Zusammenfassung
GRUNDLAGEN: Durch die Implantation eines Netzes bei medianen Laparotomien soll die Narbenhernienrezidivrate gesenkt werden. Mit dieser Studie soll geklärt werden, welche Netze mit welcher Fixierung die geforderte Verstärkung der Mittellinie ergeben. METHODIK: An 17 frisch verstorbenen Leichen wurden nach medianer Laparotomie in Onlay-Technik 6 verschiedene Netze auf die Linea Alba mit folgenden Fixierungstechniken befestigt: Tissucol Duo Quick, ProGrip, A.M.I. EasyTack, AbsorbaTack, ProTack, Nahtfixation in fortlaufender Technik mit 4-0, 3-0, 2-0, 0, 1. Anschließend wurde das Netz mit einem Tensiometer bis zum Abscheren belastet. Ausgewertet wurden Haltekraft und Ursache der Abscherung. ERGEBNISSE: Bei den Nahtfixationen zeigte sich eine Zunahme der Haltekraft mit steigender Nahtstärke, alle anderen Fixiertechniken erreichten nicht die geforderte Festigkeit von 40 Newton. SCHLUSSFOLGERUNGEN: Mit fortlaufender Nahtfixation kann in Onlay-Technik ab der Fadenstärke 3-0 eine Netzfestigkeit auf dem Gewebe von durchschnittlich 58 N erreicht werden. Neben der einfachen Durchführbarkeit ist diese Fixation kostengünstig und für den klinischen Einsatz für die prophylaktische Mittellinienverstärkung empfehlenswert.
Summary
BACKGROUND: Mesh implantation by median laparotomy is believed to reduce the rate of incisional hernia. The present study was performed to determine the types of meshes and fixation that would provide the required reinforcement of the midline. METHODS: Median laparotomies were performed on 17 recently deceased cadavers. By the onlay technique, 6 different meshes were fixed by the following methods: Tissucol Duo Quick, ProGrip, A.M.I. EasyTack, AbsorbaTack, ProTack, continuous absorbable monofilament suture fixation using 4-0, 3-0, 2-0, 0, 1 (PDS). Tensile forces were applied to the meshes, using a tensiometer, until mesh ablation or mesh disruption. RESULTS: With regard to the suture fixations, retention strength increased in direct proportion to thread thickness. All other fixation techniques failed to achieve the stipulated fixation strength of 40 Newton. CONCLUSIONS: By continuous suture fixation and by using the onlay technique, a mean mesh stability of 58 N in tissue can be achieved with at least 3-0 sutures. In addition to its simple applicability, this fixation method is economical and may be recommended for clinical use in order to achieve prophylactic reinforcement of the midline.
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Hollinsky, C., Sandberg, S., Pokorny, H. et al. Prevention of incisional hernia by mesh implantation after median laparotomy: a preclinical trial. Eur Surg 42, 304–308 (2010). https://doi.org/10.1007/s10353-010-0570-x
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DOI: https://doi.org/10.1007/s10353-010-0570-x