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Parastomale Hernienversorgung mit prothetischer Netzplastik

Parastomal hernia treatment with prosthetic mesh repair

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Zusammenfassung

Nach Stomaanlage treten bei 30–50% der Patienten parastomale Hernien auf. Ein Drittel dieser Hernien erfordert eine operative Korrektur. Die Rezidivrate ist nach einer Korrektur, die lediglich unter Verwendung von Nahtmaterial oder einer Verlegung des Stomas durchgeführt wird, sehr hoch. Durch offene oder laparoskopische Eingriffe konnten unter Verwendung von Netzmaterial deutlich niedrigere Rezidivraten erzielt werden. Langzeitbeobachtungen zu den verschiedenen Eingriffstechniken zur Korrektur parastomaler Hernien stehen noch aus, ebenso randomisierte Studien.

Randomisierte Studien konnten zeigen, dass unter der prophylaktischen Verwendung eines prothetischen Netzes in Sublay-Technik im Rahmen des Ersteingriffs das Auftreten parastomaler Hernien reduziert werden kann. Auch in nichtrandomisierten Studien war der prophylaktische Einsatz von Netzmaterial in Onlay-, Sublay- und intraperitonealer Onlay-Position mit einer niedrigen Rezidivrate verbunden.

Obwohl viele Fragen zu diesem Thema noch beantwortet werden müssen, erscheint es offensichtlich, dass die Verwendung von Netzmaterial eine geeignete Maßnahme sowohl zur Prävention als auch zur Korrektur von parastomalen Hernien darstellt.

Abstract

After stoma formation, parastomal hernia develops in 30–50% of patients, with one-third of these require operative correction. Recurrence rates are very high after suture repair of parastomal hernias or relocation of the stoma. Open or laparoscopic mesh repairs have resulted in much lower recurrence rates. Long-term follow-up of the various techniques for parastomal hernia repair is lacking, as are randomized trials.

A prophylactic prosthetic mesh placed in a sublay position at the index operation has reduced the rate of parastomal hernia in randomized trials. A prophylactic mesh in an onlay position, a sublay position, and an intraperitoneal onlay position has also been associated with low herniation rates in non-randomized studies.

Although several questions within this field still have to be answered, it seems obvious that use of a mesh represents a suitable measure for the prevention of parastomal hernia as well as parastomal hernia repair.

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Literatur

  1. Goligher JC (1984) Surgery of the Anus, Colon and Rectum 5th edn. Baillière Tindall, London, pp 703–704

  2. Israelsson LA (2008) Parastomal hernias. Surg Clin North Am 88:113–125

    Article  PubMed  Google Scholar 

  3. Pearl RK (1989) Parastomal hernias. World J Surg 13:569–572

    Article  CAS  PubMed  Google Scholar 

  4. Williams JG, Etherington R, Hayward MW, Hughes LE (1990) Paraileostomy hernia: a clinical and radiological study. Br J Surg. Dec 77(12):1355–1357

    CAS  Google Scholar 

  5. Cingi A, Cakir T, Sever A, Aktan AO (2006) Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum 49(10):1559–1563

    Article  PubMed  Google Scholar 

  6. Jänes A, Cengiz Y, Israelsson LA (2004) Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 91:280–282

    Article  PubMed  Google Scholar 

  7. Jänes A, Cengiz Y, Israelsson LA (2004) Preventing parastomal hernia with a prosthetic mesh: a randomized study. Arch Surg 139:1356–1358

    Article  PubMed  Google Scholar 

  8. Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J et al (2009) Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 249(4):583–587

    Article  PubMed  Google Scholar 

  9. Moreno-Matias J, Serra-Aracil X, Darnell-Martin A et al (2009) The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Colorectal Dis 11(2):173–177

    Article  CAS  PubMed  Google Scholar 

  10. Marimuthu K, Vijayasekar C, Ghosh D, Mathew G (2006) Prevention of parastomal hernia using preperitoneal mesh: a prospective observational study. Colorectal Dis 8(8):672–675

    Article  CAS  PubMed  Google Scholar 

  11. Helgstrand F, Gogenur I, Rosenberg J (2008) Prevention of parastomal hernia by the placement of a mesh at the primary operation. Hernia 12(6):577–582

    Article  CAS  PubMed  Google Scholar 

  12. Kald A, Juul KN, Hjortsvang H, Sjodahl RI (2008) Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy. Scand J Gastroenterol 43(5):627–633

    Article  PubMed  Google Scholar 

  13. Guenaga KF, Lustosa SA, Saad SS et al (2007) Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Cochrane Database Syst Rev (1):CD004647

    Google Scholar 

  14. Devlin HB, Kingsnorth AN (1998) Parastomal hernia. In: Devlin HB, Kingsnorth A (eds) Management of abdominal hernias. 2nd edn. Butterworths, London, pp 257–266

  15. Londono-Schimmer EE, Leong AP, Phillips RK (1994) Life table analysis of stomal complications following colostomy. Dis Colon Rectum 37(9):916–920

    Article  CAS  PubMed  Google Scholar 

  16. Sjodahl R, Anderberg B, Bolin T (1988) Parastomal hernia in relation to site of the abdominal stoma. Br J Surg 75(4):339–341

    Article  CAS  PubMed  Google Scholar 

  17. Eldrup J, Wied U, Bishoff N, Moller-Pedersen V (1982) Parakolostomihernier. Incidens og relation till stomiens placering. Ugeskr Laeger 144:3742–3743

    CAS  PubMed  Google Scholar 

  18. Berger D (2009) Parastomal hernia – persistent frustration? Hernia 13 [Suppl 1]:34

  19. Berger D, Bientzle M (2007) Laparoscopic repair of parastomal hernias: a single surgeon’s experience in 66 patients. Dis Colon Rectum 50(10):1668–1673

    Article  PubMed  Google Scholar 

  20. Hansson BM, Hingh IH de, Bleichrodt RP (2007) Laparoscopic parastomal hernia repair is feasible and safe: early results of a prospective clinical study including 55 consecutive patients. Surg Endosc 21:989–993

    Article  CAS  PubMed  Google Scholar 

  21. LeBlanc KA, Bellanger DE, Whitaker JM, Hausmann MG (2005) Laparoscopic parastomal hernia repair. Hernia 9(2):140–144

    Article  CAS  PubMed  Google Scholar 

  22. Israelsson LA (2005) Preventing and treating parastomal hernia. World J Surg 29:1086–1089

    Article  PubMed  Google Scholar 

  23. Kelly ME, Behrman SW (2002) The safety and efficacy of prosthetic hernia repair in clean-contaminated and contaminated wounds. Am Surg 68(6):524–529

    PubMed  Google Scholar 

  24. Vijayasekar C, Marimuthu K, Jadhav V, Mathew G (2008) Parastomal hernia: Is prevention better than cure? Use of preperitoneal polypropylene mesh at the time of stoma formation. Tech Coloproctol 12(4):309–313

    Article  CAS  PubMed  Google Scholar 

  25. Morris-Stiff G, Hughes LE (1998) The continuing challenge of parastomal hernia: failure of a novel polypropylene mesh repair. Ann R Coll Surg Engl 80(3):184–187

    CAS  PubMed  Google Scholar 

  26. Janes A, Cengiz Y, Israelsson LA (2004) Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 91(3):280–282

    Article  CAS  PubMed  Google Scholar 

  27. Janes A, Cengiz Y, Israelsson LA (2009) Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 33(1):118–122

    Article  PubMed  Google Scholar 

  28. Bayer I, Kyzer S, Chaimoff C (1986) A new approach to primary strengthening of colostomy with Marlex mesh to prevent paracolostomy hernia. Surg Gynecol Obstet 163(6):579–580

    CAS  PubMed  Google Scholar 

  29. Gogenur I, Mortensen J, Harvald T et al (2006) Prevention of parastomal hernia by placement of a polypropylene mesh at the primary operation. Dis Colon Rectum 49(8):1131–1135

    Article  PubMed  Google Scholar 

  30. Berger D (2008) Prevention of parastomal hernias by prophylactic use of a specially designed intraperitoneal onlay mesh (Dynamesh IPST). Hernia 12(3):243–246

    Article  CAS  PubMed  Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Der Autor ist Berater der Ethicon Innovation Group Worldwide.

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Department of Surgery and Perioperative Science, Umeå University, Umeå, Schweden

    L.A. Israelsson MD, PhD

  2. Kirurgkliniken, Sundsvalls sjukhus, SE-85186, Sundsvall, Schweden

    L.A. Israelsson MD, PhD

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  1. L.A. Israelsson MD, PhD
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Correspondence to L.A. Israelsson MD, PhD.

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Vom Englischen ins Deutsche übersetzt von Sibylle Merk (Heidelberg).

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Israelsson, L. Parastomale Hernienversorgung mit prothetischer Netzplastik. Chirurg 81, 216–221 (2010). https://doi.org/10.1007/s00104-009-1820-y

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