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Der Chirurg

, Volume 85, Issue 2, pp 112–116 | Cite as

Rezidiv nach Hernienplastik: Komplikation oder natürlicher Verlauf?

  • A. Kohler
  • G. BeldiEmail author
Leitthema

Zusammenfassung

Die Rezidivhäufigkeit nach Hernienplastik ist ein Qualitätsmerkmal der chirurgischen Technik. Für eine korrekte Beurteilung der Rezidivrate muss zwischen einem klinisch relevanten, klinisch irrelevanten und einem Pseudorezidiv unterschieden werden. Bei der chirurgischen Therapie von Inguinalhernien werden mit den heutigen Techniken mittels laparoskopischer oder offener Netzeinlage sehr niedrige Rezidivraten erreicht. Somit soll bei einem Rezidiv nach einer Inguinalhernienoperation von einer chirurgischen Komplikation ausgegangen werden. Im Gegensatz zur Inguinalhernie liegt die Rezidivrate bei der Operation großer Narbenhernien trotz stetiger Optimierung der Technik weiterhin über 10 %. Um das Rezidivrisiko abzuschätzen, müssen nebst der Größe und Lokalisation der Hernie technische und patientenspezifische Aspekte beurteilt werden. Je nach Risikoprofil kann das Hernienrezidiv in seltenen Fällen dem natürlichen Verlauf entsprechen.

Im Allgemeinen werden Hernienrezidive als Abweichung von der Norm wahrgenommen und können von der Indikation, Wahl der Operation und der chirurgischen Technik und Taktik abhängen. Somit soll der Chirurg ein postoperatives Rezidiv in erster Linie als Komplikation und nicht als natürlichen Verlauf ansehen, mit dem Ziel die Chirurgie kontinuierlich zu verbessern.

Schlüsselwörter

Inguinalhernie Narbenhernie Rezidivrate Komplikationsrate Risikofaktoren 

Recurrence after hernia surgery: complication or natural course?

Abstract

Recurrence after hernia surgery remains a relevant measure of surgical quality. In order to correctly assess the recurrence rate the surgeon needs to distinguish clinical relevant recurrence, clinically irrelevant recurrence and pseudo-recurrence. Current surgical techniques for inguinal hernia repair using mesh are associated with a low rate of recurrence. Thus, recurrence after inguinal hernia surgery is seen as a surgical complication. Conversely, the recurrence rate for large incisional hernias remains above 10 % and in rare cases a recurrence might represent the natural course. Recurrent hernia can depend on the indication, choice of operation and surgical technique. Therefore, postoperative hernia recurrence probably does not represent the natural course but rather a surgical complication that needs to be prevented by an optimized surgical technique.

Keywords

Inguinal hernia Incisional hernia Recurrence rate Complication rate Risk factors 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Kohler und G. Beldi geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Universitätsklinik für Viszerale Chirurgie und MedizinInselspitalBernSchweiz

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