Zusammenfassung
Hintergrund: Normalerweise wird für die laparoskopische Hernioplastik (peritoneale onlay Technik)
ein PTFE-Netz verwandt, um das Risiko viszeraler Adhäsionen gering zu halten. Im vorliegenden
Bericht stellen wir unsere Ergebnisse mit einem anderen Biomaterial dar.
Studiendesign: Wir verwendeten für die laparoskopische Bauchwandhernienversorgung ein Komposite-Netz,
das aus zwei verschiedenen klinisch erprobten Materialien besteht, einem Polypropylennetzanteil
und einer dünnen Schicht von PTFE. Mit dem Polypropylenanteil soll ein festes Einwachsen
in die Umgebung erreicht werden, umgekehrt soll der PTFE-Anteil das Risiko viszeraler
Adhäsionen verringern. Die Patienten und klinischen Daten wurden prospektiv erfasst.
Die Patienten wurden regelmäßig nachbeobachtet, nach vier Wochen und dann alle sechs
Monate nach dem Eingriff.
Ergebnisse: Bisher wurden 15 Patienten in die Studie aufgenommen. Die mittlere Operationszeit
betrug 101.2 (64-190) Minuten. Intraoperative Komplikationen oder Konversionen wurden
nicht beobachtet. Postoperativ kam es zu einem Serom, bei vier Patienten zu einem
verlängerten Ileus und bei einem Patienten war eine second-look Laparoskopie erforderlich,
da es zu Schmerzen an der Tackerstelle kam. Die Patienten wurden sechs Tage (3-10
Tage) nach dem Eingriff entlassen. Die mittlere Nachuntersuchungsdauer beträgt bis
jetzt 12,4 (Spanne 5-29) Monate, dabei ist es zu keinen Spätkomplikationen oder einem
Hernienrezidiv gekommen.
Folgerung: Die laparoskopische Hernioplastik mit dem Komposite-Netz zeigte einen kurzen Hospitalaufenthalt
und akzeptable Komplikationsraten sowohl für primäre als auch Rezidivbauchwandhernien.
Der Nachteil des Netzes ist seine schwierige Handhabung, es ist nicht leicht, das
Mesh genügend klein zusammenzurollen, um es in die Bauchhöhle zu positionieren.
Abstract
Background: The standard technique for laparoscopic ventral hernioplasty (peritoneal onlay) reduces
the recurrence rate and the rate of other complications, in particular the risk of
infections. However, the procedure requires a special mesh to mitigate the risk of
visceral adhesions. For this purpose an ePTFE mesh is generally used. There are limited
reported clinical data regarding the long-term results and benefits of other biomaterials.
Study design: Bard Composix¿ mesh was used for laparoscopic ventral hernia repair. This biomaterial
combines two different clinically proven materials - polypropylene with a thin layer
of ePTFE - to maximize ingrowth of surrounding tissue, while mitigating the risk of
visceral adhesions. Demographic, operative and postoperative data were collected and
analyzed. Follow-up clinical evaluations were conducted 6-10 days, 4 weeks, and every
6th month after surgery in all patients.
Results: Fifteen patients were involved in the study. The mean operating time was 101.2 min
(64-190 min). There were no intraoperative complications or conversion to open procedure.
Postoperative complications were 1 seroma, 4 cases of prolonged ileus, one tacks-site
pain requiring second-look laparoscopy. Hospital discharge occurred on average 6 days
(3-10 days) after surgery. The mean follow-up was 12.4 months (range 5-29 months).
No late complications or hernia recurrence were observed.
Conclusions: Laparoscopic prosthetic ventral hernioplasty using the composite polypropylen/ePTFE
mesh offers short hospital stay and acceptable complications for primary and recurrent
ventral hernias. Disadvantage of the composite mesh is the difficulty to roll this
product into a sufficiently small size to permit its easy introduction into the abdominal
cavity.
Schlüsselwörter
Laparoskopie - Bauchwandhernie - Komposite-Netz - Ergebnisse
Key words
Laparoscopy - abdominal wall hernia - composite-mesh - results
Literatur
- 1
Ambrosiani N, Harb J, Gavelli A, Huguet C.
Failure of the treatment of eventrations and hernias with the PTFE plate (111 cases).
Ann Chir.
1994;
48
917-920
- 2
Amid P K, Shulman A G, Lichtenstein I L.
Experimental evaluation of a new composite mesh with the selective property of incorporation
to the abdominal wall without adherence to the intestines.
J Biomed Mater Res.
1994;
28
373-375
- 3
Bellon J M, Bujan J, Contreras L A, Jurado F.
Use of nonporous polytetrafluoroethylen prosthesis in combination with polypropylene
prosthetic abdominal wall implants in prevention of peritoneal adhesions.
J Biomed Mater Res.
1997;
38
197-202
- 4
Bleichrodt R P, Simmermacher R KJ, van der Lei B, Schakenraad J M.
Expanded polytetrafluoroethylen patch versus polypropylene mesh for the repair of
contaminated defects of the abdominal wall.
Surg Gynecol Obstet.
1993;
176
18-24
- 5
Bobyn J D, Wilson G J, Mac Gregor D C. et al .
Effect of pore size on the peel strength of attachment of fibrous tissue to porous
surfaced implants.
J Biomed Mater Res.
1982;
16
571-584
- 6
Carbajo M A, del Olmo J C, Blanco J I, de la Cuesta C. et al .
Laparoscopic treatment of ventral abdominal wall hernias: preliminary results in 100
patients.
JSLS.
2000;
4
141-145
- 7
Cassar K, Munro A.
Surgical treatment of incisional hernia.
Br J Surg.
2002;
89
534-545
- 8
Chapvil M, Holusa R, Kliment K. et al .
Some chemical and biological characteristics of a new collagen-polymer compound material.
J Biomed Mater Res.
1969;
3
315-322
- 9
Cristoforini P M, Kim Y B, Preys Z, Lay R Y, Montz F J.
Adhesion formation after incisional hernia repair: a randomized porcine trial.
Am Surg.
1996;
62
935-938
- 10
Cumberland V H.
A preliminary report on the use of prefabricated nylon weave in the repair of ventral
hernia.
Med J Aust.
1952;
1
143-144
- 11
Franklin M E, Dorman J P, Glaas J L, Balli J I, Gonzales J J.
Laparoscopic ventral and incisional hernia repair.
Surg Laparosc Endosc.
1998;
8
294-299
- 12
Heniford B T, Park A, Ramshaw B J, Voeller G.
Laparoscopic ventral and incisional hernia repair in 407 patients.
J Am Coll Surg.
2000;
190
645-650
- 13
Hesselink V J, Luijendijk R W, de Wilt J HW. et al .
An evaluation of risk factors in incisional hernia recurrence.
Surg Gynecol Obstet.
1993;
176
228-234
- 14
Houck J P, Rypins E B, Sarfeh I J, Juler G L, Shimoda K J.
Repair of incisional hernia.
Surg Gynecol Obstet.
1989;
169
397-399
- 15
Leber G E, Garb J L, Albert A I. et al .
Long-term complications associated with prosthetic repair of incisional hernias.
Arch Surg.
1998;
133
378-382
- 16
Lobato R F, Santos C M, Deballon P O, Lopez J MF. et al .
Colocutaneus fistula due to polypropylen mesh.
Hernia.
2001;
5
107-109
- 17
Morris-Stiff G J, Hughes L E.
The outcomes of nonabsorbable mesh placed within the abdominal cavity: literature
review and clinical experience.
J Am Coll Surg.
1998;
186
352-367
- 18
Mueller C B.
Editorial. Abdominal incisional hernia - the role of wound infection.
Can J Surg.
1974;
17
195
- 19
Nagy K K, Fildes J J, Mahr C, Roberts R R. et al .
Experience with three prosthetic materials in temporary abdominal wall closure.
Am Surg.
1996;
62
331-335
- 20
Park A, Gagner M, Pomp A.
Laparoscopic repair of large incisional hernias.
Surg Laparosc Endosc.
1996;
6
123-128
- 21
Ramshow B J, Esartia P, Schwab J, Mason E M. et al .
Comparison of laparoscopic and open ventral herniorrhaphy.
Am Surg.
1999;
65
827-831
- 22
Scales J T.
Discussion on metals and synthetic materials in relation to soft tissue reaction to
synthetic materials.
Proc R Soc Med.
1953;
46
647-652
- 23
Simmermacher R KJ, Schakenraad J M, Bleichrodt R P.
Reherniation after repair of the abdominal wall with expanded polytetrafluoroethylene.
J Am Coll Surg.
1994;
178
613-616
- 24
Stoppa R E.
The treatment of complicated groin and incisional hernias.
World J Surg.
1989;
13
545-554
- 25
Temudom T, Siadati M, Sarr M G.
Repair of complex giant or recurrent ventral hernias by using tension-free intraparietal
prosthetic mesh (Stoppa technique): lessons learned from our initial experience (fifty
patients).
Surgery.
1996;
120
738-744
- 26
Toy F K, Bailey R W, Carey S, Chappuis C W, Gagner M. et al .
Prospective, multicenter study of laparoscopic ventral hernioplasty. Preliminary results.
Surg Endosc.
1998;
12
955-959
1 Übersetzung: R. T. Grundmann, Altötting-Burghausen
Istvan Gal
Department of Surgery
Buget Pal Hospital
Dozsa Gy. U 20-22
H-3200 Gyongyos
