Skip to main content
SpringerLink
Log in

Antirefluxoperationen

Indikation und Techniken

Antireflux operations

Indications and techniques

  • CME Zertifizierte Fortbildung
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Bei ausgeprägter gastroösophagealer Refluxkrankheit ist die Fundoplikation eine gute Therapieoption, wenn eine Langzeittherapie mit Protonenpumpenblockern nicht in Betracht kommt. Bei der Indikationsstellung ist besondere Sorgfalt geboten: Das Vorliegen einer Refluxkrankheit muss objektiv nachgewiesen sein und die Wahrscheinlichkeit sollte gering sein, dass die betreffenden Patienten funktionelle Nebenwirkungen entwickeln.

Operationstechnisch kommen in erster Linie die 360°-Manschette nach Nissen oder die 270°-Manschette nach Toupet in Betracht, die heute im Wesentlichen als gleichwertig gelten. In beiden Fällen gilt, dass die Manschettenbildung locker und nicht zu breit ausgeführt wird. Sie muss sicher fixiert werden; bei der Präparation müssen Schädigungen der vagalen Innervation unbedingt vermieden werden.

Die Langzeitergebnisse sind nach beiden Verfahren hinsichtlich der Refluxverhütung sehr gut und der medikamentösen Behandlung überlegen. Allerdings müssen funktionelle Nebeneffekte in Kauf genommen werden. Um die Inzidenz gering zu halten, ist eine sorgfältige präoperative Patientenselektion empfehlenswert.

Abstract

In severe gastroesophageal reflux disease fundoplication is a sound therapeutic alternative if long-term treatment with proton pump inhibitors is not a viable option. However, careful patient selection is mandatory and reflux disease has to be proven objectively. Patients who are particularly prone to develop postoperative functional side effects should be excluded.

For surgical treatment either a 360° wrap (Nissen) or a 270° wrap (Toupet) can be performed with more or less equivalent results. The common technical denominators are to achieve a loose, short wrap. In both instances the cuff has to be fixed securely with non-absorbable sutures and any damage to the vagal innervation has to be avoided.

Long-term reflux prevention is excellent and superior to medical treatment; nonetheless, functional side effects still occur and to keep the incidence as low as possible preoperative selection of patients is essential.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Vakil N, Zanten SV van, Kahrilas P et al (2007) Die Montreal-Definition und -Klassifikation der gastroösophagealen Refluxkrankheit: Ein globales evidenzbasiertes Konsensus-Papier. Z Gastroenterol 45:1125–1140

    Article  PubMed  CAS  Google Scholar 

  2. Pehl C, Keller J, Allescher HD et al (2012) Ösophageale Refluxdiagnostik – pH-Metrie, Impedanzmessung, Bilirubin-Messung: Empfehlungen der Deutschen Gesellschaft für Neurogastroenterologie und Motilität und der Arbeitsgruppe Neurogastroenterologie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten. Z Gastroenterol 50:1310–1332

    Article  PubMed  CAS  Google Scholar 

  3. Sifrim D, Zerbib F (2012) Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut 61(9):1340–1354

    Article  PubMed  CAS  Google Scholar 

  4. Bajbouj M, Becker V, Phillip V et al (2009) High-dose esomeprazole for treatment of symptomatic refractory gastroesophageal reflux disease – a prospective pH-metry/impedance-controlled study. Digestion 80(2):112–118

    Article  PubMed  CAS  Google Scholar 

  5. Corley D, Kubo A, Zhao W, Quesenberry C (2010) Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. Gastroenterology 139:93–101

    Article  PubMed  Google Scholar 

  6. Fuchs KH, Feußner H (2003) Laparoskopische Fundoplikatio: Indikationen und Ergebnisse. Internist 44(1):36–42

    PubMed  CAS  Google Scholar 

  7. Allaix ME, Herbella FA, Patti MG (2012) Laparoscopic total fundoplication for gastroesophageal reflux disease. How I do it. J Gastrointest Surg (Epub ahead of print)

  8. Kauttu TME, Rantanen TK, Sihvo EI et al (2011) Esophageal adenocarcinoma arising after antireflux surgery: a population-based analysis. Eur J Cardiothorac Surg 40:1450–1454

    PubMed  Google Scholar 

  9. Broeders JA, Broeders EA, Watson DI et al (2012) Objective outcomes 14 years after laparoscopic anterior 180-degree partial versus Nissen fundoplication: results from a randomized trial. Ann Surg (Epub ahead of print)

  10. Broeders JA, Mauritz FA, Ahmed Ali U et al (2010) Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease. Br J Surg 97(9):1318–1330

    Article  PubMed  CAS  Google Scholar 

  11. Ma S, Qian B, Shang L et al (2012) A meta-analysis comparing laparoscopic partial versus Nissen fundoplication. ANZ J Surg 82(1–2):17–22

    Google Scholar 

  12. Ramos RF, Lustosa SA, Almeida CA et al (2011) Surgical treatment of gastroesophageal reflux disease: total or partial fundoplication? systematic review and meta-analysis. Arq Gastroenterol 48(4):252–260

    PubMed  Google Scholar 

  13. Tan G, Yang Z, Wang Z (2011) Meta-analysis of laparoscopic total (Nissen) versus posterior (Toupet) fundoplication for gastro-oesophageal reflux disease based on randomized clinical trials. ANZ J Surg 81(4):246–252

    Article  PubMed  Google Scholar 

  14. Varin O, Velstra B, De Sutter S, Ceelen W (2009) Total vs partial fundoplication in the treatment of gastroesophageal reflux disease: a meta-analysis. Arch Surg 144(3):273–278

    Article  PubMed  Google Scholar 

  15. Rosemurgy A, Paul H, Madison L et al (2012) A single institution’s experience and journey with over 1000 laparoscopic fundoplications for gastroesophageal reflux disease. Am Surg 78(9):917–925

    PubMed  Google Scholar 

  16. Engström C, Jamieson GG, Devitt PG, Watson DI (2011) Meta-analysis of two randomized controlled trials to identify long-term symptoms after division of the short gastric vessels during Nissen fundoplication. Br J Surg 98(8):1063–1067

    Article  PubMed  Google Scholar 

  17. Khatri K, Sajid MS, Brodrick R et al (2012) Laparoscopic Nissen fundoplication with or without short gastric vessel division: a meta-analysis. Surg Endosc 26:970–978

    Article  PubMed  Google Scholar 

  18. Markar SR, Karthikesalingam AP, Wagner OJ et al (2011) Systematic review and meta-analysis of laparoscopic Nissen fundoplication with or without division of the short gastric vessels. Br J Surg 98(8):1056–1062

    Article  PubMed  CAS  Google Scholar 

  19. Ipek T, Eyuboglu E, Ozben V (2010) Partial splenic infarction as a complication of laparoscopic floppy nissen fundoplication. J Laparoendosc Adv Surg Tech A 20(4):333–337

    Article  PubMed  Google Scholar 

  20. Louie BE, Kapur S, Blitz M et al (2012) Length and pressure of the reconstructed lower esophageal sphincter is determined by both crural closure and Nissen fundoplication. J Gastrointest Surg (Epub ahead of print)

  21. Feußner H, Friess H, Wilhelm D (2011) Netzversorgung am Hiatus: Pro und Contra. Passion Chirurgie Q1:10–13

    Google Scholar 

  22. Arendt T, Stüber E, Mönig H et al (2000) Dysphagia due to transmural migration of surgical material into the esophagus nine years after Nissen fundoplication. Gastrointest Endosc 51(5):607–610

    Article  PubMed  CAS  Google Scholar 

  23. Carpelan-Holmström M, Kruuna O, Salo J et al (2011) Late mesh migration through the stomach wall after laparoscopic refundoplication using a dual-sided PTFE/ePTFE mesh. Hernia 15(2):217–220

    Article  PubMed  Google Scholar 

  24. Coluccio G, Ponzio S, Ambu V et al (2000) Dislocation into the cardial lumen of PTFE prosthesis used in the treatment of voluminous hiatal sliding hernia, a case report. Minerva Chir 55(5):341–345

    PubMed  CAS  Google Scholar 

  25. Dutta S (2007) Prosthetic esophageal erosion after mesh hiatoplasty in a child, removed by transabdominal endogastric surgery. J Pediatr Surg 42:252–256

    Article  PubMed  Google Scholar 

  26. Griffith PS, Valenti V, Qurashi K, Martinez-Isla A (2008) Rejection of goretex mesh used in prosthetic cruroplasty: a case series. Int J Surg 6(2):106–109

    Article  PubMed  Google Scholar 

  27. Hazebroek EJ, Ng A, Yong DH et al (2008) Evaluation of lightweight titanium-coated polypropylene mesh (TiMesh) for laparoscopic repair of large hiatal hernias. Surg Endosc 22(11):2428–2432

    Article  PubMed  Google Scholar 

  28. Hergueta-Delgado P, Marin-Moreno M, Morales-Conde S et al (2006) Transmural migration of a prosthetic mesh after surgery of a paraesophageal hiatal hernia. Gastrointest Endosc 64(1):120–121

    Article  PubMed  Google Scholar 

  29. Kepenekci I, Turkcapar AG (2009) Mesh erosion as a complication of laparoscopic fundoplication with prosthetic hiatal closure: report of a case. Surg Laparosc Endosc Percutan Tech 19(2):e51–e54

    Article  PubMed  Google Scholar 

  30. Koh EH, Wong K (2011) Perforated gastric volvulus post-lap fundoplication and hiatal mesh herniorrhaphy. ANZ J Surg 81(10):754–755

    Article  PubMed  Google Scholar 

  31. Rumstadt B, Kähler G, Mickisch O, Schilling D (2008) Gastric mesh erosion after hiatoplasty for recurrent paraesophageal hernia. Endoscopy 40:E70

    Article  PubMed  Google Scholar 

  32. Stadlhuber RJ, Sherif AE, Mittal SK et al (2009) Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc 23(6):1219–1226

    Article  PubMed  Google Scholar 

  33. Zügel N, Lang RA, Kox M, Hüttl TP (2009) Severe complication of laparoscopic mesh hiatoplasty for paraesophageal hernia. Surg Endosc 23(11):2563–2567

    Article  PubMed  Google Scholar 

  34. Baladas HG, Smith GS, Richardson MA et al (2000) Esophagogastric fistula secondary to Teflon pledget: a rare complication following laparoscopic fundoplication. Dis Esophagus 13(1):72–74

    Article  PubMed  CAS  Google Scholar 

  35. Mickevičius A, Endzinas Ž, Kiudelis M et al (2012) Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study. Surg Endosc (Epub ahead of print)

  36. Feußner H, Kauer W, Stein H (2001) Intra- und postoperative Komplikationen bei der laparoskopischen Fundoplicatio. Chir Gastroenterol 17:43–50

    Article  Google Scholar 

  37. Carlson MA, Frantzides CT (2001) Complications and results of primary minimally invasive antireflux procedures: a review of 10,735 reported cases. J Am Coll Surg 193(4):428–439

    Article  PubMed  CAS  Google Scholar 

  38. Fumagalli U, Bona S, Battafarano F et al (2008) Persistent dysphagia after laparoscopic fundoplication for gastroesophageal reflux disease. Dis Esophagus 21(3):257–261

    Article  PubMed  CAS  Google Scholar 

  39. Perdikis G, Hinder RA, Lund RJ et al (1997) Laparoscopic Nissen fundoplication: where do we stand? Surg Laparosc Endosc 7(1):17–21

    Article  PubMed  CAS  Google Scholar 

  40. Pessaux P, Arnaud JP, Ghavami B et al (2002) Morbidity of laparoscopic fundoplication for gastroesophageal reflux: a retrospective study about 1470 patients. Hepatogastroenterology 49:447–450

    PubMed  CAS  Google Scholar 

  41. Rantanen TK, Oksala NKJ, Oksala AK et al (2008) Complications in antireflux surgery. Arch Surg 143(4):359–365

    Article  PubMed  Google Scholar 

  42. Lidor AO, Chang DC, Feinberg RL et al (2011) Morbidity and mortality associated with antireflux surgery with or without paraesophageal hernia: a large ACS NSQIP analysis. Surg Endosc 25:3101–3108

    Article  PubMed  Google Scholar 

  43. Wang YR, Dempsey DT, Richter JE (2011) Trends and perioperative outcomes of impatient antireflux surgery in the United States, 1993–2006. Dis Esophagus 24:215–223

    Article  PubMed  CAS  Google Scholar 

  44. Eyuboglu E, Ipek T (2011) Laparoscopic floppy Nissen fundoplication: 16 years of experience from the historical clinic of Rudolph Nissen. Hepatogastroenterology 58(110–111):1607–1610

    Google Scholar 

  45. Niebisch S, Fleming FJ, Galey KM et al (2012) Perioperative risk of laparoscopic fundoplication: safer than previously reported – analysis of the American College of Surgeons National Surgical Quality Improvement Program 2005–2009. J Am Coll Surg 215(1):61–68

    Article  PubMed  Google Scholar 

  46. Le K, Griner D, Hope WW, Tackett D (2012) Splenic torsion requiring splenectomy six years following laparoscopic Nissen fundoplication. JSLS 16:184–188

    Article  PubMed  Google Scholar 

  47. Beenen E, Fogarty P, Roberts RH (2012) Predicting patient dissatisfaction following laparoscopic Nissen fundoplication: an analysis of symptoms. Surg Endosc (Epub ahead of print)

  48. Bhandarwar AH, Kasat GV, Palep JH et al (2012) Impact of laparoscopic Nissen’s fundoplication on response of disease specific symptoms and quality of life. Updates Surg (Epub ahead of print)

  49. Davis CS, Baldea A, Johns JR et al (2010) The evolution and long-term results of laparoscopic antireflux surgery for the treatment of gastroesophageal reflux disease. JSLS 14(3):332–341

    Article  PubMed  CAS  Google Scholar 

  50. McKenna D, Beverstein G, Gould J (2011) Gastrointestinal symptoms and patient satisfaction more than 1 year after laparoscopic Nissen fundoplication. Surg Endosc 25(6):1797–1801

    Article  PubMed  Google Scholar 

  51. Galmiche JP, Hatlebakk J, Attwood S et al (2011) Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial. JAMA 305(19):1969–1977

    Article  PubMed  CAS  Google Scholar 

  52. Wileman SM, McCann S, Grant AM et al (2010) Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults. Cochrane Database Syst Rev 3:CD003243

    PubMed  Google Scholar 

  53. Dallemagne B, Weerts J, Markiewicz S et al (2006) Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 20:159–165

    Article  PubMed  CAS  Google Scholar 

  54. Cowgill SM, Gillman R, Kraemer E et al (2007) Ten-year follow up after laparoscopic Nissen fundoplication for gastroesophageal reflux disease. Am Surg 73(8):748–752

    PubMed  Google Scholar 

  55. Kelly JJ, Watson DI, Chin KF et al (2007) Laparoscopic Nissen fundoplication: clinical outcomes at 10 years. J Am Coll Surg 205(4):570–575

    Article  PubMed  Google Scholar 

  56. Fein M, Bueter M, Thalheimer A et al (2008) Ten-year outcome of laparoscopic antireflux surgery. J Gastrointest Surg 12:1893–1899

    Article  PubMed  CAS  Google Scholar 

  57. Cai W, Watson DI, Lally CJ et al (2008) Ten-year clinical outcome of a prospective randomized clinical trial of laparoscopic Nissen versus anterior 180° partial fundoplication. Br J Surg 95:1501–1505

    Article  PubMed  CAS  Google Scholar 

  58. Miholic J, Hafez J, Lenglinger J et al (2012) Hiatal hernia, Barrett’s esophagus, and long-term symptom control after laparoscopic fundoplication for gastroesophageal reflux. Surg Endosc 26:3225–3231

    Article  PubMed  Google Scholar 

  59. Salminen P, Hurme S, Ovaska J (2012) Fifteen-year outcome of laparoscopic and open Nissen fundoplication: a randomized clinical trial. Ann Thorac Surg 93(1):228–233

    Article  PubMed  Google Scholar 

  60. Richter JE (2012) GERD treatment: side effects and complications of fundoplication. Clin Gastroenterol Hepatol (Epub ahead of print)

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland

    H. Feussner & D. Wilhelm

Authors
  1. H. Feussner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Wilhelm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Feussner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Feussner, H., Wilhelm, D. Antirefluxoperationen. Chirurg 84, 339–350 (2013). https://doi.org/10.1007/s00104-012-2385-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-012-2385-8

Schlüsselwörter

Keywords

Search

Navigation