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Laparoskopische Magenbypasschirurgie

Laparoscopic stomach bypass surgery

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Zusammenfassung

Die morbide Adipositas entwickelt sich in Industrienationen derzeit zu einem relevanten medizinischen Problem. Die Chirurgie ist hierbei die bisher einzige Therapieform, die einen Langzeiteffekt beweisen konnte. Aufgrund der geringen Belastbarkeit adipöser Patienten ist laparoskopischen Eingriffen der Vorzug zu geben. Für die laparoskopische Bypasschirurgie stehen zwei Techniken zur Verfügung: die Jejunojejunostomie und die Gastrojejunostomie. Die Anlage der Jejunojejunostomie wird in unterschiedlichen Techniken durchgeführt: Seit-zu-Seit-Anastomose in halbmaschineller Technik, Seit-zu-Seit-Anastomose, komplett maschinell angelegt, End-zu-Seit-Anastomose in Handnahttechnik und die Seit-zu-Seit-Anastomose in Handnahttechnik. Die Anlage der Gastrojejunostomie wird ebenfalls in verschiedenen Techniken durchgeführt: maschinelle Anastomose mit dem Zirkularstapler, wobei die Andruckplatte des Gerätes entweder peroral oder per Gastrotomie eingebracht wird, die maschinelle Anastomose mit dem Linearstapler und die Anastomose in Handnahttechnik. Der Übersichtsbeitrag beschäftigt sich mit den chirurgisch-technischen Aspekten der beiden Anastomosentypen in unterschiedlichen Vorgehensweisen.

Abstract

Obesity is rapidly becoming a major medical problem in the developed world. Surgery is the only treatment with proven long-term efficiency for morbid obesity. We claim this surgery should be done by laparoscopy, because it is less invasive and morbidity is relatively low in obese patients, who are by definition fragile. Jejunojejunostomy can be performed by different techniques: side-to-side semimechanical, side-to-side entirely mechanical, end-to-side hand-sewn, and side-to-side hand-sewn. Gastrojejunostomy can be performed by different techniques: circular mechanical anastomosis with the anvil inserted through the mouth, gastrostomy, linear mechanical anastomosis, or hand-sewn anastomosis. We report our technique of laparoscopic gastric bypass with different possibilities for the two anastomoses.

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Alle Zeichnungen wurden erstellt von der European School of Laparoscopic Surgery der G.I. Surgery, Saint Pierre University Hospital, Brüssel.

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Authors and Affiliations

  1. Department of Gastrointestinal and Obesity Surgery, Saint Pierre University Hospital, Brüssel, Belgien

    G. B. Cadière, J. Himpens & G. Dapri

  2. Department of Gastrointestinal and Obesity Surgery, Saint Pierre University Hospital, Rue Haute 322, 1000 , Brüssel, Belgien

    G. B. Cadière

Authors
  1. G. B. Cadière
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  2. J. Himpens
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  3. G. Dapri
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Correspondence to G. B. Cadière.

Additional information

Übersetzt und bearbeitet von PD Dr. C. Schuhmacher, Chirurgische Klinik, Klinikum rechts der Isar der TU München.

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Cadière, G.B., Himpens, J. & Dapri, G. Laparoskopische Magenbypasschirurgie. Chirurg 76, 668–677 (2005). https://doi.org/10.1007/s00104-005-1059-1

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