Zusammenfassung
Die vaginale Netzchirurgie ist gleichermaßen innovativ wie umstritten. Transvaginale Zugangswege, Reduktion der Netzgewichte und inerte Beschichtungen reduzieren nachweisbar netzspezifische Komplikationen, sodass Patientinnen insbesondere in der Rezidiv- Prolapssituation von einer vaginalen Netzapplikation profitieren. Erweiterte Indikationsstellungen werden daher diskutiert und bereits klinisch umgesetzt. Die kritische Diskussion um die vaginale Netzchirurgie trägt dazu bei, mehr wissenschaftliche Daten zu rekrutieren, mehr Expertise in die operative Umsetzung einzubringen und die Betroffene noch aktiver in die Entscheidungsfindung für bzw. gegen eine vaginale Netzapplikation einzubinden. Die teils zu emotionale Bewertung der vaginalen Netzchirurgie verhindert mitunter den sinnvollen Einsatz und führt oft unzureichend indiziert zu Revisionsoperationen und kompletten Netzentfernungen, unter Umständen mit fragwürdigen forensischen Konsequenzen. Der Beitrag soll die aktuelle Situation zur Descensuschirurgie mit Gewebeersatz widerspiegeln sowie aus wissenschaftlicher und insbesondere klinischer Sicht kritisch Stellung beziehen.
Abstract
Vaginal mesh surgery is both innovative and controversial. It has been proven that transvaginal access, reduction of mesh weight and inert coatings reduce mesh-specific complications so that patients profit from the use of vaginal meshes particularly in recurrent prolapse situations. Extended indications were therefore discussed and have already been clinically implemented. The critical discussion on vaginal mesh surgery means that more scientific data are being recruited, more expertise is being incorporated into operative implementation and affected patients are being more actively included in decision-making for or against the use of vaginal meshes. The sometimes too emotional assessment of vaginal mesh surgery occasionally diminishes a reasonable implementation and often leads to insufficiently indicated revision operations and complete mesh removal under conditions with questionable legal consequences. This article describes the current situation for prolapse surgery with tissue replacement and takes a critical stance from a scientific and especially clinical perspective.
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Wildt, B., Tunn, R. Vaginale Deszensuschirurgie mit Gewebeersatz. Gynäkologe 46, 463–468 (2013). https://doi.org/10.1007/s00129-012-3120-8
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DOI: https://doi.org/10.1007/s00129-012-3120-8