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Postoperative Anastomoseninsuffizienz

Endoskopische und chirurgische Therapieoptionen

Postoperative anastomotic leaks

Endoscopic and surgical therapeutic options

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  • 1 Citations

Zusammenfassung

Hintergrund

Leckagen können bei allen Formen der gastrointestinalen Anastomose auftreten. Die Behandlungsstrategien haben sich in den letzten Jahren deutlich gewandelt. Die endoskopische Therapie hat eine zunehmende Bedeutung gewonnen und in einigen Bereichen die chirurgische Revisionsoperation fast völlig verdrängen können. Es bleiben aber ganz klar auch Indikationen für die chirurgische Revision. Dies ist u. a. abhängig von der Lokalisation der Leckage im Gastrointestinaltrakt.

Ziel der Arbeit

In dieser Arbeit möchten wir uns vom Ösophagus bis zum Rektum den verschiedenen Anastomosen und deren Behandlungsarten zuwenden. Wir gehen sowohl auf die Diagnostik als auch die unterschiedliche Therapie ein. Es sollen die relevanten endoskopischen Therapieverfahren und ihr Einsatzbereich, aber auch ihre Grenzen dargestellt werden.

Ergebnisse und Diskussion

In diesem Beitrag wird deutlich, dass nur durch eine gemeinsame, interdisziplinäre Betreuung eine optimale Behandlung dieser gefürchteten Komplikation zu erreichen ist. Das Wissen der Möglichkeiten und Grenzen der jeweils anderen Fachdisziplin ist hierfür von großer Bedeutung. Der Artikel soll diese gemeinschaftliche Sichtweise der Dinge unterstützen.

Abstract

Background

Leaks can occur at any type of gastrointestinal anastomosis. Treatment strategies have changed over the last years. Endoscopic therapy has increasingly gained acceptance and has replaced surgical revision in various indications. However, there are still many indications for a surgical approach. The type and location of the anastomosis are important in this context.

Objectives

In this review article we report on the various types of anastomotic leaks from the esophagus to the rectum. We report the diagnostics and therapeutic approach depending on the location. The capabilities of the relevant endoscopic methods as well as their limitations will be discussed.

Results and conclusions

This article clearly shows that only an interdisciplinary approach can achieve an optimal medical treatment of this dangerous complication. Therefore, it is important to know the various treatment options with their specific advantages and disadvantages. This article supports the interdisciplinary approach to anastomotic leaks.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Pauthner, D. Lorenz und J. Wedemeyer geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Correspondence to Prof. Dr. J. Wedemeyer.

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Pauthner, M., Lorenz, D. & Wedemeyer, J. Postoperative Anastomoseninsuffizienz. Gastroenterologe 9, 237–243 (2014). https://doi.org/10.1007/s11377-013-0855-2

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Schlüsselwörter

  • Anastomose
  • Stentanlage
  • Endoskopische Vakuumschwammtherapie
  • Over-the-scope-Clip
  • Chirurgische Revision

Keywords

  • Anastomosis
  • Stent
  • Endoscopic vacuum sponge therapy
  • Over the scope clip
  • Surgical revision