Kapischke Matthias, Schulz Tim, Schipper Thorsten, Tensfeldt Jochen, Caliebe Amke
Department of Surgery, Martin Luther Hospital, Lutherstrasse 22, 24837 Schleswig, Germany.
Surg Endosc. 2008 Oct;22(10):2251-60. doi: 10.1007/s00464-008-9773-7. Epub 2008 Mar 5.
Incisional hernias after laparotomy are a large financial burden for society as well as for the patients suffering from pain and limitations of activity over time. The introduction of alloplastic materials such as polypropylene seems to improve the results. The question of whether to apply open or laparoscopic implantation of the mesh is of ongoing interest. We compare the available alloplastic materials and try to clarify the question of whether the laparoscopic procedure is superior to the conventional (open) technique based on the available randomized studies.
All available meshes for intraperitoneal and extraperitoneal implantation were described regarding their handling and their pros and cons. A database search (PubMed, Medline, Ovid, and in the secondary literature) was carried out to retrieve all randomized studies comparing laparoscopic and open hernia repair. Data were reviewed by two independent scientists for surgical and statistical design.
The ideal mesh for a laparoscopic maintenance of abdominal wall hernias as well as the optimal fixation of the mesh has not been found yet. Recent available literature shows no evidence demonstrating the superiority of one of these meshes. The available studies found a lower infection rate, but higher occurrence of seroma for the laparoscopic procedure. The value of the different studies is reduced due to deficiency in study design and power. Guidelines for further studies are discussed to avoid surgical and statistical pitfalls.
Laparoscopic incisional hernia repair shows, in some (randomized) studies as well as a large number of retrospective analyses and in case control studies, superiority compared to conventional hernia repair. Long-term results with a high level of evidence are not available. Additional well-designed randomized trials including long-term observation of patients are required in order to clarify a number of interesting questions.
剖腹手术后的切口疝对社会以及长期遭受疼痛和活动受限折磨的患者而言是一项巨大的经济负担。诸如聚丙烯等异体材料的引入似乎改善了治疗效果。关于采用开放还是腹腔镜方式植入补片的问题一直备受关注。我们比较了现有的异体材料，并试图基于现有的随机研究阐明腹腔镜手术是否优于传统（开放）技术这一问题。
描述了所有可用于腹腔内和腹膜外植入的补片的操作方法及其优缺点。进行了数据库检索（PubMed、Medline、Ovid以及二次文献）以检索所有比较腹腔镜和开放疝修补术的随机研究。由两名独立的科学家对数据的手术和统计设计进行审查。
尚未找到用于腹腔镜修补腹壁疝的理想补片以及补片的最佳固定方法。最近的现有文献没有证据表明这些补片中任何一种具有优越性。现有研究发现腹腔镜手术的感染率较低，但血清肿的发生率较高。由于研究设计和效能的不足，不同研究的价值有所降低。讨论了进一步研究的指导原则以避免手术和统计方面的缺陷。
在一些（随机）研究以及大量回顾性分析和病例对照研究中，腹腔镜切口疝修补术显示出优于传统疝修补术。目前尚无具有高水平证据的长期结果。需要进行更多设计良好的随机试验，包括对患者的长期观察，以阐明一些有趣的问题。
