Evidenzbasierte laparoskopische Chirurgie - Narbenhernie

Zusammenfassung

Trotz der hohen Inzidenz an Narbenhernien im chirurgischen Patientenkollektiv ist das Evidenzniveau der meisten Publikationen zur Narbenhernienreparation erschreckend niedrig, liegen kaum kontrollierte Studien zu technischen Fragestellungen vor. Immerhin sind innerhalb der letzten Jahre die Nahtverfahren weitestgehend durch vornehmlich offene Netzreparationen abgelöst worden. Dabei wird die Sublay-Position gegenüber der Onlay-Position bevorzugt, und scheint in der Tat eine geringere Rezidivrate aufzuweisen. Durch den Einsatz von laparoskopischen Techniken bei der Reparation von Narbenhernien stellt die IPOM-Position eine weitere Alternative dar. Erste Analysen zeigen Vorteile in der Rate lokaler Wundkomplikationen und einer schnelleren Rekonvaleszenz. Unklar ist jedoch weiterhin die zumindest mittelfristig zu verzeichnende Rezidivrate, die optimale Fixationstechnik, das geeignetste Material bzw. die Anzahl adhäsions-bedingter Komplikationen im Langzeitverlauf. Anhand einer Medline Recherche wird eine Einschätzung der laparoskopischen Technik im Vergleich mit den offenen Netzverfahren, unter Berücksichtigung der jeweiligen Vor- und Nachteile, versucht.

Abstract

Beside the high incidence of incisional hernias in visceral surgery the evidence level of most publication on incisional hernia repair is noticeable low, almost no controlled studies concerning technical aspects available. At least a replacement of suture repair by primarily open mesh repair has taken place. Thereby the sublay position seems to have a lower recurrence rate than the onlay position. The possibility of laparoscopic techniques for the repair of incisional hernias the intraabdominal position (IPOM) is another alternative. First analyses show advantages for the rate of wound complications and a faster convalescence. What remains unclear are at least the middle-term recurrence rate, the ideal fixation technique, the most appropriate mesh material respectively the number of adhesion-related long-term complications. On the basis of a Medline research we try an evaluation of the laparoscopic technique in comparison with the open mesh repairs for incisional hernia under consideration of advantages and disadvantages of each technique.

Narbenhernie - Netzverfahren - Laparoskopie - Rezidiv - Komplikationen

Incisional hernia - mesh techniques - laparoscopy - recurrence - complications

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