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Evidenzbasierte Viszeralchirurgie benigner Erkrankungen pp 85–92Cite as

Magen- und Duodenalulkus

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

Zusammenfassung

Die Evidenz für die verschiedenen chirurgischen Behandlungsverfahren beim perforierten Magen- und Duodenalulkus ist trotz der Häufigkeit der Pathologie begrenzt. Viele der in den Leitlinien, Metaanalysen und klinischen Studien analysierten Daten sind mehr als 10 Jahre alt und stammen zum Teil sogar aus den 1990er-Jahren. Patienten mit dem Verdacht auf eine Perforation des Magens oder Duodenums müssen chirurgisch vorgestellt werden. Eine Peritonitis oder septischer Schock müssen dann zur unverzüglichen operativen Versorgung führen. Bei Patienten ohne Peritonitis und Schockzeichen kann ein konservatives Vorgehen ausreichend sein. Bei klinischer Verschlechterung unter konservativer Therapie ist die Operation indiziert. Zur Behandlung des benignen Ulkus wird die einfache Übernähung empfohlen, resezierende Verfahren sollten möglichst vermieden werden. In erfahrenen Händen ist die Laparoskopie der Laparotomie zur Fokussanierung und im kurz- und langfristigen Outcome nicht unterlegen. Wenn möglich, soll eine intraoperative Schnellschnittuntersuchung erfolgen, gerade bei Patienten über 70 Jahren ist in mehr als 10 % ein Karzinom Ursache der Perforation. Die Resektion und Rekonstruktion soll auch bei Zeichen einer Peritonitis erfolgen. Bei Schock und hämodynamischer Instabilität sowie schwerer Peritonitis ist ein zweizeitiges Vorgehen dem einzeitigen in Bezug auf das onkologische Outcome nicht unterlegen. Perforationen nach ERCP und Duodenoskopie können häufig im Rahmen der eigentlichen Intervention oder konservativ behandelt werden.

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Authors and Affiliations

  1. Klinik für Allgemeine Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    M Hoffmann

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  1. M Hoffmann
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Correspondence to M Hoffmann .

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Editors and Affiliations

  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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Hoffmann, M. (2017). Magen- und Duodenalulkus. 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_7

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  • DOI: https://doi.org/10.1007/978-3-662-53553-0_7

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