Schmedt C-G, Leibl B J, Bittner R
Department of General Surgery, Marienhospital, Boeheimstrasse 37, D-70199 Stuttgart, Germany.
Dig Surg. 2002;19(6):511-7. doi: 10.1159/000067607.
This article provides an overview of randomized studies which compare endoscopic hernia repair techniques (TAPP/TEP) with the Shouldice and Lichtenstein repair.
Systematic analysis of 33 published studies which meet the criteria of a randomized controlled trial with a high evidence level.
The majority of the studies document statistically significant advantages of the endoscopic repair techniques in relation to wound pain (15/22), need for analgesics (16/21), return-to-work time (16/22) and physical activity (18/25), although only one study showed significant advantages of the Lichtenstein method. Six of 28 studies showed a lower morbidity in comparison to open approaches, although 22 of 28 studies documented no significant difference. The first long-term studies with follow-up periods between 5 and 6 years also show advantages of the endoscopic techniques.
Even with cautious interpretation of the data, it is clear that endoscopic techniques are more comfortable for patients and that morbidity is no higher than for open procedures. Due to the short follow-up periods final evaluation regarding long-term complications and recurrence is not yet possible.
本文概述了比较内镜疝修补技术（TAPP/TEP）与肖尔代斯（Shouldice）修补术和利chtenstein修补术的随机研究。
对33项已发表的符合高证据水平随机对照试验标准的研究进行系统分析。
大多数研究表明，内镜修补技术在伤口疼痛（15/22）、镇痛需求（16/21）、恢复工作时间（16/22）和体力活动（18/25）方面具有统计学上的显著优势，尽管只有一项研究显示利chtenstein方法具有显著优势。28项研究中有6项显示与开放手术相比发病率较低，尽管28项研究中有22项记录无显著差异。随访期为5至6年的首批长期研究也显示了内镜技术的优势。
即使对数据进行谨慎解读，很明显内镜技术对患者来说更舒适，且发病率不高于开放手术。由于随访期短，目前尚无法对长期并发症和复发进行最终评估。
