergen

5021 Haukeland Hospital

Norway

Phone: 00 47 / 55 97 50 00

Email: frank-pfeffer@web.de