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DOI: 10.1055/s-2001-15010
Narbenhernien: Konventionelle chirurgische Therapie
oder grundsätzlich Netzplastik?
Incisional Hernias: Conventional surgical treatment or always mesh repair?
Publication History
Publication Date:
31 December 2001 (online)
![](https://www.thieme-connect.de/media/viszeralchirurgie/200103/lookinside/thumbnails/10.1055-s-2001-15010-1.jpg)
Zusammenfassung.
Narbenhernien sind mit einer Inzidenz von ca. 10 - 20 % die häufigsten Komplikationen nach Laparotomie. Wegen möglicher Progredienz und Komplikationen ist häufig auch bei asymptomatischen Hernien die operative Reparation indiziert. Neben der Rezidivrate sind dabei Schmerzfreiheit und Verbesserung der physischen Leistungsfähigkeit die wesentlichen Endpunkte. Konventionelle chirurgische Techniken führen zu Rezidivraten von 20 - 50 %, Netzplastiken zu 10 - 20 % Rezidiven. Prognostisch ungünstig für eine Rezidiventstehung sind u. a. Re-Rezidive, Hernien > 10 cm, Infektionen, Kollagenerkrankungen und Konditionen, die mit einem erhöhten intraabdominellen Druck einhergehen. Patienten mit großen komplizierten Hernien sollten demnach mit einer Netzplastik rekonstruiert werden. Bei jüngeren sonst gesunden Patienten mit kleineren Hernien (< 5 [10] cm im größten Durchmesser) kann die primäre Versorgung durch die Stoß-auf-Stoß-Rekonstruktion gerechtfertigt sein, um die Nebenwirkungen der Netzimplantation (chronische Fremdkörperreaktion und Schmerzen, Elastizitätsverlust der Bauchdecke, höhere Infektraten etc.) zu vermeiden. Die Mayo-Dopplung ist nicht mehr indiziert.
Incisional Hernias: Conventional surgical treatment or always mesh repair?
With an incidence of 10 - 20 % incisional hernias are the most common complication of laparotomy. Due to progression of diseases and complications operative revision is usually indicated even in asymptomatic hernias. Beside recurrence absence of pain and improvement in physical function are the main endpoints. Conventional surgical techniques have reported recurrence rates of up to 20 - 50 % while those of mesh-repair are between 10 and 20 %. Unfavourable prognostic factors are re-recurrences, hernias > 10 cm in diameter, infection, collagen disease, and conditions associated with high abdominal pressure. Therefore, patients with large and complicated hernias should undergo a mesh repair. In younger otherwise healthy patients with smaller hernias (< 5[10] cm in diameter) direct simple suture repair can be justified in order to avoid side effects of mesh implantation (chronic foreign body reaction and pain, decreased elasticity of abdominal wall, higher infection rate, etc.). Vertical Mayo repair is no more further indicated.
Schlüsselwörter:
Narbenhernien - Einfache Naht - Netzplastik
Key words:
Incisional hernias - Simple suture repair - Mesh repair
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Priv.-Doz. Dr. med. Andreas Paul, MSc, FRCS (Eng.)
Universitätsklinikum Essen, Klinik und Poliklinik für
Allgemeine- und Transplantationschirurgie
Hufelandstraße 55
45122 Essen