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Die evidenzbasierte Lichtenstein-Technik

Evidence-based Lichtenstein technique

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Zusammenfassung

Die Lichtenstein-Operation ist weltweit Nummer 1 der offenen netzbasierten Verfahren bei Leistenbrüchen. Das Prinzip der Lichtenstein-Hernioplastik ist die spannungsfreie Verstärkung der Leistenkanalhinterwand durch eine auf die Fascia transversalis und den M. obliquus internus aufgebrachte Kunststoffprothese. Die aktuelle Operationstechnik wird detailliert beschrieben. Die meist in örtlicher Betäubung durchführbare Lichtenstein-Operation ist einfacher zu lernen und apparativ weniger aufwendig als die laparoendoskopischen Verfahren. Die Rezidivraten nach der Lichtenstein-Operation sind signifikant niedriger als nach Nahtverfahren und vergleichbar mit denen der laparoendoskopischen Techniken. Die Lichtenstein-Hernioplastik ist mit weniger schwerwiegenden Eingeweideverletzungen, aber mehr frühpostoperativen und chronischen Schmerzen assoziiert als das TAPP (transabdominale präperitoneale Hernioplastik) und TEP (total extraperitoneale Hernioplastik) -Verfahren. In Langzeit-Follow-up-Studien sind die chronischen Schmerzraten allerdings vergleichbar.

Abstract

Lichtenstein hernioplasty is the number one technique worldwide for open, mesh-based inguinal hernia repair. The principle of Lichtenstein hernioplasty is the tension-free reinforcement of the abdominal wall by covering the transversalis fascia and the oblique muscles with an artificial patch of mesh. The Lichtenstein technique has been modified since its inception. The technique has the benefits of low costs and a rapid learning curve and can be performed with the patient under local anesthesia. The recurrence rates after the Lichtenstein operation are significantly lower compared to open suture repair and equal to laparoendoscopic techniques. Compared to laparoendoscopic techniques the Lichtenstein operation is associated with less severe visceral lesions but more early postoperative and chronic pain; however, the chronic pain rates in long-term follow-up studies are comparable.

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Correspondence to W. Reinpold.

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W. Reinpold und D. Chen geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Reinpold, W., Chen, D. Die evidenzbasierte Lichtenstein-Technik. Chirurg 88, 296–302 (2017). https://doi.org/10.1007/s00104-017-0402-7

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