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Konventionelle und minimal-invasive chirurgische Therapie der gastroösophagealen Refluxkrankheit

Conventional and minimally invasive surgical methods for gastroesophageal reflux

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Zusammenfassung

Die Einführung der minimal-invasiven Zugangstechnik hatte einen nachhaltigen Einfluss auf die chirurgische Therapie der gastroösophagealen Refluxkrankheit. Ziel dieser Arbeit ist eine aktuelle Analyse und Übersicht über den gegenwärtigen Wissensstand unter evidenzbasierten Bedingungen und eine kritische Wertung der offenen und laparoskopischen Operationsverfahren:

Die Analyse der randomisierten Studien ergab Überlegenheit der laparoskopischen Zugangstechnik für die Fundoplikatio als Teil- oder als Vollmanschette wegen geringerer Morbidität, kürzerer postoperativer Hospitalisation aufgrund einer schnelleren Erholungsphase sowie signifikant weniger Narbenprobleme verglichen mit der offenen Variante. Die funktionellen Ergebnisse waren zwischen der offenen Technik und der laparoskopischen Technik nicht unterschiedlich. Die 5-Jahres-Ergebnisse zeigen für die laparoskopische Operationstechnik eine effektive Refluxkontrolle bei mindestens 85% der Patienten. Bezüglich der technischen Varianten konnte bei der Analyse der randomisierten Studien kein Vorteil für die Durchtrennung der Vasa gastrici breves festgestellt werden. Ein Bougie zur Kalibrierung der Kardia während der Fundoplikatio kann die postoperative Dysphagie verringern.

Abstract

The introduction of minimally invasive techniques has had great influence on the indication and surgical therapy for gastroesophageal reflux disease. This analysis is an overview of the current evidence-based status and a critical reprisal of open and laparoscopic antireflux surgery.

Results: The analysis of randomized trials showed an advantage for patients after laparoscopy for total and partial fundoplication because of reduced morbidity, shorter postoperative hospitalization due to faster recovery, and significantly fewer scar and wound problems. The functional results of open and laparoscopic techniques were similar. Five-year follow-up results for the latter showed effective reflux control in at least 85% of patients. Randomized trials regarding technical variations did not show an advantage for division of the short gastric vessel. A bougie for the cardia calibration can prevent postoperative dysphagia after fundoplication.

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  1. Klinik für Visceral-, Gefäß- und Thoraxchirurgie, Markus-Krankenhaus, Frankfurter Diakonie-Kliniken

    K.-H. Fuchs

  2. Klinik für Visceral-, Gefäß- und Thoraxchirurgie, Markus-Krankenhaus, Frankfurter Diakonie-Kliniken, Wilhelm-Epstein-Straße 2, 60431, Frankfurt am Main

    K.-H. Fuchs

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Fuchs, KH. Konventionelle und minimal-invasive chirurgische Therapie der gastroösophagealen Refluxkrankheit. Chirurg 76, 370–378 (2005). https://doi.org/10.1007/s00104-004-0954-1

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