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Hernienchirurgie in der Urologie

Teil 2: Parastomale Hernien, Trokarhernien, Narbenhernien – Grundlagen der Diagnostik und operativen Therapie

Hernia surgery in urology

Part 2: Parastomal, trocar and incisional hernias – fundamentals of clinical diagnostics and treatment

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Zusammenfassung

Hernien sind häufige Erkrankungen mit entsprechenden klinischen und ökonomischen Folgen für unser Gesundheitssystem. Parastomale und Trokarhernien sind im urologischen Alltag selten. Deutlich häufiger werden Leisten-, Narben- und Nabelhernien diagnostiziert und therapiert. Die Versorgung parastomaler Hernien ist problematisch; grundsätzlich stehen dem Operateur sowohl konventionelle Nahtverfahren als auch Techniken mit Netzimplantation zur Verfügung. Die offenen Verfahren mit Implantation synthetischer Netze lassen sich in Sublay-, Onlay- und intraperitoneale Technik einteilen. Einen besonderen Stellenwert nimmt die Rekonstruktion mit gleichzeitiger Translokation des Stomas ein. Trokarhernien stellen eine seltene, jedoch gefährliche Komplikation dar. Bei der stetig steigenden Zahl minimal-invasiv durchgeführter Operationen besteht die Gefahr der Zunahme ihres Auftretens. Narbenhernien treten nach Laparotomie häufig auf. Für ihre Therapie stehen sowohl verschiedene Operationstechniken als auch verschiedene Netztypen zur Verfügung. Diese Arbeit vermittelt eine Übersicht über Epidemiologie, Pathogenese, klinische Symptomatik, Diagnostik und Therapie von Parastomal-, Trokar- und Narbenhernien.

Abstract

Hernias are a common occurrence with a correspondingly huge clinical and economic impact on the healthcare system. Parastomal and trocar hernias are rare in routine urological work. The therapy of parastomal hernias remains problematic but basically the surgeon is able to use conventional techniques with suture repair or procedures with mesh implantation. The conventional parastomal hernia repair with mesh can be classified into sublay, onlay and intraperitoneal techniques. Furthermore, a relocation of the stoma is possible. Trocar hernias represent a rare but hazardous complication. Due to the increase in keyhole surgery there is also the danger of a rise in their occurrence. Incisional hernias occur frequently in patients who have undergone laparotomy and for repair different surgical techniques and types of meshes are available. This article presents an overview of the epidemiology, pathogenesis, clinical symptoms, diagnostic and therapy of parastomal, trocar and incisional hernias.

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Abbreviations

IPOM:

Intraperitoneales Onlay-Mesh

PPM:

Polypropylen-Mesh

PTFE:

Polytetrafluoroethylen

PVDF:

Polyvinylidenfluorid

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    T. Franz, T. Schwalenberg & J.-U. Stolzenburg

  2. Klinik für Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    A. Dietrich

  3. Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    J. Müller

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  1. T. Franz
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  2. T. Schwalenberg
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  4. J. Müller
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  5. J.-U. Stolzenburg
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Correspondence to T. Franz.

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Franz, T., Schwalenberg, T., Dietrich, A. et al. Hernienchirurgie in der Urologie. Urologe 52, 871–883 (2013). https://doi.org/10.1007/s00120-013-3200-y

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