Zusammenfassung
Nach Stomaanlage treten bei 30–50% der Patienten parastomale Hernien auf. Ein Drittel dieser Hernien erfordert eine operative Korrektur. Die Rezidivrate ist nach einer Korrektur, die lediglich unter Verwendung von Nahtmaterial oder einer Verlegung des Stomas durchgeführt wird, sehr hoch. Durch offene oder laparoskopische Eingriffe konnten unter Verwendung von Netzmaterial deutlich niedrigere Rezidivraten erzielt werden. Langzeitbeobachtungen zu den verschiedenen Eingriffstechniken zur Korrektur parastomaler Hernien stehen noch aus, ebenso randomisierte Studien.
Randomisierte Studien konnten zeigen, dass unter der prophylaktischen Verwendung eines prothetischen Netzes in Sublay-Technik im Rahmen des Ersteingriffs das Auftreten parastomaler Hernien reduziert werden kann. Auch in nichtrandomisierten Studien war der prophylaktische Einsatz von Netzmaterial in Onlay-, Sublay- und intraperitonealer Onlay-Position mit einer niedrigen Rezidivrate verbunden.
Obwohl viele Fragen zu diesem Thema noch beantwortet werden müssen, erscheint es offensichtlich, dass die Verwendung von Netzmaterial eine geeignete Maßnahme sowohl zur Prävention als auch zur Korrektur von parastomalen Hernien darstellt.
Abstract
After stoma formation, parastomal hernia develops in 30–50% of patients, with one-third of these require operative correction. Recurrence rates are very high after suture repair of parastomal hernias or relocation of the stoma. Open or laparoscopic mesh repairs have resulted in much lower recurrence rates. Long-term follow-up of the various techniques for parastomal hernia repair is lacking, as are randomized trials.
A prophylactic prosthetic mesh placed in a sublay position at the index operation has reduced the rate of parastomal hernia in randomized trials. A prophylactic mesh in an onlay position, a sublay position, and an intraperitoneal onlay position has also been associated with low herniation rates in non-randomized studies.
Although several questions within this field still have to be answered, it seems obvious that use of a mesh represents a suitable measure for the prevention of parastomal hernia as well as parastomal hernia repair.
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Vom Englischen ins Deutsche übersetzt von Sibylle Merk (Heidelberg).
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Israelsson, L. Parastomale Hernienversorgung mit prothetischer Netzplastik. Chirurg 81, 216–221 (2010). https://doi.org/10.1007/s00104-009-1820-y
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DOI: https://doi.org/10.1007/s00104-009-1820-y