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Trend zur konservativen Therapie der komplizierten Sigmadivertikulitis

Hat die Chirurgie noch einen Stellenwert?

The growing trend towards conservative therapy of complicated sigmoid diverticulitis

Is surgery still significant?

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coloproctology Aims and scope

Zusammenfassung

Gegenwärtig besteht ein starker Trend zur konservativen Therapie der komplizierten Sigmadivertikulitis. Dieser basiert auf neuen wissenschaftlichen Erkenntnissen zu Pathogenese und Krankheitsverlauf. Durch Fortschritte in der antibiotischen Behandlung und eine Weiterentwicklung diagnostischer Verfahren ist es in vielen Fällen möglich, eine Notfalloperation mit hohem Morbiditäts- und Mortalitätsrisiko zu vermeiden und die Patienten einer elektiven Sigmaresektion oder weiter einer konservativen Therapie zuzuführen. Durch die Erweiterung des Spektrums der chirurgischen Therapie um minimalinvasive Eingriffe behauptet die Chirurgie trotz dieses Trends auch weiterhin ihren hohen Stellenwert in der Behandlung der komplizierten Sigmadivertikulitis. Bei der freien Perforation gilt die Operation auch heute als Goldstandard. Neu hinzugekommen ist die Laparoskopie mit Lavage und Drainage als Therapieoption bei der eitrigen Peritonitis. Auch bei der Sigmaresektion hat sich ein minimalinvasives Vorgehen durchgesetzt, sodass in den 2014 herausgegebenen deutschen Leitlinien zur Divertikelkrankheit/Divertikulitis die laparoskopische Sigmaresektion als Therapie der Wahl bei der elektiven Operation eingestuft wird.

Abstract

Currently, there is a strong trend towards conservative treatment of complicated sigmoid diverticulitis. It is based upon recent scientific knowledge on pathogenesis and course of disease. Through progress in antibiotic treatment and improvement of diagnostic procedures in many patients, it is possible to avoid emergency surgery, which is linked to a high morbidity and mortality risk. This means that surgeons can plan an elective sigmoidectomy or continue with conservative therapy. However, surgery is significant for the treatment of complicated sigmoid diverticulitis as a result of the extension towards minimally invasive procedures. In the case of free perforation, the operation is still considered the gold standard. Laparoscopic lavage and drainage offers a new therapeutic option for purulent peritonitis. Also, in sigma resection, a minimally invasive approach is clearly established. According to the German guidelines for diverticulosis/diverticulitis, laparoscopic sigma resection is the treatment of choice for elective surgery.

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Authors and Affiliations

  1. Abteilung für Koloproktologie, Prosper-Hospital, Mühlenstraße 27, 45659, Recklinghausen, Deutschland

    A. Dorenkamp, E. Berg, K.-P. Jung &  S. Kersting

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  1. A. Dorenkamp
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  2. E. Berg
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  3. K.-P. Jung
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  4. S. Kersting
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Correspondence to S. Kersting.

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A. Dorenkamp, E. Berg, K.-P. Jung und S. Kersting geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Dorenkamp, A., Berg, E., Jung, KP. et al. Trend zur konservativen Therapie der komplizierten Sigmadivertikulitis. coloproctology 38, 3–7 (2016). https://doi.org/10.1007/s00053-015-0059-y

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  • DOI: https://doi.org/10.1007/s00053-015-0059-y

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