Die endoskopische Leistenhernienreparation im Vergleich zu offenen Operationsverfahren: Was ist Evidence-basiert? Eine systematische Literaturübersicht randomisierter Studien

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Abstract
At present a range of randomized, controlled trials is available for the evaluation of endoscopic inguinal hernia repair (TAPP/TEP) in comparison to open techniques. This paper summarizes the results of these trials. The aim is to investigate whether the expectations placed on the endoscopic operation techniques have been fulfilled, especially in regard to low wound pain and need for an algesics as well as speedier restoration of physical activity and fitness for work, and whether this possible advantage for the patient is in any way connected to increased risks or a higher recurrence rate. The evaluation covered 45 randomized trials which were published from 1994 to 1999. Due to the inhomogeneous structure and the differing methods of data presentation, a quantitative meta-analysis was only possible for few variables, so that for the most part a qualitative analysis was carried out. The majority of the trials documented statistically significant advantages of the endoscopic repair techniques in regard to wound pain (25/37), need for analgesics (21/27), physical activity (26/33) and fitness for work (21/31), whereby none of the trials produced significant advantages of an open technique in these parameters. 26 of 38 studies showed no significant difference in morbidity rates, while 9 of 38 studies documented a lower morbidity rate for the endoscopic operation techniques in comparison with open techniques. Taking into account all the restrictions which necessarily arise when interpreting data in the literature, it becomes clear that endoscopic techniques for the repair of inguinal hernia offer greater comfort for the patient and that morbidity is not higher when compared to open methods. Because of the short postoperative observation period, a conclusive evaluation of long-term complications and recurrence rates is not yet possible.

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