Nahtinsuffizienzen in der Abdominalchirurgie

Eine Nahtinsuffizienz in der Viszeralchirurgie ist die vom Chirurgen am meisten gefürchtete postoperative Komplikation; deren Detektion und die damit einhergehende zusätzliche Diagnostik und Therapie stellt die behandelnde Klinik häufig vor große Herausforderungen. Dieser Beitrag gibt einen Überblick über die möglichen Lokalisationen von Nahtinsuffizienzen sowie deren Diagnostik und Therapie.

Schlüsselwörter

Anastomoseninsuffizienz - Nahtundichtigkeit - Pankreasfistel - Galleleckage - Platzbauch

• Literatur

• 1 Louis M, Johnston SA, Churilov L. et al. Financial burden of postoperative complications following colonic resection: A systematic review. Medicine (Baltimore) 2021; 100: e26546
• 2 Kamarajah SK, Lin A, Tharmaraja T. et al. Risk factors and outcomes associated with anastomotic leaks following esophagectomy: a systematic review and meta-analysis. Dis Esophagus 2020; 33: doz089
• 3 Schaible A, Schmidt T, Diener M. et al. [Intrathoracic anastomotic leakage following esophageal and cardial resection: Definition and validation of a new severity grading classification]. Chirurg 2018; 89: 945-951
• 4 Nimptsch U, Haist T, Krautz C. et al. Hospital Volume, In-Hospital Mortality, and Failure to Rescue in Esophageal Surgery. Dtsch Arztebl Int 2018; 115: 793-800
• 5 Chen C, Jiang H. The assessment of intraoperative technique-related risk factors and the treatment of anastomotic leakage after esophagectomy: a narrative review. J Gastrointest Oncol 2021; 12: 207-215
• 6 Makuuchi R, Irino T, Tanizawa Y. et al. Esophagojejunal anastomotic leakage following gastrectomy for gastric cancer. Surg Today 2019; 49: 187-196
• 7 Noble F, Curtis N, Harris S. et al. Risk assessment using a novel score to predict anastomotic leak and major complications after oesophageal resection. J Gastrointest Surg 2012; 16: 1083-1095
• 8 Naf F, Warschkow R, Kolb W. et al. Selective decontamination of the gastrointestinal tract in patients undergoing esophageal resection. BMC Surg 2010; 10: 36
• 9 Kamarajah SK, Gujjuri RR, Elhadi M. et al. Elderly patients have increased perioperative morbidity and mortality from oesophagectomy for oesophageal cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 47: 1828-1835
• 10 Gong W, Li J. Combat with esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer: A critical review of the literature. Int J Surg 2017; 47: 18-24
• 11 Aurello P, Berardi G, Moschetta G. et al. Recurrence Following Anastomotic Leakage After Surgery for Carcinoma of the Distal Esophagus and Gastroesophageal Junction: A Systematic Review. Anticancer Res 2019; 39: 1651-1660
• 12 Hesp WL, Lubbers EJ, de Boer HH. et al. Anastomotic insufficiency in small bowel surgery – incidence and treatment. Langenbecks Arch Chir 1986; 368: 105-111
• 13 He X, Chen Z, Huang J. et al. Stapled side-to-side anastomosis might be better than handsewn end-to-end anastomosis in ileocolic resection for Crohnʼs disease: a meta-analysis. Dig Dis Sci 2014; 59: 1544-1551
• 14 Rollins KE, Javanmard-Emamghissi H, Acheson AG. et al. The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery: A Meta-analysis. Ann Surg 2019; 270: 43-58
• 15 Bashir Mohamed K, Hansen CH, Krarup PM. et al. The impact of anastomotic leakage on recurrence and long-term survival in patients with colonic cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2020; 46: 439-447
• 16 Zarnescu EC, Zarnescu NO, Costea R. Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery. Diagnostics (Basel) 2021; 11: 2382
• 17 Williamson AJ, Alverdy JC. Influence of the Microbiome on Anastomotic Leak. Clin Colon Rectal Surg 2021; 34: 439-446
• 18 Pulvirenti A, Marchegiani G, Pea A. et al. Clinical Implications of the 2016 International Study Group on Pancreatic Surgery Definition and Grading of Postoperative Pancreatic Fistula on 775 Consecutive Pancreatic Resections. Ann Surg 2018; 268: 1069-1075
• 19 Smits FJ, van Santvoort HC, Besselink MG. et al. Management of Severe Pancreatic Fistula After Pancreatoduodenectomy. JAMA Surg 2017; 152: 540-548
• 20 Laaninen M, Sand J, Nordback I. et al. Perioperative Hydrocortisone Reduces Major Complications After Pancreaticoduodenectomy: A Randomized Controlled Trial. Ann Surg 2016; 264: 696-702
• 21 Bednarsch J, Trauwein C, Neumann UP. et al. [Complication management after bile duct surgery]. Chirurg 2020; 91: 29-36
• 22 Denys A, Monbailliu T, Allaeys M. et al. Management of abdominal wound dehiscence: update of the literature and meta-analysis. Hernia 2021; 25: 449-462