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Narbenhernien

Incisional hernia

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Zusammenfassung

Narbenhernien sind trotz aller Entwicklungen und Fortschritte in der Chirurgie mit einer Inzidenz von 10–20% im Langzeitverlauf weiterhin einer der häufigsten Komplikationen. Neben technischen Ursachen wird zunehmend eine Störung der Wundheilung bei den betroffenen Patienten diskutiert. Die Ergebnisse konventioneller Nahtverfahren sind enttäuschend und sollten nur noch in Ausnahmefällen eingesetzt werden. Durch den Einsatz von Netzprothesen konnten die Ergebnisse der Narbenhernienreparation deutlich verbessert werden mit Rezidivraten von <10%. Grundprinzip ist die retromuskuläre Netzverstärkung der gesamten Narbe. Insbesondere in der Nachbarschaft zu knöchernen Strukturen erlaubt nur die retromuskuläre Platzierung des Meshes eine allseitige Unterfütterung gesunden Gewebes um wenigstens 5 cm. Die Präparation hat die anatomischen Besonderheiten der Bauchwand, insbesondere im Bereich der Linea alba bzw. der Linea semilunaris zu berücksichtigen

Abstract

With a long-term incidence of 10–20%, incisional hernias remain one of the most common surgical complications. Beside technical causes, wound-healing problems are increasingly being discussed. Conventional suture repair shows disappointing results and should be used only in selected cases. By the implantation of mesh prostheses, notable improvement could be achieved, with recurrence rates of <10%. Its main principle is retromuscular mesh reinforcement of the entire scar. Particularly in the neighbourhood of osseous structures, only retromuscular placement allows sufficient subduction of the mesh by healthy tissue of at least 5 cm in all directions. Preparation must take into account the special anatomic features of the abdominal wall, especially in the area of the Linea alba and Linea semilunaris.

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  1. Chirurgische Klinik und Poliklinik der RWTH Aachen

    J. Conze, U. Klinge & V. Schumpelick

  2. Chirurgische Klinik und Poliklinik der Rheinisch Westfälischen Technischen Hochschule, Pauwelsstraße 30, 52074 , Aachen

    J. Conze

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Conze, J., Klinge, U. & Schumpelick, V. Narbenhernien. Chirurg 76, 897–910 (2005). https://doi.org/10.1007/s00104-005-1072-4

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