Biomaterialien zur Versorgung der Narbenhernie

Zusammenfassung.

Die schlechten Ergebnisse mesh-freier Techniken bei der Narbenhernienreparation machen den Einsatz alloplastischen Materials unverzichtbar. Die narbige Integration großflächiger Kunststoffimplantate induziert eine obligate Fremdkörperreaktion mit erhöhtem Remodelling, verstärkter Fibrose sowie einer konsekutiven Schrumpfung der Implantatfläche. Sowohl die biologische Verträglichkeit wie auch die funktionellen Einschränkungen lassen sich durch den Einsatz moderner Mesh-Materialien optimieren. Die Senkung der Rezidivrate sollte aber nicht darüber hinwegtäuschen, dass die Implantation einer präperitonealen Mesh-Prothese eine ausgedehnte Präparation erfordert und mit einer großen Wundfläche verbunden ist. Darüber hinaus können bei den meist komorbiden Patienten schwerwiegende Komplikationen wie Bauchdeckeninfekt oder Fistelbildung zu Darmstrukturen, die u. U. in eine dauerhafte Invalidität einmünden können, auftreten. Um die Implantat-Risiken zu minimieren, ist wie bei allen Implantaten eine langfristige Verlaufskontrolle, eine Optimierung der Prothesen und eine verfeinerte Stratifikation der Indikation notwendig.

Biomaterials for incisional hernia repair.

The disappointing results of conventional incisional hernia repair led to the use of alloplastic meshes. Although the recurrence rates are improved, the implantation of a large mesh-prosthesis still requires an extensive preparation and leads to a big wound. The scar formation around the mesh-material induces a foreign-body reaction with increased remodeling, fibrosis and consecutive shrinkage of the implanted material. Major complications like infections or intestinal fistula formation as well as considerable complaints at the implant area can result in a lasting disability of the patient. The functional impairment as well as the biological behavior is dependent not only on the surgical technique and can be improved by the use of modern, modified mesh-materials. To minimize these complications, which frequently appear with a delay of months or even years and thus demand long-term follow-ups, further development of better mesh-materials is mandatory.

Schlüsselwörter:

Biomaterialien - Narbenhernien - Kunststoffnetze

Key words:

Biomaterials - Incisional hernia - Meshes

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