Dietz U A, Wiegering A, Germer C T
Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland,
Chirurg. 2014 Feb;85(2):97-104. doi: 10.1007/s00104-013-2591-z.
Hernia surgery is generally a rewarding task, patient satisfaction is high and the long-term results are generally good. Incisional hernias are more heterogeneous and there is a higher variability of morphologies to be matched with the available therapeutic approaches but the majority of patients are also satisfied with the results. This positive scenario for hernia surgery can be largely attributable to careful preoperative planning, effective surgical techniques and a high degree of standardization. The picture is somewhat clouded by the complications associated with hernia surgery. If complications do arise, the outcome largely depends on how well the surgeon responds. For inguinal and femoral hernias, the risk profile of the patient is crucial to the surgical planning and the wrong operation on the wrong patient can be disastrous. Open procedures have complication risks in common but the question of how best to deal with the nerves has yet to be answered. Endoscopic procedures are an indispensable part of the hernia surgery repertoire and the hernia specialist should be proficient in TEP and TAPP techniques. Ventral and incisional hernias have higher complication rates and the treatment is similar despite differences in etiology and pathophysiology. Although open procedures are better for morphological reconstruction they are accompanied by a higher complication rate. Laparoscopic procedures had a severe complication profile early on but the situation has greatly improved today due to continued refinement of the learning curve. A critical approach to the application of methods and meshes, a deep knowledge of anatomical peculiarities and the careful planning of tactics for dealing with intraoperative problems are the hallmarks of today's good hernia surgeon.
疝气手术通常是一项有意义的任务，患者满意度高，长期效果总体良好。切口疝更为复杂多样，需要与现有治疗方法相匹配的形态学变异更高，但大多数患者对手术结果也很满意。疝气手术的这种积极情况很大程度上可归因于仔细的术前规划、有效的手术技术和高度的标准化。与疝气手术相关的并发症使情况略显复杂。如果确实出现并发症，结果很大程度上取决于外科医生的应对能力。对于腹股沟疝和股疝，患者的风险状况对手术规划至关重要，对错误的患者进行错误的手术可能是灾难性的。开放手术有一些共同的并发症风险，但如何最好地处理神经问题尚未得到解答。内镜手术是疝气手术方法不可或缺的一部分，疝气专科医生应精通经腹膜外修补术（TEP）和经腹腔腹膜前修补术（TAPP）技术。腹疝和切口疝的并发症发生率较高，尽管病因和病理生理学存在差异，但治疗方法相似。虽然开放手术在形态重建方面更好，但并发症发生率较高。腹腔镜手术早期并发症情况严重，但由于学习曲线的不断优化，如今情况已大为改善。对方法和补片应用采取批判性方法、深入了解解剖学特点以及仔细规划处理术中问题的策略是当今优秀疝气外科医生的标志。
