Zusammenfassung.
Die definitive Heilung des M. Crohn kann durch eine chirurgische Therapie nicht erreicht
werden. Auf Grund seiner Neigung zur Rekurrenz und der häufigen Notwendigkeit einer
Reoperation unterliegt die chirurgische Therapie besonderen Prinzipien. Da eine Rekurrenz
durch eine ausgedehnte Resektion mit mikroskopisch Crohn-freien Absetzungsrändern
nicht verhindert werden kann und die Rezidivhäufigkeit bei Crohn-befallenen Resektionsrändern
nicht höher ist, sollte eine Resektion im makroskopisch gesunden Darm und maximal
organerhaltend erfolgen. Im Gegensatz zur Karzinomchirurgie wird dabei der Darm wandnah
skelettiert, eine Lymphadenektomie wird nicht durchgeführt. Anastomosen werden zur
Vermeidung von Blindsackbildungen als End-zu-End-Anastomosen in einreihiger Nahttechnik
unter Verwendung von resorbierbarem Nahtmaterial angelegt. Zur Therapie kurzstreckiger
Stenosen hat sich die organerhaltende Strikturoplastik bewährt. Laparoskopische Techniken
finden bei zunehmender Erfahrung und Sicherheit mehr und mehr Verbreitung. Bei Anwendung
dieser Verfahren müssen aber im gleichen Maße wie bei offenen Operationstechniken
die chirurgischen Prinzipien der Crohn-Therapie eingehalten werden.
Crohn's disease: patterns of surgical therapy in view of laparoscopical techniques.
Surgical therapy of Crohn's disease. Crohn's disease can neither be cured by surgery
nor by medical therapy. After surgical therapy the recurrence rate is up to 50 % after
20 years. Surgery requires therefore special precautions. As recurrence is unaffected
by the width of the margin of macroscopic bowel involvement the major principle of
therapy is a minimallyresecting surgery. This concerns mainly strictures and stenosis.
Strictures should therefore be treated by stricturoplasty, stenosis by limited resection
with Crohn-free resection margins. Extensive resection should be avoided. Since several
studies have demonstrated the feasibility and safety of laparoscopic techniques in
Crohn's disease, these procedures have gained more and more acceptance. Nevertheless,
laparoscopic surgery underlies the same rules as open surgery.
Schlüsselwörter
M. Crohn - Chirurgische Prinzipien - Laparoskopische Verfahren
Key words:
Crohn's disease - Surgery - Laparoscopic surgery
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Prof. Dr. med. H. J. Buhr
Chirurgische Klinik und Poliklinik IAllgemein-, Gefäß- und ThoraxchirurgieUniversitätsklinikum
Benjamin Franklin
Hindenburgdamm 3012200 Berlin
Telefon: Tel. 030/8445-2541
Fax: Fax 030/8445-2740
eMail: E-mail: buhr@ukbf.fu-berlin.de
