Zusammenfassung
Hintergrund: Die Netzschrumpfung gehört zu den nur unzureichend gelösten Problemen der laparoskopischen
Narbenhernienreparation. Methodik: Literaturrecherche über die Online-Datenbanken DIMDI und Pubmed mit den Suchbegriffen
„ventral hernia, incisional hernia, laparoscopic hernia repair, mesh shrinkage“. Die Schätzung
der Oberflächenveränderungen des Abdomens durch die Volumenveränderung durch Gasinsufflation
erfolgt am Modell der Halbkugel. Ergebnisse: Elf experimentelle und 3 klinische Studien machen Angaben zur Schrumpfung intraperitoneal
platzierter Netze mit unterschiedlichen methodischen Ansätzen. Polypropylennetze weisen
eine Schrumpfung von 3,6–25,4 %, PTFE-Netze von 4–51 %, die beschichteten Polypropylen-
und Polyesternetze von 6,1–33,6 % auf. Die klinischen Studien bestätigen Schrumpfungsraten
von 5–57 %. Die Insufflation des Abdomens in den laparoskopischen Operationsverfahren
hat eine erhebliche Oberflächenvergrößerung des Abdomens zur Folge. Bereits eine Volumenvermehrung
von 3 l führt zu einer 80 % größeren Oberfläche. Dies übersteigt die größte bisher
publizierte Schrumpfungsrate. Schlussfolgerung: Bei der laparoskopischen Hernienreparation muss mit einer erheblichen Schrumpfung
der Netze gerechnet werden. Das Ausmessen der erforderlichen Netzgröße muss die Oberflächenvergrößerung
des insufflierten Abdomens und die Schrumpfung der Netze berücksichtigen.
Abstract
Introduction: Mesh shrinkage is one of the unsolved problems of laparoscopic hernia repair. Methods: A literature search via the online database DIMDI and Pubmed with the key words “ventral
hernia, incisional hernia, laparoscopic hernia repair, mesh shrinkage” was carried
out. Surface and volume changes caused by insufflation of the abdomen were estimated
with a simplified hemisphere model. Results: Eleven experimental and 3 clinical studies published data referring to shrinkage
of intraperitoneally placed meshes. Polypropylene meshes showed shrinkage in the order
of 3.6–25.4 %, PTFE meshes 4.0–51.0 %, coated polypropylene and polyester meshes 6.1–33.6 %.
Three clinical studies confirmed these data (5–57 %). Since gas insufflation of the
abdomen is essential for laparoscopic hernia repair, the volume and surface of the
abdominal wall are intraoperatively significantly increased. An additional volume
of 3 l increases the abdominal surface by about 80 %. This is more than the published
shrinkage rates can compensate. Consequences: The surgeon has to anticipate significant mesh shrinkage in laparoscopic hernia repair.
The measurement of the proper mesh dimensions has to consider the changes of volume
and surface of the insufflated abdomen and the expected mesh shrinkage.
Schlüsselwörter
ventrale Bauchdeckenhernie - Narbenhernie - laparoskopische Hernienreparation - Netzschrumpfung
Key words
ventral hernia - incisional hernia - laparoscopic hernia repair - mesh shrinkage
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PD Dr. med. J. Jonas
Klinik für Allgemein-, Gefäß- und Visceralchirurgie · St. Marienkrankenhaus
Richard-Wagner-Str. 14
60318 Frankfurt / Main
Phone: 0 69 / 15 63 12 21
Email: J.Jonas@katharina-kasper.de
