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Adhäsionen im Abdomen: chirurgische vs. konservative Behandlung

Abdominal adhesions: surgery vs. conservative treatment

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Zusammenfassung

Adhäsionen sind für die betroffenen Patientinnen und Patienten häufig mit heftigen und schwer lokalisierbaren chronischen Schmerzsyndromen verbunden und sind darüber hinaus für 15–20 % aller Fälle sekundärer Infertilität sowie für 60–70 % aller mechanischen Ileuserkrankungen verantwortlich. Einen besonderen Stellenwert hat die Adhäsionsprävention durch möglichst atraumatische chirurgische Verfahren und die Anwendung antiadhäsiver Materialien. Operative Adhäsiolyse stellt für einen überwiegenden Anteil der Patientinnen und Patienten ein effektives Therapieverfahren zur Linderung adhäsionsbedingter Symptome dar. Die Zunahme der Komplikationsrate durch Zweitoperationen und das hohe Risiko für rezidivierende Adhäsionen können ein primär konservatives Vorgehen zur Behandlung adhäsionsabhängiger Beschwerden erfordern. Dieser Übersichtsartikel bewertet die aktuelle Evidenz hinsichtlich Prävention sowie operativer und konservativer Behandlungsoptionen bei postoperativen Adhäsionen des Bauchraums.

Abstract

For affected patients abdominal adhesions are often associated with severe chronic pain syndromes that are difficult to localize and are furthermore responsible for 15–20% of cases of secondary infertility and for 60–70% of all mechanical diseases of the ileus. Adhesion prevention through preferably atraumatic surgical procedures and the use of antiadhesive materials are of particular importance. For the majority of patients surgical adhesiolysis is an effective treatment method to alleviate adhesion-related symptoms. The increase in the complication rate due to secondary operations and the high risk of recurrent adhesions can necessitate a primary conservative approach to treat adhesion-related symptoms. This review article assesses the current evidence regarding prevention, surgical, and conservative treatment options for postoperative abdominal adhesions.

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Authors and Affiliations

  1. Department für Frauengesundheit, Eberhard Karls Universität Tübingen, Calwerstr. 7, 72076, Tübingen, Deutschland

    Martin Weiss

  2. NMI – Naturwissenschaftliches und Medizinisches Institut, Reutlingen, Deutschland

    Martin Weiss

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Correspondence to Martin Weiss.

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M. Weiss gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Barbara Schmalfeldt, Hamburg

Nicolai Maass, Kiel

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Weiss, M. Adhäsionen im Abdomen: chirurgische vs. konservative Behandlung. Gynäkologie 56, 471–477 (2023). https://doi.org/10.1007/s00129-023-05103-y

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