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Indikationsstellung zur chirurgischen Therapie der Divertikelkrankheit

Indications for surgical treatment of diverticular disease

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Zusammenfassung

Hintergrund

Die korrekte medizinische Indikationsstellung ist der grundlegende Entscheidungsprozess für die chirurgische Behandlung und deren Qualität.

Ziel der Arbeit

Darstellung der Indikationsstellung zur chirurgischen Therapie bei den unterschiedlichen Typen der Divertikelkrankheit nach aktuellem Evidenzniveau.

Material und Methoden

Das narrative Review basiert auf aktuellen nationalen und internationalen Leitlinien und einer selektiven Literaturrecherche.

Ergebnisse

Es bestehen grundlegend drei Indikationen zur Sigmaresektion: 1) prophylaktisch zur Vermeidung von Komplikationen nach erfolgreicher konservativer Therapie einer akuten komplizierten Divertikulitis mit Makroabszess mit hohem Rezidivrisiko („classification of diverticular disease“ [CDD] Typ 2b). 2) Bei Patienten mit anhaltender Symptomatik und eingeschränkter Lebensqualität kann die Sigmaresektion bei unterschiedlichen Typen (CDD-Typ 1–3) effektiv eine signifikante Verbesserung der Lebensqualität ermöglichen und ist daher bei individuell vertretbaren perioperativen Risiken zu empfehlen. 3) Indikation zur umgehenden Sigmaresektion besteht bei der freien Perforation oder beim Versagen der konservativen Therapie.

Diskussion

Die Indikationsstellung sollte den Typ der Divertikelkrankheit, die Festlegung des Behandlungsziels, die Bewertung der Effektivität der chirurgischen Therapie im Vergleich zur konservativen Therapie und eine individuelle Bewertung von Risiken beinhalten.

Abstract

Background

The correct medical indications are the fundamental decision process for the surgical treatment and ensuring the quality.

Objective

Description of the indications for surgical treatment of the various types of diverticular disease according to the current level of evidence.

Material and methods

The narrative review is based on current national and international guidelines and a selective literature search.

Results

There are basically three main indications for resection of the sigmoid colon. 1) Prophylactic for avoidance of complications after successful conservative treatment of acute complicated diverticulitis with macroabscess formation and high risk of recurrence (classification of diverticular disease, CDD, type 2b). 2) In patients with persistent symptoms and impaired quality of life resection of the sigmoid colon of various types (CDD types 1–3) can effectively enable a significant improvement in the quality of life and is therefore to be recommended in cases of individually acceptable perioperative risks. 3) Indications for urgent resection of the sigmoid colon are present for free perforation or failure of conservative treatment.

Conclusion

The indications for surgery should be defined by the type of diverticular disease, the aim of surgical treatment, the evaluation of the efficacy of surgical treatment in comparison to conservative treatment and an individual appraisal of the risks.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    Johan Lock, A. Wiegering & C.-T. Germer

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  1. Johan Lock
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  3. C.-T. Germer
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Correspondence to Johan Lock.

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Interessenkonflikt

C.-T. Germer und J. Lock erhielten Honorare für die Vorbereitung wissenschaftlicher Tagungen von der Falk Foundation. A. Wiegering gibt an, dass kein Interessenkonflikt besteht.

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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C.-T. Germer, Würzburg

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Lock, J., Wiegering, A. & Germer, CT. Indikationsstellung zur chirurgischen Therapie der Divertikelkrankheit. Chirurg 92, 694–701 (2021). https://doi.org/10.1007/s00104-021-01432-7

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