Summary
Today controversial points of view in ulcer surgery are related to operative tactics. In principal resective and non-resective procedures and the type of anastomosis are discussed. Physiopathological criteria for decision are the effects on acid reduction, motility, intestinal acid exposure and entero-gastric reflux. Therapeutic security and the frequency of side effects are determined by these parameters. Postpyloric ulcer remains the domain of vagotomy. Gastric ulcers should be resected or treated by a combined procedure. In reconstructing the gastrointestinal tract the dualism of residual acid and postresectional reflux must be taken into account.
Zusammenfassung
Kontroverse Standpunkte in der Ulcuschirurgie bestehen derzeit in der Wahl der operativen Taktik. Prinzipiell konkurrieren resezierende und nichtresezierende Verfahren sowie die Form der Anastomose. Pathophysiologische Entscheidungskriterien sind die Wirkungen auf Säurereduktion, Motilität, enterale Säurebelastung und intestino-gastralen Reflux. Diese Parameter determinieren die therapeutische Sicherheit und Rate an Nebenwirkungen. Postpylorische Ulcera bleiben die Domäne der Vagotomie. Ulcera des Magens sollen reseziert bzw. mit einem kombinierten Verfahren behandelt werden. Bei der Rekonstruktion der gastrointestinalen Kontinuität gilt es dem Dualismus von Säure und Reflux Rechnung zu tragen.
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Schumpelick, V., Arlt, G., Winkeltau, G. et al. 30. Gastroduodenales Rezidivulcus: Kontroversen bei Primär- und Sekundäreingriffen. Langenbecks Arch Chiv 372, 189–198 (1987). https://doi.org/10.1007/BF01297814
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DOI: https://doi.org/10.1007/BF01297814