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Refluxkrankheit des Ösophagus/Hiatushernie

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Evidenzbasierte Viszeralchirurgie benigner Erkrankungen

Part of the book series: Evidenzbasierte Chirurgie ((EC))

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Zusammenfassung

Die laparoskopische Fundoplikatio gilt als der Goldstandard für die chirurgische Therapie der gastroösophagealen Refluxkrankheit (GERD) und symptomatischen Hiatushernien. Nach Ausschluss maligner Erkrankungen oder funktioneller Erkrankungen wie z. B. der Achalasie, liegt die Wahl der Antirefluxmanschette (Voll- oder Teilmanschette) letztlich im Ermessen des Operateurs. Es konnte in der Vergangenheit gezeigt werden, dass die partielle Fundoplikatio (z. B. 270° Toupet) die Inzidenz postoperativer Dysphagien senkt, ohne den günstigen Effekt auf die Refluxsymptomatik einzuschränken. Im Falle großer Hernien wird eine Netzimplantation zur Hiatusverstärkung diskutiert und nach aktueller Datenlage unter entsprechenden Voraussetzungen als sinnvoll angesehen. Laparoskopische Revisionseingriffe nach fehlgeschlagener primärer Antirefluxoperation sollten erfahrenen Operateuren vorbehalten bleiben. Aufgrund der unzureichenden Evidenz sollte die endoskopische Antirefluxtherapie lediglich auf ein ausgewähltes Patientenkollektiv und nach umfangreicher Aufklärung über Nutzen und Risiken beschränkt bleiben.

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Authors and Affiliations

  1. Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    P Wilhelm

  2. Klinik für Allgemein- und Viszeralchirurgie, Zentrum für Minimal-invasive Chirurgie, Krankenhaus Neuwerk, Dünner Str. 214-216, 41066, Mönchengladbach, Deutschland

    S A Antoniou

  3. Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    A Kirschniak

  4. Krankenhaus Neuwerk „Maria von den Aposteln“, Fachabteilung Allgemein- und Viszeralchirurgie, Dünner Straße 214-216, 41066, Mönchengladbach, Deutschland

    F.-A Granderath

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  1. Allgemein-,Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany

    Christoph-Thomas Germer

  2. Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany

    Tobias Keck

  3. ehem. Wissenschaftlich Medizinischer, Direktor Kreiskliniken Altötting-Burghausen, Burghausen, Germany

    Reinhart T. Grundmann

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Wilhelm, P., Antoniou, S.A., Kirschniak, A., Granderath, FA. (2017). Refluxkrankheit des Ösophagus/Hiatushernie. In: Germer, CT., Keck, T., Grundmann, R. (eds) Evidenzbasierte Viszeralchirurgie benigner Erkrankungen. Evidenzbasierte Chirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-53553-0_6

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