Therapie von Narbenhernien mit oder ohne Implantation von Kunststoff-Netzen : Ergebnisse der Klinik für Chirurgie der RWTH Aachen 1985-2000

Any defect on the abdominal wall can always cause the herniation of intra-abdominal organs. Combined with the possibility of incarceration, this herniation should be considered as a permanent danger to the patient. Moreover, an increase in size of the defect is always seen with time, leading to increasing limitation of the patient’s physical activities, coupled with pains and other symptoms, which may even be reported at rest. Hernia repairs belong to the daily scope of surgical operations. In the federal republic of Germany, about 250,000 inguinal hernias and 50,000 incisional hernias are repaired yearly. In USA alone, some one million hernia repairs are done yearly, of which 689,000 are inguinal hernias. At the surgical department of the RWTH Aachen, hernia repairs cover up 16-19% of all the operations. Here, this is the highest percentage of operations devoted to one organ system. Of all the inguinal hernias, 10-15% are seen in children, meanwhile incisional hernias in this age group are very rare [49]. While primary hernias develop through anatomically weak points of the abdominal wall, incisional hernias are located at scars, most probably after laparotomy. The development of an incisional hernia with an incidence of 10-20% is one of the most frequent surgical complications [48], which can lead to impairment of the already healed patient. Experiences made at the surgical department of the RWTH Aachen in the past fifteen years with 500 incisional hernia patients reflect changes that have taken place in this area of surgery within the past few years. Of recent, the implantation of alloplastic materials (meshes) has come to replace the hitherto dominating mesh-free hernia repair techniques. In this study, firstly, mesh-free hernia repairs done between 1985 and 1999 will be analysed retrospectively. The Mayo-plastic and the edge-to-edge repair techniques will be analysed for recurrence hernias, postoperative complications and their functional consequences. Secondly, results of this analysis will be compared with prospectively collected data on hernia repairs done with the mesh techniques between 1992 and 2000. Thirdly, patients after mesh implantation will be studied for the influence of used biomaterial. This will include the following factors: stability, frequency of wound infections and seroma, integration of the mesh into the abdominal wall tissue, movement restrictions of the abdominal wall, the meaning of mesh size, the position of the mesh and complete closure of the peritoneum. Summary: Worldwide, the incisional hernia repair has experienced a change from suture methods to mesh techniques, in which the abdominal wall is strengthened with alloplastic materials. With the aid of an analysis of data obtained from 454 Patients operated on between 1985 and 2000, results are here presented, with particular reference to the development of recurrence hernia, the rate of local complications and consequences on the quality of lives of the patients. While mostly suture techniques were implemented in hernia repair in the years 1985-1992, mesh implantation in sublay position subsequently dominated this area of surgery in the 90ies. In the early days of mesh era, the Marlex® mesh was used. Later on, the Atrium® mesh was preferred and today, almost only the newly developed Vypro® mesh is being used. Doubling of the fascia like in the Mayo-plastic does not lead to any reduced hernia recurrence rate when compared with the edge-to edge-repair. Clinical experience could show that both repair principles lead to an equal hernia recurrence rate of over 50% after six years. The mesh repair techniques were able to reduce the hernia recurrence after the same period of time to rates below 10% independent of the mesh material used. Several factors were studied for their effect on the development of recurrence hernias. The recurrence-status played a role in the development of recurrence hernias after suture techniques as well as after mesh implantation. Due to the fact that multivariate analysis showed interaction of recurrence-status with other factors, this factor can only be judged in combination with others as a risk factor. Furthermore, our study isolated the male gender as a significant risk factor for the development of recurrence incisional hernia independent of the applied therapy principle. Obese patients (BMI > 26) and those younger than 60 years also have a higher risk for the development of recurrence incisional hernias. Among patients receiving conventional incisional hernia repair, a lower, but not significant recurrence rate could be seen for hernias smaller than, compared to those larger than 4 cm (28 and 34% respectively). In all repair techniques studied, no relationship could be found between the surgeon as a factor and the recurrence of incisional hernia. This was the same case for size of the mesh as a factor. Despite the implantation of large masses of alloplastic materials during mesh repair, wound infection rates were not more than those seen after mesh free repair techniques. All methods of hernia repair with the aid of meshes influence abdominal wall movement. Using the Vypro® mesh bettered up functional integration into the abdominal wall with a reduction of paraesthesia as well as that of mesh-related symptoms. It also prevented the development of large Seroma around the mesh. 3D-stereography allows objective studies of abdominal wall movements. After mesh implantation, mobility of the abdominal wall is impaired. Greatest impairment was observed for the heaviest mesh with the smallest pores (Marlex®). All in all, this impairment reduces for Vypro® and Atrium® after an observation period of over one year.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2002

Author dc:creator

• Ntouba, Alexandre

Contributors dc:contributor

• Schumpelick, Volker

• info:eu-repo/classification/ddc/610
• Medizin

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-119099%22

OAI identifier oai:identifier

oai:publications.rwth-aachen.de:57029