Wirth U, Saller M-L, von Ahnen T, Köckerling F, Schardey H M, Schopf S
Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.
Chirurg. 2017 Sep;88(9):792-798. doi: 10.1007/s00104-017-0429-9.
TAPP surgery can be considered as a gold standard in inguinal hernia repair. Patients benefit of a faster reconvalescence and less pain compared to other techniques. TAPP surgery in Germany is performed in an in-patient setting routinely. However, according to European guidelines, inguinal hernia surgery should be considered as day-case surgery whenever possible.
The safety of day-case surgery was examined in relation to postoperative pain, complications, comorbidities, recurrent inguinal hernia and bilateral procedures.
In a retrospective, monocentric study we analyzed 522 elective inguinal hernia repairs using TAPP technique in a specialized hernia center. Supplemental data from Herniamed registry is analyzed.
Parts of the procedures should be performed in an in-patient setting, whereas a much larger number of cases should be carried out as day-case surgeries. Logistic regression analyses show that "age", "bilateral procedures" and "comorbidities" affect the complication rate. "Age" and "recurrent inguinal hernia" are risk factors for an increased need for analgetic medication. Furthermore, we present an actual distribution of day-case vs. in-patient surgeries in inguinal hernia repair based on data from the Herniamed registry.
A much larger part of procedures could safely be carried out as day-case surgeries. Based on a false incentive there is an incorrect steering in the German health system. These procedures cannot be carried out covering the costs as day-surgery cases. If there is no reevaluation of the proceeds of these procedures in a day-case surgery setting, the reasonable quality in treatment is compromised especially in inguinal hernia surgery.
经腹腹膜前疝修补术（TAPP）可被视为腹股沟疝修补的金标准。与其他技术相比，患者康复更快，疼痛更少。在德国，TAPP手术通常在住院环境下进行。然而，根据欧洲指南，腹股沟疝手术应尽可能被视为日间手术。
研究日间手术在术后疼痛、并发症、合并症、复发性腹股沟疝及双侧手术方面的安全性。
在一项回顾性单中心研究中，我们分析了一家专业疝中心采用TAPP技术进行的522例择期腹股沟疝修补术。分析了来自Herniamed注册中心的补充数据。
部分手术应在住院环境下进行，而更多的病例应作为日间手术开展。逻辑回归分析表明，“年龄”“双侧手术”和“合并症”会影响并发症发生率。“年龄”和“复发性腹股沟疝”是增加镇痛药物需求的危险因素。此外，我们根据Herniamed注册中心的数据展示了腹股沟疝修补术中日间手术与住院手术的实际分布情况。
更大比例的手术可以安全地作为日间手术进行。由于错误的激励措施，德国医疗体系存在错误的导向。这些手术作为日间手术进行无法覆盖成本。如果不对这些手术在日间手术环境下的收益进行重新评估，尤其是在腹股沟疝手术中，治疗的合理质量将受到影响。
