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Der Chirurg

, Volume 90, Issue 4, pp 331–348 | Cite as

Hiatushernie

Standards und Kontroversen in Diagnostik und Therapie
  • D. WeyheEmail author
  • V. Uslar
  • J. Kühne
  • A. Kluge
CME
  • 320 Downloads

Zusammenfassung

Eine Hiatushernie ist als transdiaphragmale Protrusion/Migration intrabdominellen Inhaltes durch den Hiatus oesophageus des Zwerchfells definiert. Die Klassifikation erfolgt bei Hiatushernien durch eine anatomisch morphologische Differenzierung (Typ I–IV). Leitsymptome und Leidensdruck variieren zwischen Reflux- und Kompressionssymptomen. Gastroskopie und multikanal-intraluminale Impedanz-pH-Metrie sind obligate präoperative Funktionsdiagnostik. Es wird zwischen den häufigen Typ-I-Hernien (Antirefluxchirurgie), symptomatischen paraösophagealen, thorakalen und gemischten Hernientypen (II–IV) unterschieden. Operationsindikationen bestehen bei symptomatischen Typ-II- bis -IV-Hernien. Hiatale Netzaugmentation verringert Rezidive. Das Komplikationspotenzial synthetischer Netze muss dabei berücksichtigt werden. Biologische Implantate zeigen keine Vorteile.

Schlüsselwörter

Operationsindikation Refluxdiagnostik Antirefluxchirurgie Netzaugmentation Fundoplikation 

Hiatus hernia

Standards and controversies in diagnostics and treatment

Abstract

A hiatus hernia is defined as a transdiaphragmatic protrusion/migration of the intrabdominal contents through the esophageal hiatus of the diaphragm. The classification of hiatus hernias is based on anatomical morphological differentiation (types I–IV). The leading symptoms and psychological stress vary with respect to the symptoms, e. g. reflux and compression symptoms. Gastroscopy and multichannel intraluminal impedance pH measurement are obligatory preoperative functional diagnostics. A distinction is made between frequent type I hernia (antireflux surgery), symptomatic paraesophageal, thoracic and mixed hernia types (II–IV). Surgical indications exist in symptomatic type II–IV hernias. Hiatal mesh augmentation reduces recurrences. The complication potential of synthetic meshes must be taken into account. Biological implants show no advantages.

Keywords

Indications for surgery Reflux diagnostics Antireflux surgery Mesh augmentation Fundoplication 

Notes

Danksagung

Die Autoren danken Ina Burkowski für die Schemazeichung hiataler Hernien und Sonja Janssen für die Aufbereitung von Patientendaten für die Bildgebungsbeispiele.

Einhaltung ethischer Richtlinien

Interessenkonflikt

D. Weyhe, V. Uslar, J. Kühne und A. Kluge geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Universitätsklinik für Viszeralchirurgie, Pius-Hospital OldenburgMedizinischer Campus Universität OldenburgOldenburgDeutschland
  2. 2.Klinik für Innere Medizin, Pneumologie und GastroenterologiePius-Hospital OldenburgOldenburgDeutschland
  3. 3.Institut für Diagnostische und Interventionelle RadiologiePius-Hospital OldenburgOldenburgDeutschland

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