Prophylaxe von parastomalen, perinealen und Narbenhernien in der kolorektalen Chirurgie

Prophylaxis of parastomal, perineal and incisional hernias in colorectal surgery

Zusammenfassung

Diese Arbeit soll eine Übersicht der relevanten Literaturevidenz zu dem Thema „prophylaktische Netzimplantationen zur Prävention von Narben- und parastomalen Hernien“ in der kolorektalen Chirurgie geben. Zudem wird mittels strukturierter Literaturrecherche die Hernieninzidenz in der kolorektalen Chirurgie der vergangenen 5 Jahre analysiert. Eine knappe Mehrzahl (54 %) der Artikel empfiehlt den Einsatz prophylaktischer Netzimplantationen in der kolorektalen Chirurgie. Prophylaktische Netze scheinen das Risiko von Hernien in der kolorektalen Chirurgie zu reduzieren, sind jedoch mit einer leicht erhöhten perioperativen Wundinfektionsrate assoziiert. Parastomale Hernien gehen im Vergleich zu Narbenhernien mit höheren Inzidenzraten einher und scheinen auch mehr von prophylaktischen Netzimplantationen zu profitieren. Die Literaturevidenz bleibt in Bezug auf die Verwendung synthetischer oder biologischer Implantate unklar, da zu wenig randomisiert-kontrollierte Studien verfügbar sind. Perineale Hernien wurden von der Analyse aufgrund der nicht vergleichbaren, überwiegend kasuistischen Literatur ausgeschlossen. Eine Übersicht wird in der Diskussion gegeben. Unsere Literaturanalyse kommt auch in Reflexion unserer eigenen Erfahrung zu dem Schluss, dass die operationsbedingte gestörte Bauchwandintegrität prophylaktisch verstärkt werden sollte. Eine evidenzbasierte Empfehlung ist basierend auf dem aktuellen Stand der Forschung zur Implantationstechnik (Onlay, Sublay, intraperitoneales Onlay-Mesh) sowie zur Wahl des Implantates nicht möglich.

Abstract

This article gives an overview of the relevant evidence from the literature on the topic of prophylactic use of meshes to prevent incisional and parastomal hernias in colorectal surgery. In addition, based on a structured literature search the incidence of hernias in colorectal surgery over the past 5 years was analyzed. A slight majority (54%) of articles recommended the use of prophylactic mesh implantation in colorectal surgery. The prophylactic use of meshes appears to reduce the risk of hernias in colorectal surgery but is associated with a slightly increased perioperative wound infection rate. Parastomal hernias are associated with higher incidence rates compared with incisional hernias and also appear to benefit more from prophylactic mesh implantation. The evidence in the literature is still unclear regarding the use of synthetic or biological implants due to the lack of randomized controlled trials. Perineal hernias were excluded from the analysis due to the incomparability of the mainly casuistic literature. An overview is given in the discussion. The analysis of the literature and also in reflection of our own experience comes to the conclusion that the disrupted integrity of the abdominal wall due to the operation should be prophylactically reinforced with a mesh after colorectal surgery. An evidence-based recommendation is not possible based on the current state of research on implantation techniques, e.g. onlay, sublay intraperitoneal onlay mesh (IPOM) and selection of the implant.

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Correspondence to Prof. Dr. med. Dirk Weyhe.

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Interessenkonflikt

D. Weyhe, D. Salzmann und K. Gloy geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Bei dieser Arbeit handelt es sich um eine vergleichende Literaturanalyse. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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M. Anthuber, Augsburg

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Weyhe, D., Salzmann, D. & Gloy, K. Prophylaxe von parastomalen, perinealen und Narbenhernien in der kolorektalen Chirurgie. Chirurg (2021). https://doi.org/10.1007/s00104-021-01415-8

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Schlüsselwörter

  • Netzimplantation
  • Inzidenz
  • Wundinfektion
  • Serombildung
  • Nahtverschluss

Keywords

  • Mesh implantation
  • Incidence
  • Wound infection
  • Seroma formation
  • Suture closure