Zusammenfassung
Hintergrund: Die chirurgische Therapie des Refluxrezidivs nach Fundoplikatio ist problematisch.
Ziel dieser Arbeit ist die Bestimmung des Stellenwertes der Manschettenauflösung mit
distaler Magenresektion und Rekonstruktion nach Roux-Y zur Behandlung der fehlgeschlagenen
Fundoplikatio. Material und Methoden: Die Verläufe von 26 chirurgisch revidierten Patienten wurden untersucht. Eine Manschettenauflösung
mit distaler Magenresektion und Rekonstruktion nach Roux-Y wurde bei 6 Patienten durchgeführt
(Gruppe a); eine Neuanlage der Fundoplikatio erfolgte bei 15 Patienten (Gruppe b)
und eine alleinige Revision der Hiatoplastik bei 5 Patienten (Gruppe c). Ergebnisse: Patienten der Gruppe a hatten die längste Anamnese (p = 0,01) und häufigsten Voroperationen
(p = 0,01) zwischen Ersteingriff und Revision. Im Gegensatz hierzu war die Dauer des
stationären Aufenthaltes und die Krankenhausmorbidität nach Magenresektion am höchsten
(p = n. s.). Im Follow-up war die Verbesserung der Symptomatik durch die Magenresektion
am zuverlässigsten (Gruppen a–c: 100 %, 78,6 % und 60 % der Patienten; p = n. s.).
Schlussfolgerung: Bei ausgewählten Patienten führt die Manschettenauflösung mit distaler Magenresektion
und Rekonstruktion nach Roux-Y zuverlässig zu einer Verbesserung der Rezidivsymptomatik.
Trotz der erhöhten Morbidität ist dieser Eingriff eine wichtige Ergänzung des operativen
Spektrums, insbesondere bei multipel voroperierten Patienten.
Abstract
Background: Failure of conventional antireflux surgery is a challenging problem. This study aims
at defining the role of distal gastrectomy with Roux-en-Y diversion in the treatment
of failed fundoplication. Material and Methods: This report reviews the indications and results of 26 patients who underwent revisional
antireflux surgery in our department. Distal gastrectomy and Roux-en-Y reconstruction
were performed in 6 patients (group a), refundoplication in 15 (group b), and re-hiatoplasty
in 5 patients (group c). Results: Group a patients had the longest history (p = 0.001) and the highest number of previous
operative procedures (p = 0.001). In contrast, hospital stay was longer and postoperative
morbidity was higher after distal gastrectomy (p = n. s.). At follow-up, symptom improvement
was achieved most reliably after distal gastrectomy (groups a–c: 100 %, 78.6 %, and
60 % of patients; p = n. s.). Conclusion: Distal gastrectomy with Roux-en-Y diversion is a safe and reliable surgical option
for selected patients after failed fundoplication. Distal gastrectomy with Roux-en-Y
diversion is a reliable surgical option for selected patients after failed fundoplication.
Despite a higher morbidity, this procedure represents an important addition to the
surgical armamentarium, particularly in patients with a history of multiple previous
interventions.
Schlüsselwörter
Fundoplikatio - Refluxrezidiv - Magenresektion - Roux-Y
Key words
fundoplication - reflux recurrence - gastric resecion - Roux-en-Y
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Priv.-Doz. Dr. med. C. A. Gutschow
Klinik für Allgemein-, Viszeral- und Tumorchirurgie · Universität zu Köln
Kerpener Straße 62
50962 Köln
Deutschland
Phone: 00 49 / 2 21 / 48 03
Email: 00 49 / 2 21 / 62 58
Email: christian.gutschow@uk-koeln.de