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Die evidenzbasierte TEP-Technik

Evidence-based TEP technique

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Zusammenfassung

In den Guidelines aller internationaler Herniengesellschaften werden die laparoendoskopischen Techniken TEP (total extraperitoneale Patchplastik) und TAPP (transabdominale präperitoneale Patchplastik) sowie die offene Lichtenstein-Operation als bevorzugte Verfahren zur Behandlung der elektiven Leistenhernie empfohlen. Die Lernkurve der laparoendoskopischen Techniken, besonders der TEP, ist aufgrund der Komplexität der Eingriffe länger als für die offene Lichtenstein-Technik. Dementsprechend ist es bei den laparoendoskopischen Techniken besonders wichtig, dass die Operationen in standardisierter Weise nach den evidenzbasierten Empfehlungen der technischen Details durchgeführt werden. Beim strikten Vorgehen nach den Guidelines der internationalen Herniengesellschaften kann bei der TEP mit niedrigen Raten an perioperativen Komplikationen, komplikationsbedingten Reoperationen, Rezidiven und chronischen Schmerzen gerechnet werden. Auch die Überwindung der Lernkurve kann durch leitlinienorientiertes Vorgehen bei der TEP günstig beeinflusst werden. Die technischen Guidelines zur TEP basieren auf Studienergebnissen und der Erfahrung zahlreicher Experten. Deshalb sollten sie unbedingt im chirurgischen Alltag umgesetzt werden.

Abstract

The guidelines of all international hernia societies recommend as procedures of choice the laparoendoscopic techniques total extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) as well as the open Lichtenstein operation for elective inguinal hernia repair. The learning curve associated with the laparoendoscopic techniques, in particular TEP, is longer than that for the open Lichtenstein technique due to the complexity of the procedures. Accordingly, for laparoendoscopic techniques it is particularly important that the operations are conducted in a standardized manner in compliance with the evidence-based recommendations given for the technical details. When procedures are carried out in strict compliance with the guidelines of the international hernia societies, low rates of perioperative complications, complication-related reoperations, recurrences and chronic pain can be expected for TEP. Compliance with the guidelines can also positively impact mastery of the learning curve for TEP. The technical guidelines on TEP are based on study results and on the experiences of numerous experts; therefore, it is imperative that they are implemented in routine surgical practice.

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Correspondence to F. Köckerling.

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Köckerling, F. Die evidenzbasierte TEP-Technik. Chirurg 88, 288–295 (2017). https://doi.org/10.1007/s00104-016-0360-5

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