Zusammenfassung
Die Narbenhernie, in der angelsächsischen Literatur als sekundäre ventrale Hernie bezeichnet, stellt bei einer Frequenz von bis 20 % und darüber eine häufige Konsequenz einer Laparotomie dar. Die Mehrzahl der betroffenen Patienten ist symptomatisch. Ursächlich wird eine Störung der Kollagensynthese angenommen. Aus diesem Grund ist für die Reparation eine Augmentation mit einem großporigen Kunststoffnetz aus nichtresorbierbarem Material, welches die gesamte ursprüngliche Narbe abdecken und überlappen muss, obligat. Die Netzstrukturen können auf der Faszie („onlay“), retromuskulär („sublay“) oder intraperitoneal („IPOM“) platziert werden. Die letztgenannte Alternative wird bei laparoskopischen Reparationen angewendet. Vorteil dieses Vorgehens ist die reduzierte Rate von Wundkomplikationen. Große Bauchwanddefekte der Mittellinie bedürfen einer Bauchwandrekonstruktion mittels Komponentenseparation (anteriore und posteriore Varianten), die grundsätzlich mit einer Netzaugmentation ergänzt werden muss. Mit diesen Verfahren lassen sich Rezidivraten unter 10 % bei akzeptabler Morbidität erreichen.
Abstract
Secondary ventral hernia or incisional hernia occurs in at least 20 % of cases after laparotomy and most patients are symptomatic. The pathogenesis of incisional hernia is believed to be based on a defect in collagen synthesis indicating the necessity of covering the whole original incision with a non-resorbable, macroporous mesh. These meshes can be used on top of the fascia (onlay), in a retromuscular fashion (sublay) or intraperitoneally (IPOM). The IPOM technique is the preferred procedure during laparoscopic repair of ventral hernias. The clear advantage of the laparoscopic approach is the dramatically reduced rate of wound complications, especially infections. Major defects of the abdominal wall require plastic reconstruction with the component separation technique in both anterior and posterior approaches. The component separation technique must be combined with retromuscular mesh augmentation enabling a recurrence rate of less than 10 % and an acceptable morbidity to be achieved.
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Interessenkonflikt. D. Berger und A. Lux geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Berger, D., Lux, A. Operative Therapie der Narbenhernie. Chirurg 84, 1001–1012 (2013). https://doi.org/10.1007/s00104-011-2245-y
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DOI: https://doi.org/10.1007/s00104-011-2245-y