Herausforderung Bauchwandverschluss – Übersicht zur Problematik und Lösungsansätze

Zusammenfassung

Die zahlenmäßig häufigsten Komplikationen nach abdominalchirurgischen Eingriffen – Wundinfektionen und die Entwicklung von Narbenhernien – hängen mit der Eröffnung und dem Verschluss der Bauchhöhle zusammen. In Abhängigkeit vom Patientengut werden Wundinfektionsraten bis 19 % und Hernienraten bis 38 % berichtet. Wenn man die aktuelle Literatur als Grundlage nimmt, so sollte die Bauchwand mit fortlaufenden, langsam resorbierbaren Fäden mit einem Faden-zu-Wund-Längenverhältnis größer 4 und schmalen Stichen verschlossen werden. Während antibakterielles Nahtmaterial die Zahl der Wundinfektionen zu reduzieren hilft, ist die Vorbeugung der Entwicklung von Narbenhernien ein ungelöstes Problem. Da sich noch immer keine chirurgische Standardtechnik beim Bauchwandverschluss durchgesetzt hat, sollten Chirurgen in größerem Maße auf die Vereinheitlichung und Dokumen­tation der Technik sowie der Wundversorgung drängen. 

Abstract

The most common complications after abdominal surgery – wound infections and the development of incisional hernia – are associated with the opening and closing of the abdominal wall. Depending on the selection of patients, wound infection rates of up to 19 % and hernia rates of up to 38 % are reported. Based on a summary of the actual literature, the abdominal wall should be closed with continuous slowly absorbable sutures with a suture length to wound length ratio of over 4 using small stitches. While antiseptic suture material may help to reduce wound infections after abdominal incision, preventing the development of incisional hernia is still a unsolved problem. As there is still no standard surgical technique for abdominal wall closure, surgeons should pay greater attention to the standardisation and documentation of techniques and wound care. 

Wundinfektion - Hernie - Abdominalchirurgie

abdominal surgery - hernia - wound infection

Literatur

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