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Komponentenseparationstechnik bei komplizierten Bauchwandhernien

Abdominal wall components separation method for closure of complicated abdominal hernias

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Zusammenfassung

Hintergrund

Das Management komplizierter abdomineller Narbenhernien bleibt eine Herausforderung. Die Komponentenseparation nach Ramirez zur autologen Augmentation der Bauchwand, insbesondere in Kombination mit einer Verstärkung durch ein epifaszial positioniertes Netz, wird zunehmend zur Reparation dieser speziellen Hernien eingesetzt.

Patienten und Methoden

Am Universitätsklinikum Bonn wurden im Zeitraum 2002 bis 2010 in einer retrospektive Studie konsekutive 40 Patienten mit abdominellen Narbenhernien analysiert.

Ergebnisse

Indikation zur Hernienreparation war 22-mal (55%) ein sekundär abgeheiltes Abdomen apertum und 10-mal (25%) eine Reanastomosierung nach Hartmann-Operation mit großer Fasziendehiszenz. Eine postoperative Wundinfektion trat in 9 Fällen auf (9/40 Patienten, 22,5%). Hernienrezidive wurden bei 10 Patienten diagnostiziert (10/36, 27,8%; Beobachtungszeitraum: 3,8 [Zeitspanne 1–9] Jahre). Bei den zusätzlich mit Netz verstärkten Bauchdecken waren Rezidive deutlich seltener (19% mit Netz vs. 40% ohne Netz).

Schlussfolgerungen

Die Komponentenseparation nach Ramirez, ggf. kombiniert mit einer epifaszialen Netzverstärkung, ist die Methode der Wahl zur Bauchdeckenrekonstruktion bei einem großen Anteil komplizierter Narbenhernien und sollte demzufolge zum Repertoire operativer Techniken eines Viszeralchirurgen gehören. Die Rezidivrate ist abhängig von der Grunderkrankung des Patienten und der Komplexität der Hernie.

Abstract

Background

The repair of complicated abdominal hernias remains a challenging problem. The components separation technique introduced by Ramirez et al. is an increasingly popular method for autogenous reconstruction of the abdominal wall, especially in combination with epifascial mesh reinforcement.

Patients and methods

In a retrospective study carried out at a university hospital, 40 consecutive patients between 2002 and 2010 were analyzed.

Results

Indications for abdominal reconstruction were fascial defects after secondary healed laparostoma in 22 patients (55%) and fascial defects combined with colostomy reversal after a Hartmann procedure in 10 patients (25%). A total of 9 wound infections (22.5%) occurred and 10 hernia recurrences (10/36 patients) were identified in the follow-up (mean 3.8 years, range 1–9 years). Reconstructions with mesh reinforcement resulted in a lower rate of recurrences (19% with mesh vs 40% without mesh).

Conclusions

The components separation technique, in combination with epifascial mesh reinforcement as appropriate, is the procedure of choice for most complicated abdominal wall hernias. Therefore, each visceral surgeon should be able to perform this method. Recurrence rates depend on the underlying disease of the patient and the complexity of the hernia.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universität Bonn, Sigmund- Freud-Str. 25, 53105, Bonn, Deutschland

    D. Pantelis, A. Jafari, T.O. Vilz, N. Schäfer, J.C. Kalff & M. Kaminski

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  1. D. Pantelis
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  2. A. Jafari
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  3. T.O. Vilz
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  4. N. Schäfer
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  5. J.C. Kalff
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  6. M. Kaminski
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Correspondence to D. Pantelis.

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Pantelis, D., Jafari, A., Vilz, T. et al. Komponentenseparationstechnik bei komplizierten Bauchwandhernien. Chirurg 83, 555–560 (2012). https://doi.org/10.1007/s00104-011-2171-z

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