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Gefässchirurgie

, Volume 23, Issue 3, pp 152–156 | Cite as

Präventive abdominelle Netzplastik nach offenem abdominellem Aortenersatz

Eine Übersicht
  • E. S. DebusEmail author
  • S. H. Wipper
  • C.-A. Behrendt
  • N. Tsilimparis
  • A. Larena-Avellaneda
  • T. Kölbel
  • H. Diener
Leitthema
  • 171 Downloads

Zusammenfassung

Einleitung

Die Inzidenz von Narbenhernien nach offenem abdominellem Aortenersatz variiert zwischen 10 und 38 %. Neue Optionen zur Reduktion dieses hohen Risikos beinhalten die prophylaktische Mesh-Augmentation. Das vorliegende Manuskript gibt einen allgemeinen Überblick über aktuelle Ergebnisse unter Verwendung unterschiedlicher Techniken der Mesh-Implantation im Vergleich zum direkten Abdominalverschluss nach medianer Laparotomie.

Methodik

Es wurde eine systematische Literaturanalyse unter Verwendung der Datenbanken PubMed und Medline zwischen 2007 und 2017 durchgeführt (Suchdatum: 30. Dezember 2017). Es wurde ausschließlich in der englischsprachigen Literatur nach folgenden Begriffen gesucht: „prophylactic – mesh – abdominal aortic aneurysm repair – incisional hernia“. Von insgesamt 304 Studien wurden ausschließlich randomisierte prospektive klinische Studien sowie Kohortenstudien und Metaanalysen in diese Übersicht eingeschlossen.

Ergebnisse

Patienten entwickeln nach offenem Aortenersatz signifikant seltener eine Narbenhernie, wenn eine prophylaktische Netzaugmentation durchgeführt wird. Onlay- und Sublay-Techniken unterscheiden sich in Details, jedoch sind beide Techniken effektiv. Die prophylaktische Netzanlage sollte daher grundsätzlich durchgeführt werden und auch Eingang in die aktuellen Leitlinien finden.

Schlüsselwörter

Abdominelles Aortenaneurysma Narbenhernie Abdominale Wundverschlusstechniken Onlay-Netzplastik RCT 

Preventive abdominal mesh augmentation after abdominal aortic aneurysm repair

An overview

Abstract

Background

The reported incidence of incisional hernia after repair of abdominal aortic aneurysms (AAA) by midline incision varies between 10% and 38%. New options to reduce this high incidence include prophylactic mesh augmentation. This article gives a general overview on current results using different techniques of mesh implantation in comparison to direct abdominal wall closure.

Methods

A systematic literature search using PubMed and Medline between 2007 and 2017 was performed (final search day: 30 December 2017). Search items were “prophylactic, mesh, abdominal aortic aneurysm repair and incisional hernia”. Only the english literature was reviewed. Out of 304 studies, only randomized prospective clinical trials, cohort studies and metaanalyses were included in this survey.

Results

Onlay mesh augmentation after median laparotomy for AAA repair prevents postincisional hernia better than suturing alone. Onlay and underlay techniques differ in details but mesh augmentation in general is beneficial. Prophylactic mesh augmentation should therefore generally be performed following open AAA repair and should be included in current guidelines.

Keywords

Abdominal aortic aneurysm Incisional hernia Abdominal wound closure techniques Onlay mesh augmentations RCT 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

E. Debus, S. Wipper, C.-A. Behrendt, N. Tsilimparis, A. Larena-Avellaneda, T. Kölbel und H. Diener geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • E. S. Debus
    • 1
    Email author
  • S. H. Wipper
    • 1
  • C.-A. Behrendt
    • 1
  • N. Tsilimparis
    • 1
  • A. Larena-Avellaneda
    • 1
  • T. Kölbel
    • 1
  • H. Diener
    • 1
  1. 1.Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum HamburgUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland

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