Präperitoneale umbilikale Netzplastik (PUMP): Indikationen, Technik und Resultate

Zusammenfassung

Einleitung Das Prinzip der präperitonealen umbilikalen Mesh-Plastik (PUMP) besteht in der extraperitonealen Netzplatzierung hinter der Rektusmuskulatur mit nachfolgendem anterioren Fasziendefektverschluss. Schwierigkeiten können im Rahmen der Dissektion ebenso auftreten wie bei der Netzeinbringung, Entfaltung und Positionierung.

Methodik 81 konsekutive Patienten mit primären umbilikalen oder epigastrischen Hernien zwischen 2 und 4 cm Defektgröße, die zwischen Januar 2015 und März 2018 mittels PUMP-Technik operiert wurden, konnten prospektiv in der Herniamed-Datenbasis erfasst und retrospektiv ausgewertet werden. Es wurde konsistent dieselbe Technik angewendet, aber 3 verschiedene Implantate kamen im Verlauf des Beobachtungszeitraumes zum Einsatz. Diese Arbeit schildert unsere Erfahrungen und Resultate in Bezug auf die jeweils verwendeten Materialien.

Resultate Es gab keine intraoperativen, aber 6 postoperative Komplikationen (6/81 = 7,4%). Drei Patienten mussten ungeplant reoperiert werden. 76 von 81 Patienten (93,8%) waren für die 1-Jahres-Nachkontrolle verfügbar. Drei von 76 Patienten (3,9%) erlitten ein Rezidiv und 5 Patienten (6,6%) berichteten über behandlungsbedürftigen chronischen Schmerz.

Schlussfolgerung Jeder Chirurg sollte mit dem Implantat arbeiten, das am besten seinen Bedürfnissen sowie den klinischen Anforderungen und patientenindividuellen Faktoren gerecht wird. Die PUMP-Technik ist gut geeignet für Ventralhernien zwischen 2 und 4 cm Defektgröße ohne reparationsbedürftige pathologische Rektusdiastase und ermöglicht eine lokale extraperitoneale netzbasierte Defektverstärkung ohne das Risiko von intraperitonealen Komplikationen. Die Rezidivraten können im Vergleich zum Nahtverschluss gesenkt werden, ohne die Komplikationsraten zu erhöhen.

Abstract

Background The principle of the preperitoneal umbilical mesh plasty (PUMP) technique is placement of the prosthesis in the extraperitoneal space, posterior to the rectus muscles, followed by ventral fascia closure. Difficulties can arise from preperitoneal dissection, mesh insertion, deployment, and positioning.

Methods 81 elective patients underwent preperitoneal repair of primary umbilical or epigastric hernias sized from 2 – 4 cm between January 2015 and March 2018 and were prospectively collected in the Herniamed database and retrospectively analysed. The same general technique was applied, but over time three different types of mesh devices were used. The experience from these cases and the gradual change between the implants during the observation period is described in this study.

Results No intraoperative complications were recorded. Postoperative complications occurred in 6 of 81 patients (7.4%) with the need for unplanned re-operation in 3 cases. Seventy-six of 81 patients (93.8%) attended the one year follow-up evaluation. Three of 76 patients (3.9%) suffered recurrence and five patients (6.6%) requires treatment for chronic pain.

Conclusion Surgeons must work with the implant that best suits their patientsʼ needs and that also provides good results and adequate working comfort. The PUMP technique performs well for ventral hernias sized between 2 and 4 cm without the need of midline reconstruction due to diastasis of the rectus muscles. It enables a local extraperitoneal mesh augmentation without the risk of intraperitoneal complications. PUMP repair lowers the risk of recurrence in comparison with suture repair without increasing the risk of complications.

Schlüsselwörter

Hernie - Abdominalchirurgie - chirurgische Technik

Key words

hernia - abdominal surgery - surgical technique

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