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Aktuelle Studienlage zum Bauchdeckenverschluss

Klassische Nahttechniken

Current standards of abdominal wall closure techniques

Conventional suture techniques

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Zusammenfassung

Hintergrund

Zu den häufigsten Komplikationen nach abdominalchirurgischen Eingriffen mittels Laparotomie gehören Narbenhernien und Wundinfektionen, welche in mehr als 10–15 % der Fälle auftreten. Das Risiko dieser Komplikationen lässt sich durch chirurgische Technik und die Verwendung von speziellem Nahtmaterial jedoch reduzieren. Im Jahr 2010 ergab die INLINE-Metaanalyse des Studienzentrums der Deutschen Gesellschaft für Chirurgie (SDGC), dass eine fortlaufende Nahttechnik mit einem langsam resorbierbaren Nahtmaterial die besten Ergebnisse nach elektiver medianer Laparotomie in Bezug auf das Narbenhernienrisiko zeigt.

Ziel der Arbeit

Ziel dieser Arbeit soll eine Aktualisierung der INLINE-Metaanalyse sein. Dazu sollen mittels einer systematischen Literaturrecherche alle randomisiert-kontrollierten Studien (RCT) erfassen werden, die seit 2010 zum Thema Bauchdeckenverschluss veröffentlicht wurden, um so den aktuellen Stand der Evidenz zu den konventionellen Nahttechniken zusammenfassend darzustellen.

Material und Methoden

Am 28.01.2016 erfolgte eine systematische Literaturrecherche über „MEDLINE“ und das „Cochrane Central Register of Controlled Trials“ (CENTRAL). Hierüber wurden alle verfügbaren RCTs zu chirurgischen Techniken des Bauchdeckenverschlusses identifiziert und eingeschlossen.

Ergebnisse

Seit 2010 wurden neun RCTs identifiziert, die verschiedene Techniken zum Bauchdeckenverschluss verglichen. In drei monozentrischen RCTs zum Vergleich von Nahtmaterialien nach Laparotomie ergaben sich keine neuen Erkenntnisse zur INLINE-Metaanalyse, sodass weiterhin ein langsam resorbierbarer Faden in fortlaufender Technik zum Erreichen einer möglichst niedrigen Narbenhernienrate empfohlen werden kann. Des Weiteren wurden sechs RCTs zum Thema antimikrobielle Beschichtung gefunden, die insgesamt keinen signifikanten Vorteil in Bezug auf Wundinfektionen durch Triclosan-Nahtmaterial zeigen konnten.

Diskussion

Die aktuelle Studienlage ergibt, dass weiterhin ein langsam resorbierbares, monofiles Nahtmaterial in fortlaufender Nahttechnik bei der elektiven medianen Laparotomie die besten Ergebnisse zeigt. Triclosan-beschichtete Nahtmaterialien können zu einer Reduktion der Wundinfektionsrate nicht empfohlen werden. Für Notfalllaparotomien konnte bisher kein Vorteil für eine bestimmte Nahttechnik oder ein spezielles Nahtmaterial gezeigt werden.

Abstract

Background

The most frequent complications following midline abdominal laparotomy include incisional hernias, which develop in 10–15 % of patients and surgical site infections in 15–25 % of cases; however, the risk of these complications can be reduced by the surgical technique and the use of special suture materials. In 2010, the INLINE meta-analysis performed by the Study Centre of the German Society of Surgery (SDGC) revealed that a continuous suture technique using slowly absorbable suture material resulted in the lowest risk of developing postoperative incisional hernia after elective midline laparotomy.

Objective

The aim of this study was to perform a systematic literature search to identify all randomized controlled trials (RCTs) that have been published since 2010 concerning conventional abdominal wall closure in order to update the 2010 INLINE meta-analysis and summarize current evidence.

Material and methods

On 28 January 2016, a systematic literature search was performed in MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL). All RCTs dealing with abdominal wall closure after midline laparotomy were identified and included for further analysis.

Results

Since 2010 a total of 9 RCTs comparing different techniques of abdominal wall closure have been published. Three monocentric RCTs comparing different suture materials, showed no significant differences to the INLINE meta-analysis regarding incisional hernia development; therefore, slowly absorbable sutures using a continuous suture technique are still recommended for abdominal wall closure in elective cases. Furthermore, six RCTs were identified which investigated antimicrobial suture materials but failed to show an overall advantage for Triclosan-coated suture material with respect to surgical site infections.

Conclusion

Current evidence shows that slowly absorbable monofilament suture material using a continuous suture technique provides the best results with regard to incisional hernia rates after elective midline laparotomy. Triclosan-coated sutures cannot be recommended as a standard suture material as they failed to reduce surgical site infections. For emergency laparotomies no evidence exists to recommend a specific kind of suture technique or a special suture material.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    P. Heger, F. Pianka, M. K. Diener & A. L. Mihaljevic

  2. Studienzentrum der Deutschen Gesellschaft für Chirurgie (SDGC), Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    P. Heger, F. Pianka, M. K. Diener & A. L. Mihaljevic

Authors
  1. P. Heger
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  2. F. Pianka
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  3. M. K. Diener
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  4. A. L. Mihaljevic
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Correspondence to M. K. Diener.

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Interessenkonflikt

P. Heger, F. Pianka, M. K. Diener und A. L. Mihaljevic geben an, dass kein Interessenkonflikt besteht.

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

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Heger, P., Pianka, F., Diener, M.K. et al. Aktuelle Studienlage zum Bauchdeckenverschluss. Chirurg 87, 737–743 (2016). https://doi.org/10.1007/s00104-016-0231-0

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  • DOI: https://doi.org/10.1007/s00104-016-0231-0

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