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Benigne Erkrankungen des Ösophagus

Refluxkrankheit, diffuser Ösophagusspasmus, Achalasie

Benign esophageal disorders

Gastroesophageal reflux disease, diffuse esophageal spasm, achalasia

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Zusammenfassung

Unter den gutartigen Funktionsstörungen der Speiseröhre und des Magens sind die gastroösophageale Refluxkrankheit, die Achalasie und der diffuse Ösophagusspasmus die häufigsten Erkrankungen. Die chirurgische Therapie spielt bei diesen Krankheitsbildern neben der konservativen Behandlung eine wichtige Rolle.

Das verfügbare Behandlungsspektrum der Achalasie reicht von der endoskopischen Botox-Injektion über die seit vielen Jahrzehnten etablierte endoskopisch pneumatische Dilatation bis zur laparoskopischen Myotomie, deren Erfolgsrate bei 90% liegt.

Die Passagebehinderung und die Schmerzattacken, die durch den diffusen Ösophagusspasmus verursacht werden, können durch eine thorakoskopische lange Ösophagusmyotomie oder eine primäre minimal-invasive Ösophagusresektion mit Magenhochzug behoben werden.

Das therapeutische Management der gastroösophagealen Refluxkrankheit wird ganz wesentlich durch die konservative Therapie mit Protonenpumpeninhibitoren bestimmt. Die Einführung der minimal-invasiven Zugangstechnik führte zu einer erhöhten Akzeptanz operativer Verfahren. Die Fundoplikation nach Nissen in der kurzen lockeren („short floppy“) Form sowie die posteriore partielle Hemifundoplikation nach Toupet sind anerkannte Standardverfahren.

Abstract

Gastroesophageal reflux disease (GERD) is the most frequent benign disorder of the upper gastrointestinal (GI) tract and other defined disease entities, such as achalasia and diffuse esophageal spasm, also belong to this group. In addition to surgical therapy, medicinal therapy also has an important role in all 3 of these disorders. Therefore, it is very important to follow precise indication criteria based on diagnostic evaluation and patient selection as well as to use an optimal operative technique.

The therapeutic spectrum for achalasia varies from Botox injections and endoscopic dilatation to laparoscopic myotomy which achieves a success rate up to 90%.

Patients with diffuse spasm suffer from severe dysphagia, thoracic pain and burning sensations and even respiratory problems. Surgical therapy consists of thoracoscopic long myotomy and in selective cases with persisting pain even esophagectomy and gastric pull-up.

Therapeutic options for GERD predominantly involve conservative medicinal therapy with proton pump inhibitors and selective laparoscopic antireflux procedures. Minimally invasive techniques have led to a higher acceptance of surgical therapy. The two major procedures most frequently used are total Nissen fundoplication and posterior partial Toupet fundoplication.

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Literatur

  1. Koop H, Schepp W, Müller-Lissner S et al (2005) Gastroösophageale Refluxkrankheit, DGVS-Leitlinien. Z Gastroenterol 43:163–194

    Article  PubMed  CAS  Google Scholar 

  2. Fuchs KH (2005) Conventional and minimally invasive surgical methods for gastroesophageal reflux. Chirurg 76:370–378

    Article  PubMed  Google Scholar 

  3. AGA Institute (2008) American gastroenterological association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology 135:1383–1391

    Article  Google Scholar 

  4. Nyugen NQ, Holloway RH (2005) Recent developments in esophageal motor disorders. Curr Opin Gastroenterol 21:478–484

    Google Scholar 

  5. Campos GM, Vittinghoff E, Rabl C et al (2009) Endoscopic and surgical treatment for achalasia, a systematic review and meta-analysis. Ann Surg 249:45–57

    Article  PubMed  Google Scholar 

  6. Zaninotto G, Costantini M, Molena D (2000) Treatment of esophageal achalasia with laparoscopic Heller myotomy and Dor partial anterior fundoplication: prospective evaluation of 100 consecutive patients. J Gastrointest Surg 4:282–289

    Article  PubMed  CAS  Google Scholar 

  7. Inoue H, Kudo SE (2010) Peroral endoscopic myotomy (POEM) for consecutive 43 cases of esophageal achalasia. Nippon Rinsho 68:1749–1752

    PubMed  Google Scholar 

  8. Balaji NS, Peters JH (2002) Minimally invasive surgery for esophageal motility disorders. Surg Clin North Am 82:763–782

    Article  PubMed  Google Scholar 

  9. Klinkenberg-Knol EC, Nelis F, Dent J et al (2000) Long-term Omeprazole treatment in resistant gastroesophageal reflux disease: efficacy, safety, and influence on gastric mucosa. Gastroenterology 118:661–669

    Article  PubMed  CAS  Google Scholar 

  10. DeMeester TR, Bonavina L, Abertucci M (1986) Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg 204:19

    Article  Google Scholar 

  11. Dallemagne B, Weerts JM, Jehaes C, Markiewicz S (1996) Causes of failures of laparoscopic antireflux operations. Surg Endosc 10:305–310

    Article  PubMed  CAS  Google Scholar 

  12. Fuchs KH, Fischbach W, Labenz J et al (2005) Gastroösophageale Refluxkrankheit, Chirurgische Therapie, DGVS-Leitlinien. Z Gastroenterol 43:191–194

    Article  PubMed  CAS  Google Scholar 

  13. Fuchs KH, Eypasch E (2006) Gastroesophageal reflux disease. EAES update 2006. In: Neugebauer EAM et al (Hrsg) EAES Guidelines for Endoscopic Surgery. Springer, Heidelberg, S 125–142

  14. Campos GM, Peters JH, DeMeester TR et al (1999) Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg 3(3):292–300

    Article  PubMed  CAS  Google Scholar 

  15. Lundell L, Attwood S, Ell C et al (2008) LOTUS trial collaborators. Comparing laparoscopic antireflux surgery with esomeprazole in the management of patients with chronic gastro-esophageal reflux disease: a 3-year interim analysis of the LOTUS trial. Gut 57(9):1207–1213

    Article  PubMed  CAS  Google Scholar 

  16. Luostarinen MES, Isolauri JO (1999) Randomized trial to study the effect of fundic mobiization on long-term results of Nissen fundoplication. Br J Surg 86:614–618

    Article  PubMed  CAS  Google Scholar 

  17. Frantzides CT, Madan AK, Carlson MA, Stavrpoulos GP (2002) A prospective randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137(6):649–652

    Article  PubMed  Google Scholar 

  18. Granderath FA, Schweiger UM, Kamolz T et al (2005) Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 140:40–48

    Article  PubMed  Google Scholar 

  19. Müller-Stich BP, Linke GR, Borovicka J et al (2008) Laparoscopic mesh-augmented hiatoplasty as a treatment of GERD and hiatal hernias – preliminary clinical and functional results of a prospective case series. Am J Surg 195(6):749–756

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  21. Lundell L, Abrahamsson H, Ruth M et al (1996) Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux. Br J Surg 83(6):830–835

    Article  PubMed  CAS  Google Scholar 

  22. Fibbe C, Layer P, Keller J et al (2001) Esophageal motility in reflux disease before and after fundoplication: a prospective, randomized, clinical, and manometric study. Gastroenterology 121:5–14

    Article  PubMed  CAS  Google Scholar 

  23. Broeders JAJL, Mauritz FA, Ahmed Ali U et al (2010) Systematic review and metaanalysis of laparoscopic Nissen versus Toupet fundoplication for gastro-esophageal reflux disease. Br J Surg 97:1318–1330

    Article  PubMed  CAS  Google Scholar 

  24. Horvath KD, Jobe BA, Herron DM, Swanström LL (1999) Laparoscopic Toupet fundoplication is an inadequate procedure for patients with severe reflux disease. J Gastrointest Surg 3:583–591

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  26. Fein M, Seyfried E (2010) Is there a role for anything other than a Nissen’s operation? J Gastrointest Surg 14(Suppl1):67–74

    Article  Google Scholar 

  27. Fuchs K-H, Stein HJ, Thiede A (1997) Gastrointestinale Funktionsstörungen. Diagnose, Operationsindikation, Therapie. Springer, Berlin Heidelberg New York

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland

    K.-H. Fuchs & W. Breithaupt

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  1. K.-H. Fuchs
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  2. W. Breithaupt
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Correspondence to K.-H. Fuchs.

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Fuchs, KH., Breithaupt, W. Benigne Erkrankungen des Ösophagus. Chirurg 82, 271–282 (2011). https://doi.org/10.1007/s00104-010-2033-0

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