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Korrektur der parastomalen Hernie mit Netz

Correction of parastomal hernia using meshes

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  • 2 Citations

Zusammenfassung

Nach operativer Harnableitung über ein Ileumconduit stellen parastomale Hernien mit einer Inzidenz von 4–16% eine relativ häufige Komplikation dar. Eine operative Korrektur wird nach allgemeinen Angaben in etwa 30–35% der Fälle notwendig. Für die operative Korrektur einer parastomalen Hernie sind verschiedenste Verfahren beschrieben worden. Die primäre Fasziennaht hat eine hohe Rezidivrate von 46–100%, wohingegen die Stomaneuplatzierung mit Komplikationsraten von bis zu 88% assoziiert ist. Mit der Verwendung von alloplastischem Material (meist Polypropylennetze) kann die Rezidivrate deutlich von bis zu 100% für die primäre Fasziennaht und 71% für die Stomatranslokation auf 33% gesenkt werden.

Netze mit einer Doppelbeschichtung aus Polypropylen und ePTFE („expanded polytetrafluorethylene“), kombinieren die Vorteile der ausgeprägten Bauchwandverstärkung durch einsprossendes Bindegewebe mit der einfachen, schonenden und gut kontrollierbaren intraperitonealen Platzierungsmöglichkeit. In der Arbeit werden unsere Erfahrungen mit doppelt beschichteten Zwei-Komponenten-Netzen zur Hernienversorgung nach Anlage eines Ileumconduits vorgestellt.

Abstract

The incidence of parastomal hernia in ileal conduit urinary diversion ranges from 4% to 16%. Surgical correction is necessary in about one third of cases and different techniques of surgical reconstruction have been described. Primary fascial repair has a high recurrence rate of 46-100% whereas stoma translocation is associated with complication rates of up to 88%. The use of alloplastic material (usually polypropylene meshes) has reduced the recurrence rate by up to 100% for primary fascial repair and 71% for stoma translocation down to 33%.

Composite meshes consist of two layers, a polypropylene layer and an expanded polytetrafluoroethylene (ePTFE) layer. The former is placed against the abdominal wall for permanent reinforcement by ingrowing connective tissue and the ePTFE layer is placed against the abdominal organs preventing adhesions with the bowel. The intraperitoneal placement of such composite meshes is a standardized, simplified, gentle and controllable surgical procedure. This article reports experiences with the surgical correction of parastomal hernias in ileal conduits using composite meshes.

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Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht.

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Correspondence to Prof. Dr. A. Lampel.

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Lampel, A., Runkel, N. Korrektur der parastomalen Hernie mit Netz. Urologe 51, 965–970 (2012). https://doi.org/10.1007/s00120-012-2962-y

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Schlüsselwörter

  • Hernie, parastomale
  • Komplikationen
  • Ileumconduit
  • Alloplastisches Material

Keywords

  • Hernia, parastomal
  • Complications
  • Ileal conduit
  • Alloplastic material