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Konventionelle Reparation der parastomalen Hernie

Conventional reparation of parastomal hernia

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Zusammenfassung

Obwohl mit Einführung der Netzverfahren die Rezidivraten nach parastomaler Hernienreparation gesenkt werden konnten, bleibt die chirurgische Versorgung parastomaler Hernien und ihrer Rezidive problematisch. Zu den konventionellen Verfahren zählen die Nahtverfahren, Verfahren der Neupositionierung des Stomas (Stomarelokation) sowie die verschiedenen Netzverfahren. Den Nahtverfahren kommt aufgrund ihres hohen Rezidivrisikos heutzutage keine Bedeutung zu. Alleinige Relokationen sind wegen der hohen Raten an erneuten parastomalen Hernien nicht empfehlenswert. Die offenen Netzverfahren lassen sich hinsichtlich der Netzpositionierung in epifasziale (Onlay), retromuskuläre (Sublay) und intraperitoneale (IPOM) Techniken unterteilen. Darüber hinaus zählt zu den konventionellen Netzverstärkungen die zeitgleiche Kombination mit einer Stomarelokation. Der Stellenwert der einzelnen Netzverfahren und insbesondere der neueren, sog. biologischen Netzmaterialien muss in randomisiert kontrollierten Studien geprüft werden.

Abstract

The reparation of parastomal hernias and their recurrence remain problematic although the implementation of mesh techniques has lowered recurrences rates. Conventional surgical techniques include suture repair, relocation of the stoma as well as diverse hernia repair procedures with mesh implantation. Suture repair has been abandoned due to its high recurrence rate. Simple relocation is not recommended because of high rates of recurrent parastomal hernias. Conventional hernia repair using mesh implants is classified according to the mesh position into epifascial (onlay), retromuscular (sublay) and intraperitoneal (IPOM) techniques. Furthermore, a combination of relocation with additional mesh enforcement is also possible. The value of the different mesh techniques and of new biological mesh prostheses must be evaluated in randomized controlled studies.

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  1. Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    R. Rosch, J. Conze, K. Junge & U. Neumann

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  1. R. Rosch
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  2. J. Conze
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  3. K. Junge
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  4. U. Neumann
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Correspondence to R. Rosch.

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Rosch, R., Conze, J., Junge, K. et al. Konventionelle Reparation der parastomalen Hernie. Chirurg 81, 982–987 (2010). https://doi.org/10.1007/s00104-010-1932-4

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