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Ulkuschirurgie – was bleibt?

Ulcer surgery – what remains?

  • Schwerpunkt: Dyspepsie, Gastritis, Ulkusleiden
  • Published:
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Zusammenfassung

Ulkuschirurgie konzentriert sich heute auf die Komplikationen der Ulkuskrankheit, insbesondere die Ulkusperforation und endoskopisch nicht kontrollierbare Ulkusblutungen. Dabei steht der laparoskopische oder offen ausgeführte Verschluss des gastroduodenalen Defekts bzw. die lokale Blutstillung durch Laparotomie im Vordergrund. Elektive Eingriffe wegen rezidivierender Ulcera ventriculi oder duodeni sind sehr selten geworden. Eine Indikation bei konservativ therapieresistentem Magengeschwür kann der bleibende Malignomverdacht sein, beim Zwölffingerdarmgeschwür vorwiegend die Magenausgangsstenose. Bestehen diese Indikationen, so kommen die klassischen Magenresektionsverfahren nach Billroth I bzw. Billroth II noch zur Anwendung, während die Vagotomie praktisch nicht mehr eingesetzt wird. Insgesamt ist die Magenchirurgie trotz des seltenen Einsatzes heute sehr sicher geworden.

Abstract

Ulcer surgery today concentrates on the complications of chronic ulcer disease, especially ulcer perforation and endoscopically uncontrollable ulcer bleeding. In this case the laparoscopic or open closure of the gastroduodenal defect or local hemostasis of the bleeding ulcer by laparotomy are the main aims of surgery. Elective operations due to recurrent gastric or duodenal ulcers have become rare. An indication for gastric ulcer resistant to conservative therapy could be persisting suspicion of malignancy whereas in duodenal ulcer gastric outlet obstruction represents a reason for surgery. If these indications are confirmed the classic procedures of gastric resection like Billroth I and Billroth II are performed whereas vagotomy is no longer used. Altogether ulcer surgery has become very safe although it is practiced quite rarely.

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Literatur

  1. Alexander-Williams J (1991) Requiem for vagotomy. BMJ 302: 547–548

    PubMed  Google Scholar 

  2. Barkun A, Bardou M, Marshall J (2003) Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 139: 843–857

    PubMed  Google Scholar 

  3. Behrmann SW (2005) Management of complicated peptic ulcer disease. Arch Surg 140: 201–208

    Article  PubMed  Google Scholar 

  4. Bekada H, Charikhi M, Haicheur R et al. (1984) Bleeding peptic ulcer. Am J Surg 147: 411–418

    Article  Google Scholar 

  5. Bendinelli C, Leal T, Moncade F et al. (2002) Endoscopic surgery in Senegal. Benefits, costs and limits. Surg Endosc 16: 1488–1492

    Article  PubMed  Google Scholar 

  6. Bergamaschi R, Marvik R, Johnsen G et al. (1999) Open vs laparoscopic repair of perforated peptic ulcer. Surg Endosc 13: 679–682

    Article  PubMed  Google Scholar 

  7. Boey J, Choi S, Poon A et al. (1987) Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg 205: 22–26

    PubMed  Google Scholar 

  8. Bornman P, Theodorou N, Jeffery P et al. (1990) Simple closure of perforated duodenal ulcer: a prospective evaluation of a conservative management policy. Br J Surg 77: 73–75

    PubMed  Google Scholar 

  9. Branicki F, Boey J, Fok P et al. (1990) Bleeding duodenal ulcer. A prospective evaluation of risk factors for rebleeding and death. Ann Surg 211: 411–418

    PubMed  Google Scholar 

  10. Crofts T, Park K, Steele R et al. (1989) A randomized trial of nonoperative treatment for perforated peptic ulcer. N Engl J Med 320: 970–973

    PubMed  Google Scholar 

  11. Donovan A, Berne T, Donovan J (1998) Perforated duodenal ulcer: an alternative therapeutic plan. Arch Surg 133: 1166–1171

    Article  PubMed  Google Scholar 

  12. Ell C, Hagenmuller F, Schmitt W et al. (1995) Multizentrische prospektive Untersuchung zum aktuellen Stand der Ulcusblutung. Dtsch Med Wochenschr 120: 3–9

    PubMed  Google Scholar 

  13. Fuente de la SG, Khuri SF, Schifftner T et al. (2006) Comparative analysis of vagotomy and drainage versus vagotomy and resection procedures for bleeding peptic ulcer disease: results of 907 patients from the department of veterans affairs national surgical quality improvement program database. J Am Coll Surg 202: 78–86

    Article  PubMed  Google Scholar 

  14. Hermansson M, Stael vHC, Zilling T (1997) Peptic ulcer perforation before and after the introduction of H2-receptor blockers and proton pump inhibitors. Scand J Gastroenterol 32: 523–529

    PubMed  Google Scholar 

  15. Hermansson M, Stael vHC, Zilling T (1999) Surgical approach and prognostic factors after peptic ulcer perforation. Eur J Surg 165: 566–572

    Article  PubMed  Google Scholar 

  16. Higham J, Kang J, Majeed A (2002) Recent trends in admissions and mortality due to peptic ulcer in England: increasing frequency of haemorrhage among older subjects. Gut 50: 460–464

    Article  PubMed  Google Scholar 

  17. Hölscher A, Klingele C, Bollschweiler E et al. (1996) Postoperatives Rezidivulkus nach Magenresektion – Ergebnisse der chirurgischen Behandlung. Chirurg 67: 814–820

    Article  PubMed  Google Scholar 

  18. Hölscher AH, Bollschweiler E (2002) Ulcus ventriculi: Operationsindikation und operative Therapie. In: Siewert JR HF, Rothmund M (eds) Praxis der Viszeralchirurgie, Bd Gastroenterologische Chirurgie. Springer, Berlin Heidelberg New York, pp 361–369

  19. Hölscher AH, Vallböhmer D, Mönig SP (2004) Magen-Darm-Blutung. Chirurgische Optionen. Chir Praxis 63: 385–390

    Google Scholar 

  20. Imhof M, Schroders C, Ohmann C et al. (1998) Impact of early operation on the mortality from bleeding peptic ulcer --ten years‘ experience. Dig Surg 15: 308–314

    Article  PubMed  Google Scholar 

  21. Inadomi J, Sonnenberg A (1998) The impact of peptic ulcer disease and infection with Helicobacter pylori on life expectancy. Am J Gastroenterol 93: 1286–1290

    Article  PubMed  Google Scholar 

  22. Jamieson G (2000) Current status of indications for surgery in peptic ulcer disease. World J Surg 24: 256–258

    Article  PubMed  Google Scholar 

  23. Johansson B, Hallerback B, Glise H et al. (1996) Laparoscopic suture closure of perforated peptic ulcer. A nonrandomized comparison with open surgery. Surg Endosc 10: 656–658

    Article  PubMed  Google Scholar 

  24. Johnson A (2000) Proximal gastric vagotomy: does it have a place in the future management of peptic ulcer? World J Surg 24: 259–263

    Article  PubMed  Google Scholar 

  25. Kok K, Mathew V, Yapp S (1999) Laparoscopic omental patch repair for perforated duodenal ulcer. Am Surg 65: 27–30

    PubMed  Google Scholar 

  26. Lanas A, Serrano P, Bajador E et al. (1997) Evidence of aspirin use in both upper and lower gastrointestinal perforation. Gastroenterology 112: 683–689

    Article  PubMed  Google Scholar 

  27. Lau W, Leung K, Kwong K et al. (1996) A randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique. Ann Surg 224: 131–138

    Article  PubMed  Google Scholar 

  28. Marshall C, Ramaswamy P, Bergin F et al. (1999) Evaluation of a protocol for the non-operative management of perforated peptic ulcer. Br J Surg 86: 131–134

    Article  PubMed  Google Scholar 

  29. Mehendale V, Shenoy S, Joshi A et al. (2002) Laparoscopic versus open surgical closure of perforated duodenal ulcers: a comparative study. Indian J Gastroenterol 21: 222–224

    PubMed  Google Scholar 

  30. Miserez M, Eypasch E, Spangenberger W et al. (1996) Laparoscopic and conventional closure of perforated peptic ulcer. A comparison. Surg Endosc 10: 831–836

    Article  PubMed  Google Scholar 

  31. Mönig S, Brands F (1996) Changing incidence of peptic ulcer in Germany. Eur J Epidemiol 12: 657–658

    Article  PubMed  Google Scholar 

  32. Mönig S, Lübke T, Baldus S et al. (2002) Early elective surgery for bleeding ulcer in the posterior duodenal bulb. Own results and review of the literature. Hepatogastroenterology 49: 416–418

    PubMed  Google Scholar 

  33. Mueller X, Rothenbuehler J, Amery A et al. (1994) Factors predisposing to further hemorrhage and mortality after peptic ulcer bleeding. J Am Coll Surg 179: 457–461

    PubMed  Google Scholar 

  34. Naesgaard J, Edwin B, Reiertsen O et al. (1999) Laparoscopic and open operation in patients with perforated peptic ulcer. Eur J Surg 165: 209–214

    Article  PubMed  Google Scholar 

  35. Ohmann C, Imhof M, Ruppert C et al. (2005) Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 40: 914–920

    Article  PubMed  Google Scholar 

  36. Paimela H, Paimela L, Myllykangas-Luosujarvi R et al. (2002) Current features of peptic ulcer disease in Finland: incidence of surgery, hospital admissions and mortality for the disease during the past twenty-five years. Scand J Gastroenterol 37: 399–403

    Article  PubMed  Google Scholar 

  37. Paimela H, Tuompo P, Perakyl T et al. (1991) Peptic ulcer surgery during the H2-receptor antagonist era: a population-based epidemiological study of ulcer surgery in Helsinki from 1972 to 1987. Br J Surg 78: 28–31

    PubMed  Google Scholar 

  38. Pimpl W, Boeckl O, Heinerman M et al. (1989) Emergency endoscopy: a basis for therapeutic decisions in the treatment of severe gastroduodenal bleeding. World J Surg 13: 592–597

    Article  PubMed  Google Scholar 

  39. Rangarajan M, Subramanian C, Chandralathan T (2006) Laparoscopy-assisted truncal vagotomy with antecolic posterior gastrojejunostomy for benign gastric outlet obstruction. Surg Endosc 20: 61–63

    Article  PubMed  Google Scholar 

  40. Read RC, Huebll HD, Thal AP (1965) Randomized study of massive bleeding from peptic ulceration. Ann Surg 162: 561–577

    PubMed  Google Scholar 

  41. Röher HD, Thon K (1984) Impact of early operation on the mortality from bleeding peptic ulcer. Dig Surg 1: 32–36

    Google Scholar 

  42. Sandbichler P, Pernthaler H, Ofner D et al. (1989) Peptic ulcer with a visible non-bleeding vascular wall—early elective surgery or endoscopic therapy? Wien Klin Wochenschr 101: 736–738

    PubMed  Google Scholar 

  43. Saperas E, Pique J, Perez AR et al. (1987) Conservative management of bleeding duodenal ulcer without a visible vessel: prospective randomized trial. Br J Surg 74: 784–786

    PubMed  Google Scholar 

  44. Schiller KF, Truelove KF, Williams DG (1970) Haematemesis and melanea, with special reference to factors influencing the outcome. BMJ 2: 7–14

    PubMed  Google Scholar 

  45. Seeley SF, Campbell D (1956) Nonoperative treatment of perforated peptic ulcer. Surg Gynecol 1956: 435–440

    Google Scholar 

  46. Siewert J, Bumm R, Holscher A et al. (1989) Obere gastrointestinale Ulkusblutung-Letalitätssenkung durch früh-elektive chirurgische Therapie von Risikopatienten. Dtsch Med Wochenschr 114: 447–452

    PubMed  Google Scholar 

  47. Sillakivi T, Yang Q, Peetsalu A et al. (2000) Perforated peptic ulcer: is there a difference between Eastern Europe and Germany? Copernicus Study Group and Acute Abdominal Pain Study Group. Langenbecks Arch Surg 385: 344–349

    Article  PubMed  Google Scholar 

  48. Siu W, Leong H, Law B et al. (2002) Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg 235: 313–319

    Article  PubMed  Google Scholar 

  49. So J, Kum C, Fernandes M, Goh P (1996) Comparison between laparoscopic and conventional omental patch repair for perforated duodenal ulcer. Surg Endosc 10: 1060–1063

    Article  PubMed  Google Scholar 

  50. Svanes C, Lie R, Svanes K, Lie S et al. (1994) Adverse effects of delayed treatment for perforated peptic ulcer. Ann Surg 220: 168–175

    PubMed  Google Scholar 

  51. Takeuchi H, Kawano T, Toda T et al. (1998) Laparoscopic repair for perforation of duodenal ulcer with omental patch: report of initial six cases. Surg Laparosc Endosc 8: 153–156

    Article  PubMed  Google Scholar 

  52. Tanphiphat C, Tanprayoon T, Na TA (1985) Surgical treatment of perforated duodenal ulcer: a prospective trial between simple closure and definitive surgery. Br J Surg 72: 370–372

    PubMed  Google Scholar 

  53. Taylor H, Warren RP (1946) Perforated acute and chronic peptic ulcer. Conservative treatment. Lancet 249: 397–399

    Google Scholar 

  54. Wakayama T, Ishizaki Y, Mitsusada M et al. (1994) Risk factors influencing the short-term results of gastroduodenal perforation. Surg Today 24: 681–687

    Article  PubMed  Google Scholar 

  55. Winkeltau G, Arlt G, Truong S et al. (1995) Endoscopic emergency therapy and early elective operation of at risk bleeding types in gastroduodenal ulcer hemorrhage--a prospective study. Zentralbl Chir 120: 110–115

    PubMed  Google Scholar 

  56. Wolfe M, Lichtenstein D, Singh G (1999) Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med 340: 1888–1899

    Article  PubMed  Google Scholar 

  57. Zittel T, Jehle E, Becker H (2000) Surgical management of peptic ulcer disease today-indication, technique and outcome. Langenbecks Arch Surg 385: 84–96

    Article  PubMed  Google Scholar 

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  1. Klinik und Poliklinik für Visceral- und Gefäßchirurgie der Universität zu Köln, Kerpener Straße 62, 50937, Köln

    A. H. Hölscher, E. Bollschweiler & S. P. Mönig

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  1. A. H. Hölscher
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  2. E. Bollschweiler
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  3. S. P. Mönig
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Hölscher, A.H., Bollschweiler, E. & Mönig, S.P. Ulkuschirurgie – was bleibt?. Internist 47, 602–610 (2006). https://doi.org/10.1007/s00108-006-1625-8

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