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Zentralbl Chir 2014; 139(4): 393-398
DOI: 10.1055/s-0033-1360294
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Diagnose und chirurgische Therapie der Hiatushernie

Diagnosis and Surgical Therapy of Hiatal Hernia
O. O. Koch
1   Allgemein- und Viszeralchirurgie, Krankenhaus Barmherzige Schwestern, Linz, Österreich
,
G. Köhler
2   Zentrum für minimal invasive Chirurgie, Krankenhaus Neuwerk, Mönchengladbach, Deutschland
,
S. A. Antoniou
2   Zentrum für minimal invasive Chirurgie, Krankenhaus Neuwerk, Mönchengladbach, Deutschland
,
R. Pointner
3   Allgemeinchirurgie, Krankenhaus Zell am See, Zell am See, Österreich
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
19. März 2014 (online)

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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
 

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