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DOI: 10.1055/s-0030-1247386
© Georg Thieme Verlag Stuttgart ˙ New York
Stellenwert der distalen Magenresektion mit Rekonstruktion nach Roux-Y zur Behandlung des Refluxrezidivs nach Fundoplikatio
Value of Distal Gastrectomy as a Remedial Operation for Failed FundoplicationPublication History
Publication Date:
22 December 2010 (online)
![](https://www.thieme-connect.de/media/zblchir/201103/lookinside/thumbnails/10.1055-s-0030-1247386-1.jpg)
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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