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Therapie der Netz(-Implantat)-Infektion

Management of mesh-related infections

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Zusammenfassung

Die Netzinfektion ist für den Patienten und den behandelnden Operateur eine große Belastung. Die Inzidenzrate bei Narbenhernien liegt zwischen 1% bei laparoskopischen Eingriffen bis über 15% bei offenen Verfahren. Als primäre Ursache gilt die intraoperative Kontamination der Netze. Alle gewebten oder gestrickten Netze haben Nischen, in denen sich Bakterien ansiedeln können. Das Keimspektrum der Netzinfektionen umfasst Hautkeime wie Staphylococcus aureus (inkl. MRSA) und Streptococcus spp, aber auch E. coli, Enterokokkus und Mycobacteriae. Ausgang für die Therapie ist die Morphologie des Befundes. Bei unkomplizierter Phlegmone ist die kalkulierte Antibiotikatherapie das Verfahren der Wahl. Bei infiziertem Verhalt ist die CT-gesteuerte Punktion mit Kathetereinlage und täglicher Spülung eine Option. Bei Hautnekrose, prothetokutaner Fistel, freiliegendem Netz oder enterokutaner Fistel muss der Befund nach bildgebender Diagnostik in Narkose exploriert werden. Zunehmende Bedeutung gewinnt dabei die Vakuumkonditionierung. Bei den meisten Patienten wird das Therapiekonzept eine Individualentscheidung sein. Wenn der Patient ein Teil des ehemals infizierten Netzes behält, ist ein längeres Follow-up nötig.

Abstract

Infections of an implanted hernia mesh are a major challenge. The incidence of mesh infections after incisional hernia repair is about 1% for endoscopic techniques and can be more than 15% in open techniques. Intraoperative mesh contamination is considered to be the primary cause. All woven or knitted hernia meshes have recesses where bacteria may adhere and establish colonies. The bacterial spectrum for mesh infection includes skin pathogens, such as Staphylococcus aureus (including MRSA), Streptococcus spp., as well as E. coli, Enterococcus and Mycobacteria. The therapy approach needs to be tailored to the morphological findings and the treatment for uncomplicated phlegmon is broad spectrum antibiotic therapy. If there is encapsulated fluid accumulation, CT-controlled drainage and daily infusion of antiseptics via the drain is a good option. For dermal necrosis, mesh fistula, exposed mesh or enterocutaneous fistula, a precise CT evaluation is necessary to tailor the operation. Vacuum systems are gaining increased acceptance in conditioning the local findings. For most patients the therapeutic concept will be based on individual decisions. If parts of a formerly infected mesh remain in the patient, a lifelong follow-up is necessary.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: PD Dr. Dr. Dietz führt Forschungsprojekte mit Aesculap AG und Johnson & Johnson Medical GmbH durch. Er ist als Referent für Aesculap AG und B. Braun Melsungen AG sowie für Covidien Deutschland GmbH und Covidien Europe tätig.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    U.A. Dietz M.Sc. (UFPR), L. Spor & C.-T. Germer

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  1. U.A. Dietz M.Sc. (UFPR)
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  2. L. Spor
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  3. C.-T. Germer
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Correspondence to U.A. Dietz M.Sc. (UFPR).

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Dietz, U., Spor, L. & Germer, CT. Therapie der Netz(-Implantat)-Infektion. Chirurg 82, 208–217 (2011). https://doi.org/10.1007/s00104-010-2013-4

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  • DOI: https://doi.org/10.1007/s00104-010-2013-4

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