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Erschienen in: Der Chirurg 7/2021

28.04.2021 | Wundinfektion | Leitthema

Prophylaxe von parastomalen, perinealen und Narbenhernien in der kolorektalen Chirurgie

verfasst von: Prof. Dr. med. Dirk Weyhe, Daniela Salzmann, Kilian Gloy

Erschienen in: Die Chirurgie | Ausgabe 7/2021

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Zusammenfassung

Diese Arbeit soll eine Übersicht der relevanten Literaturevidenz zu dem Thema „prophylaktische Netzimplantationen zur Prävention von Narben- und parastomalen Hernien“ in der kolorektalen Chirurgie geben. Zudem wird mittels strukturierter Literaturrecherche die Hernieninzidenz in der kolorektalen Chirurgie der vergangenen 5 Jahre analysiert. Eine knappe Mehrzahl (54 %) der Artikel empfiehlt den Einsatz prophylaktischer Netzimplantationen in der kolorektalen Chirurgie. Prophylaktische Netze scheinen das Risiko von Hernien in der kolorektalen Chirurgie zu reduzieren, sind jedoch mit einer leicht erhöhten perioperativen Wundinfektionsrate assoziiert. Parastomale Hernien gehen im Vergleich zu Narbenhernien mit höheren Inzidenzraten einher und scheinen auch mehr von prophylaktischen Netzimplantationen zu profitieren. Die Literaturevidenz bleibt in Bezug auf die Verwendung synthetischer oder biologischer Implantate unklar, da zu wenig randomisiert-kontrollierte Studien verfügbar sind. Perineale Hernien wurden von der Analyse aufgrund der nicht vergleichbaren, überwiegend kasuistischen Literatur ausgeschlossen. Eine Übersicht wird in der Diskussion gegeben. Unsere Literaturanalyse kommt auch in Reflexion unserer eigenen Erfahrung zu dem Schluss, dass die operationsbedingte gestörte Bauchwandintegrität prophylaktisch verstärkt werden sollte. Eine evidenzbasierte Empfehlung ist basierend auf dem aktuellen Stand der Forschung zur Implantationstechnik (Onlay, Sublay, intraperitoneales Onlay-Mesh) sowie zur Wahl des Implantates nicht möglich.
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Metadaten
Titel
Prophylaxe von parastomalen, perinealen und Narbenhernien in der kolorektalen Chirurgie
verfasst von
Prof. Dr. med. Dirk Weyhe
Daniela Salzmann
Kilian Gloy
Publikationsdatum
28.04.2021
Verlag
Springer Medizin
Schlagwörter
Wundinfektion
Serom
Erschienen in
Die Chirurgie / Ausgabe 7/2021
Print ISSN: 2731-6971
Elektronische ISSN: 2731-698X
DOI
https://doi.org/10.1007/s00104-021-01415-8

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