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Z Gastroenterol 2003; 41(1): 43-49
DOI: 10.1055/s-2003-36667
Leitlinien der DGVS
© Karl Demeter Verlag im Georg Thieme Verlag Stuttgart · New York

Chirurgie - Fisteln

Surgery FistulasH. J. Buhr1 , A. J. Kroesen1 , E. F. Stange1
  • 1Chirurgische Klinik I, Universitätsklinikum Benjamin Franklin, Berlin, und 1Abteilung Innere Medizin I, Robert-Bosch-Krankenhaus, Stuttgart
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Publication Date:
16 January 2003 (online)

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Präoperative Diagnostik vor abdominellen Operationen

Konsens

Ein komplettes Staging ist obligat zur Sicherung der Diagnose. Wenn die Diagnose gesichert ist, sollten präoperativ eine Sonographie und Koloskopie (maximal vor einem halben Jahr), bei Abszess-Verdacht CT bzw. MRT (möglichst in Interventionsbereitschaft) vorliegen. Bei geplantem laparoskopischen Vorgehen ist ein Sellink oder ein MR-Sellink obligat (max. ein halbes Jahr alt) (C).

Erläuterung

Vor abdominellen resezierenden, explorierenden und ggf. mit Strikturoplastiken verbundenen Eingriffen sind die folgenden diagnostischen Untersuchungen abdingbar. Sollte die Diagnose noch nicht komplett gesichert sein, so muss ein komplettes Staging erfolgen. Dieses Staging beinhaltet: Koloskopie, Röntgen-Sellink des Dünndarms oder MR-Sellink und Ösophago-Gastro-Duodenoskopie [1] [6]. Wenn eine Diagnose uneingeschränkt gesichert ist, muss kein komplettes Staging erfolgen. Vielmehr sind hier die folgenden Verfahren mit der entsprechenden Fragestellung erforderlich: Abdomen-Sonographie zum groben Ausschluss eines Abszesses, bei Abszessverdacht eine Computertomographie bzw. eine MRT des Abdomens. Hierbei sollte von radiologischer Seite immer Interventionsbereitschaft bestehen, um ggf. drainierbare intraabdominelle Abszesse interventionell mit einer ausreichend großen Drainage zu versorgen.

Die Koloskopie sollte nicht älter ein halbes Jahr alt sein, da sich das Kolon intraoperativ nur eingeschränkt beurteilen lässt. Insbesondere Rektum und Sigma sind von außen schlecht zu beurteilen. Ein hier ggf. zusätzlich vorhandener Befund würde unter Umständen das Resektionsausmaß erweitern [7]. Ferner ist hinsichtlich eines geplanten laparoskopischen Vorgehens ein maximal 6 Monate alter Sellink des Dünndarms oder ein MRT-Sellink obligat. Diese zusätzliche Diagnostik ist deswegen erforderlich, da sich laparoskopisch der Dünndarm schlechter explorieren und palpieren lässt [8].

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