[The mesh prosthesis, indispensable component in safe hernia repair?].
The recent and actually ongoing development does not allow to design an undeniable state of the art strategy for the repair of primary and recurrent hernias at this moment. For primary hernias the posterior approach with placement of a prosthetic mesh, whether conventionally or endoscopically, is not yet a recommendable common standard. However, due to its potential advantages the endoscopic mesh hernioplasty is a choice to be offered to the patients with informed (including alternative methods) consent. Less invasive, simple techniques will remain or become the methods of first choice; Shouldice might keep its importance but Lichtenstein (a method using a mesh!) will spread out in the near future. For the repair of recurrent hernias the posterior, prosthetic hernioplasty- by the open or more and more by the endoscopic route-has become a new standard in a lot of institutions. In this situation the more invasive anaesthesia and implantation of a foreign body is easily justifiable. Surgeons strictly adhering to the anterior approach, might intraoperatively decide to perform an "anterior onlay" according to Lichtenstein or an "anterior sublay" according to Rives. Thus, the use of a prosthetic mesh for hernia repair is becoming more and more common, by the anterior approach for the primary hernia, mostly by the posterior (endoscopic) approach for the recurrent hernia.
Schlumpf
R
R
Departement Chirurgie, Universitätsspital Zürich.
Schöb
O
O
Röthlin
M
M
D004724:Endoscopy / Q000379:methods; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D007813:Laparotomy / Q000379:methods; D012008:Recurrence; D013526:Surgical Mesh
Die Netzprothese, unumgänglicher Bestandteil in der sicheren Hernienversorgung?