Diagnose und chirurgische Therapie der Hiatushernie

Zusammenfassung

Die gängigen Methoden – Bariumschluckaktröntgen, Endoskopie und Manometrie – ermöglichen es, eine Hiatushernie präoperativ zu diagnostizieren, jedoch ist es nicht möglich, eine Aussage über die zu erwartende Bruchpfortengröße resp. die Größe des Hiatusdefekts zu treffen. Wird der gastroösophageale Übergang endoskopisch beurteilt und nach Hill in die verschiedenen Typen eingeteilt, ist zumindest eine Korrelation mit dem intraoperativen Befund zu erwarten. Bis dato lässt sich kein eindeutiges Urteil in Bezug auf die ideale Versorgung der Hiatushernie, mit oder ohne Netz, welches Netz und welche Form, fällen, und es werden zu diesem Thema weitere Studien mit Langzeitergebnissen benötigt. Die Entscheidung sollte nach dem intraoperativen Befund und nicht nach der präoperativ bestimmten Größe getroffen werden.

Abstract

Using the usual diagnostic tools like barium swallow examination, endoscopy, and manometry, we are able to diagnose a hiatal hernia, but it is not possible to predict the size of the hernia opening or, respectively, the size of the hiatal defect. At least a correlation can be expected if the gastroesophageal junction is endoscopically assessed in a retroflexed position, and graded according to Hill. So far, it is not possible to come to a clear conclusion how the hiatal closure during hiatal hernia repair should be performed. There is no consensus on using a mesh, and when using a mesh which type or shape should be used. Further studies including long-term results on this issue are necessary. However, it seems obvious to make the decision depending on certain conditions found during operation, and not on preoperative findings.

Schlüsselwörter

Hiatushernie - laparoskopische Fundoplikation - OP-Management - gastroösophageale Refluxkrankheit - Indikation

Key words

hiatal hernia - laparoscopic fundoplication - surgical management - gastroesophageal reflux disease (GERD) - indication

• Literatur

• 1 Dean C, Etienne D, Carpentier B et al. Hiatal hernias. Surg Radiol Anat 2012; 34: 291-299
• 2 Gordon C, Kang JY, Neild PJ et al. The role of the hiatus hernia in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2004; 20: 719-732
• 3 Kahrilas PJ, Lin S, Chen J et al. The effect of hiatus hernia on gastro-oesophageal junction pressure. Gut 1999; 44: 476-482
• 4 Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol 2008; 22: 601-616
• 5 Skinner DB. Hernias (hiatal, traumatic, and congenital). In: Berk JE. Gastroenterology. Vol. 4. Philadelphia: W. B. Saunders; 1985: 705-716
• 6 Mitiek MO, Andrade RS. Giant hiatal hernia. Ann Thorac Surg 2010; 89: 2168-2173
• 7 Kohn GP, Price RR, DeMeester SR et al. for the SAGES Guidelines Committee. Guidelines for the management of hiatal hernia. Surg Endosc 2013; 27: 4409-4428
• 8 Dodds WJ. 1976 Walter B. Cannon Lecture: current concepts of esophageal motor function: clinical implications for radiology. AJR Am J Roentgenol 1977; 128: 549-561
• 9 Mittal RK. Hiatal hernia: myth or reality?. Am J Med 1997; 103: 33-39
• 10 Hill LD, Kozarek RA, Kraemer SJ et al. The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc 1996; 44: 541-547
• 11 Granderath FA. Measurment of the esophageal hiatus by calculation of the hiatal surface area (HSA). Why, when and how?. Surg Endosc 2007; 21: 2224-2225
• 12 Koch OO, Schurich M, Antoniou SA et al. Predictability of hiatal hernia/defect size: is there a correlation between pre- and intraoperative findings?. Hernia 2013; Jan 6 [Epub ahead of print]
• 13 Koch OO, Spaun G, Antoniou SA et al. Endoscopic grading of the gastroesophageal flap valve is correlated with reflux activity and can predict the size of the esophageal hiatus in patients with gastroesophageal reflux disease. Surg Endosc 2013; 27: 4590-4595
• 14 Al-Tashi M, Rejchrt S, Kopacova M et al. Hiatal hernia and Barrettʼs oesophagus impact on symptoms occurrence and complications. Cas Lek Cesk 2008; 147: 564-568
• 15 Kahrilas PJ. The role of hiatus hernia in GERD. Yale J Biol Med 1999; 72: 101-111
• 16 Pointner R, Granderath FA. Hiatushernie und Rezidive: die Achillessehne der Antirefluxchirurgie?. Chirurg 2008; 79: 974-981
• 17 Granderath FA, Frantzides CT, Carlson MA. Hiatal Closure – new Trends in laparoscopic Antireflux Surgery. In: Granderath FA, Kamolz T, Pointner R. Gastroesophageal Reflux Disease. Principles of Disease, Diagnosis and Treatment. Wien: Springer-Verlag; 2006: 215-234
• 18 Fernando HC, Schauer PR, Rosenblatt M et al. Quality of life after antireflux surgery compared with nonoperative management for severe gastroesophageal reflux disease. J Am Coll Surg 2002; 194: 23-27
• 19 Stylopoulos N, Gazelle GS, Rattner DW. Paraesophageal hernias: operation or observation?. Ann Surg 2002; 236: 492
• 20 Polomsky M, Hu R, Sepesi B et al. A population-based analysis of emergent vs. elective hospital admissions for an intrathoracic stomach. Surg Endosc 2010; 6: 1250-1255
• 21 Dent J, Brun J, Fendrick AM et al. An evidence-based appraisal of reflux disease management – the Genval Workshop Report. Gut 1999; 44 (Suppl. 02) S1-S16
• 22 Koop H, Schepp W, Muller-Lissner S et al. Gastroösophageale Refluxkrankheit – Ergebnisse einer evidenzbasierten Konsensuskonferenz der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten. Z Gastroenterol 2005; 43: 163-164
• 23 von Rahden BH, Filser J, Germer CT. PPI vs. fundoplication in the treatment of gastroesophageal reflux disease: results of the Cochrane meta-analysis and the LOTUS study. Chirurg 2011; 82: 944-946
• 24 Watson DI, Jamieson GG. Antireflux surgery in the laparoscopic era. Br J Surg 1998; 85: 1173-1184
• 25 Arnaund JP, Pessaux P, Ghavami B et al. Laparoscopic fundoplication for gastroesophageal reflux. Multicenter study of 1470 cases. Chirurgie 1999; 124: 516-522
• 26 Broeders JA, Roks DJ, Ahmed Ali U et al. Laparoscopic anterior versus posterior fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis of randomized clinical trials. Ann Surg 2011; 254: 39-47
• 27 Strate U, Emmermann A, Fibbe C et al. Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility. Surg Endosc 2008; 22: 21-30
• 28 Broeders JA, Mauritz FA, Ahmed Ali U et al. Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease. Br J Surg 2010; 97: 1318-1330
• 29 Hashemi M, Peters JH, DeMeester TR et al. Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg 2000; 190: 553-560
• 30 Wiechmann RJ, Ferguson MK, Naunheim K et al. Laparoscopic management of giant paraesophageal herniation. Ann Thorac Surg 2001; 71: 1080-1086
• 31 Carlson MA, Richards CG, Frantzides CT. Laparoscopic prosthetic reinforcement of hiatal herniorrhaphy. Dig Surg 1999; 16: 407-410
• 32 Champion JK, Rock D. Laparoscopic mesh cruroplasty for large paraesophageal hernias. Surg Endosc 2003; 17: 551-553
• 33 Frantzides CT, Richards CG, Carlson MA. Laparoscopic repair of large hiatal hernia with polytetrafluoroethylene. Surg Endosc 1999; 13: 906-908
• 34 Huntington TR. Laparoscopic mesh repair of the esophageal hiatus. J Am Coll Surg 1997; 184: 399-400
• 35 Kuster GG, Gilroy S. Laparoscopic technique for repair of paraesophageal hiatal hernias. J Laparoendosc Surg 1993; 3: 331-338
• 36 Basso N, De Leo A, Genco A et al. 360 degrees laparoscopic fundoplication with tension-free hiatoplasty in the treatment of symptomatic gastroesophageal reflux disease. Surg Endosc 2000; 14: 164-169
• 37 Granderath FA, Carlson MA, Champion JK et al. Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery. Surg Endosc 2006; 20: 367-379
• 38 Johnson JM, Carbonell AM, Carmody BJ et al. Laparoscopic mesh hiatoplasty for paraesophageal hernias and fundoplications: a critical analysis of the available literature. Surg Endosc 2006; 20: 362-366
• 39 Soricelli E, Basso N, Genco A et al. Long-term results of hiatal hernia mesh repair and antireflux laparoscopic surgery. Surg Endosc 2009; 23: 2499-2504
• 40 Frantzides CT, Madan AK, Carlson MA et al. A prospective, randomized trial of laparoscopic polytetrafluroethylene (PTFE) patch repair vs. simple cruroplasty for large hiatal hernia. Arch Surg 2002; 137: 649-652
• 41 Granderath FA, Schweiger UM, Kamolz T et al. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 2005; 140: 40-48
• 42 Oelschlager BK, Pellegrini CA, Hunter JG et al. Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg 2011; 213: 461-468
• 43 Antoniou SA, Koch OO, Antoniou GA et al. Mesh-reinforced hiatal hernia repair: a review on the effect on postoperative dysphagia and recurrence. Langenbecks Arch Surg 2012; 397: 19-27
• 44 Schildberg CW, Perrakis A, Croner R et al. Ergebnisse der operativen Therapie großer Hiatushernien. Zentralbl Chir 2014; 139: 66-71
• 45 Scheuerlein H, Rauchfuss F, Dittmar Y et al. Modifizierte Netzimplantation bei großer paraösophagealer Typ-III-Hernie. Zentralbl Chir 2011; 136: 625-628
• 46 Kanellos D, Moesta KT, Schug-Pass C et al. Verstärkung der Hiatoplastik durch ein leichtgewichtiges titanisiertes Polypropylennetz mit Fixierung durch Fibrinklebung. Zentrabl Chir 2011; 136: 244-248
• 47 Stadlhuber RJ, Sherif AE, Mittal SK et al. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc 2009; 23: 1219-1226
• 48 Tatum RP, Shalhub S, Oelschlager BK et al. Complications of PTFE mesh at the diaphragmatic hiatus. J Gastrointest Surg 2008; 12: 953-957
• 49 Zaninotto G, Portale G, Costantini M et al. Objective follow-up after laparoscopic repair of large type III hiatal hernia. Assessment of safety and durability. World J Surg 2007; 31: 2177-2183