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Principles of laparoscopic repair of ventral hernias

Laparoskopische Technik zur Reparation von Narbenhernien

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Zusammenfassung

GRUNDLAGEN: Die laparoskopische Reparation von Narbenhernien, die auf der so genannten intraperitonealen Onlay Mesh-Technik beruht, findet zunehmend Eingang in den klinischen Alltag. Ursache hierfür ist das reduzierte Bauchdeckentrauma im Vergleich mit den offenen Verfahren. METHODIK: Literaturübersicht zur laparoskopischen Behandlung von Narbenhernien. ERGEBNISSE: Die aktuelle Literatur zeigt niedrige Rezidiv- und Konversionsraten bei akzeptabler Morbidität im Sinne von unerkannten Darmläsionen. Der entscheidende Vorteil der laparoskopischen gegenüber den offenen Techniken ist die reduzierte Rate an Wundkomplikationen. Die Frage nach dem intraperitoneal zu applizierendem Material, die Gegner der laparoskopischen Reparation gerne anführen, ist heute geklärt. Verschiedene Netzstrukturen verhindern auf der einen Seite die Ausbildung von Adhäsionen und erlauben eine echte Inkorporation auf der anderen Seite. Eine aktuelle Entwicklung (Polyvinyliden Fluorid) scheint besonders attraktiv, da sie eine Überlappung und damit die Anwendung von mehreren Netzen erlaubt und außerdem eine der originären Bauchwand vergleichbare Elastizität aufweist. SCHLUSSFOLGERUNGEN: Fast alle Narbenhernien können zwar laparoskopisch versorgt werden. Trotzdem ist eine genaue Kenntnis der Hernienkrankheit selbst sowie der verschiedenen Behandlungsoptionen notwendig, um für den individuellen Patienten die jeweils beste Therapie zu finden.

Summary

BACKGROUND: Laparoscopic repair of incisional hernias, which basically means an intraperitoneal onlay mesh technique, is becoming increasingly popular as it reduces trauma to the abdominal wall compared with open techniques. METHODS: Review of the literature on laparoscopic repair of incisional hernias. RESULTS: The recent literature reveals low recurrence and conversion rates with acceptable morbidity in terms of unrecognized enterotomies. The main advantage of the laparoscopic repair over conventional techniques is the reduced rate of wound complications. The question of material often posed by opponents of laparoscopic repair can be answered today. Several materials are available that provide incorporation into the abdominal wall and prevent formation of adhesions to the intestine. A very recent development (polyvinylidene fluoride) seems to be most attractive because of (i) the primary pore size so that 2 meshes can be overlapped, and (ii) elasticity similar to the human abdominal wall. CONCLUSIONS: Although most incisional hernias can be repaired laparoscopically, profound knowledge of the hernia disease itself and different treatment approaches are necessary to provide the best procedure for the individual patient in the sense of tailored surgery.

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  1. Department of Surgery, Stadtklinik, Baden-Baden, Germany

    D. Berger & M. Bientzle

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  1. D. Berger
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  2. M. Bientzle
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Correspondence to D. Berger.

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Berger, D., Bientzle, M. Principles of laparoscopic repair of ventral hernias. Eur Surg 38, 393–398 (2006). https://doi.org/10.1007/s10353-006-0284-2

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  • DOI: https://doi.org/10.1007/s10353-006-0284-2

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