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Chirurgische Therapie

  • Chapter
Gastrointestinale Funktionsstörungen

Zusammenfassung

Wesentlicher Ansatz des chirurgischen Behandlungsprinzips ist die mechanische Inkompetenz des unteren ösophagealen Sphinkters, die der wichtigste zugrundeliegende Funktionsdefekt bei der gastroösophagealen Refluxkrankheit ist [20, 58]. Durch eine Verstärkung der Hochdruckzone im unteren Ösophagus wird der Widerstand gegen einen rückwärtigen Fluß vom Mageninhalt erschwert. Ein weiteres Prinzip der Antirefluxoperation ist die Verbesserung der Längsspannung der Speiseröhre nach dem von Stelzner vorgestellten Modell [43a, 68]. Vertreter dieses Konzeptes fordern die Wiederherstellung der anatomischen Situation durch Beseitigung der Hiatushernie und Fixierung des Magens im Abdomen mit Wiederherstellung des His-Winkels. Die historische Entwicklung der Antirefluxchirurgie hat besonders in den 50er und 60er Jahren Gelegenheit gegeben, die Resultate der sog. Pexieverfahren zu verfolgen [8, 9]. Darunter sind die Ösophagofundopexie nach Lortat-Jacob und die Fundophrenikopexie nach Höhle-Kümmerle zu erwähnen, die kombiniert mit einem Verschluß des Hiatus angewendet wurden [3, 38, 46]. Auch die posteriore Gastropexie nach Hill ist in ihrer ursprünglichen Form diesen Pexieverfahren zuzuordnen [36]. Die Erfolge dieses Konzeptes waren jedoch limitiert und führten zu vielen Refluxrezidiven [3].

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  1. K.-H. Fuchs
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  2. S. M. Freys
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  1. Chirurgische Universitätsklinik, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland

    K.-H. Fuchs  & A. Thiede  & 

  2. Chirurgische Klinik, Ismaninger Str. 22, 81675, München, Deutschland

    H. J. Stein

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Fuchs, KH., Freys, S.M. (1997). Chirurgische Therapie. In: Fuchs, KH., Stein, H.J., Thiede, A. (eds) Gastrointestinale Funktionsstörungen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-60372-3_40

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