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Zentralbl Chir 2021; 146(02): 200-203
DOI: 10.1055/a-1403-3558
Übersicht

Netzimplantation bei der Chirurgie der Hiatushernie und bei der Anti-Reflux-Chirurgie – Kontra-Statement

Mesh Implantation in Anti-Reflux and Hiatal Hernia Surgery – Contra Statement
Jasmina Kuvendjiska
1   Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Deutschland
,
Jens Höppner 
2   Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland
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Zusammenfassung

Bei der chirurgischen Behandlung der gastroösophagealen Refluxerkrankung und der operativen Behandlung von Hiatushernien ist die hohe Rezidivrate der Hiatushernie ein zentrales Problem. Vor diesem Hintergrund werden zur Augmentation des Nahtverschlusses am Hiatus oesophageus verschiedene alloplastische Netze eingesetzt. Es wurden in der Vergangenheit sehr unterschiedliche Ergebnisse berichtet und der Einsatz von Netzen bei der Hiatusrekonstruktion wurde kontrovers diskutiert. Im Vordergrund stehen neben der Rezidivhäufigkeit auch immer wieder Berichte über Komplikationen der Hiatusaugmentation durch alloplastische Netze. Die heutige Datenlage zeigt auf der Grundlage von mehreren prospektiv randomisierten, doppelt verblindeten Vergleichsstudien und von Metaanalysen (Klasse-Ia- und -Ib-Evidenz) keine Vorteile der netzaugmentierten Hiatoplastik für die Verhinderung des Hiatushernienrezidivs. Sie beschreibt gleichzeitig mehr langfristige postoperative Komplikationen – vor allem von Dysphagie – beim Einsatz von Netzen für die Hiatusrekonstruktion. Vom routinemäßigen Einsatz der Netzaugmentation bei der Hiatusrekonstruktion muss daher aktuell abgeraten werden.

Abstract

In the surgical treatment of gastroesophageal reflux disease and of hiatal hernias, the high rate of recurrence of hiatal hernias is a central problem. Against this background, various, primarily alloplastic, meshes are used to augment suture closure on the esophageal hiatus. Very different results have been reported in the past and the use of meshes in hiatus reconstruction is controversial. In addition to the frequency of recurrences, reports about complications of mesh augmentation are in the foreground. On the basis of several prospective randomised double-blinded comparative studies and meta-analyses (class Ia and Ib evidence), the current data do not show any advantages of mesh-augmented hiatoplasty for the prevention of recurrence of hiatal hernia. At the same time, there exist reports of more long-term postoperative complications, especially dysphagia, after use of meshes for augmentation of hiatus reconstruction. Therefore, routine use of mesh augmentation for hiatus reconstruction is currently not recommended.

Schlüsselwörter

Hiatushernie - gastroösophageale Refluxkrankheit - Viszeralchirurgie - Komplikation

Key words

hiatus hernia - gastroesophageal reflux disease (GERD) - complication


Publication History

Article published online:
13 April 2021

© 2021. Thieme. All rights reserved.

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