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Anti-Reflux-Chirurgie bei mehrfach behinderten Kindern

Anti-reflux surgery in neurologically impaired children

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Zusammenfassung

Mehrfach behinderte Kinder haben ein hohes Risiko, im Verlauf ihres Lebens eine gastroösophageale Refluxkrankheit (GÖRK) zu entwickeln. Die symptomorientierte Anamnese und körperliche Untersuchung sind Grundlage einer weiterführenden Diagnostik und Therapie. Symptome einer GÖRK können bei mehrfach behinderten Kindern sehr unspezifisch sein oder fehlen. Atemprobleme, Schluckbeschwerden, unklare Unruhezustände und Verschlechterung der Spastik können hinweisend auf eine GÖRK sein. Wenn die optimierte konservative Therapie nicht erfolgreich ist, besteht die Indikation zur Anti-Reflux-Chirurgie. Hierbei hat sich die laparoskopische Fundoplikatio als minimal-invasive Technik durchgesetzt. Im Langzeitverlauf ist die Rezidivrate der GÖRK unabhängig von der Operationsmethode hoch. Daher ist für die komplexe Behandlung von mehrfach behinderten Patienten mit GÖRK der Einsatz eines multidisziplinären Teams erforderlich.

Abstract

Children with neurological impairment have a high risk of developing gastroesophageal reflux disease (GERD). A symptom-oriented medical history and physical examination are the foundation of further diagnostics and treatment. Symptoms of GERD in neurologically impaired children can be unspecific or even missing. Breathing problems, swallowing disorders, unclear restless state and deterioration of spasticity can be indications of GERD. If the optimal conservative treatment is unsuccessful, anti-reflux surgery is indicated. Laparoscopic fundoplication is a well-established minimally-invasive technique for the treatment of GERD. In the long-term course the recurrence rate of GERD is high and independent of the surgical procedure. Therefore, a multidisciplinary team is necessary for the complex treatment of neurologically impaired patients with GERD.

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  1. Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20A, 04103, Leipzig, Deutschland

    J.-H. Gosemann &  M. Lacher

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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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I. Krägeloh-Mann, Tübingen

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Gosemann, JH., Lacher, M. Anti-Reflux-Chirurgie bei mehrfach behinderten Kindern. Monatsschr Kinderheilkd 167, 686–695 (2019). https://doi.org/10.1007/s00112-019-0733-1

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