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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
 

  • Literatur

  • 1 Dean C, Etienne D, Carpentier B et al. Hiatal hernias. Surg Radiol Anat 2012; 34: 291-299
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 3 Kahrilas PJ, Lin S, Chen J et al. The effect of hiatus hernia on gastro-oesophageal junction pressure. Gut 1999; 44: 476-482
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 5 Skinner DB. Hernias (hiatal, traumatic, and congenital). In: Berk JE. Gastroenterology. Vol. 4. Philadelphia: W. B. Saunders; 1985: 705-716
    Google Scholar
  • 6 Mitiek MO, Andrade RS. Giant hiatal hernia. Ann Thorac Surg 2010; 89: 2168-2173
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 9 Mittal RK. Hiatal hernia: myth or reality?. Am J Med 1997; 103: 33-39
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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]
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 15 Kahrilas PJ. The role of hiatus hernia in GERD. Yale J Biol Med 1999; 72: 101-111
    PubMedGoogle Scholar
  • 16 Pointner R, Granderath FA. Hiatushernie und Rezidive: die Achillessehne der Antirefluxchirurgie?. Chirurg 2008; 79: 974-981
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 19 Stylopoulos N, Gazelle GS, Rattner DW. Paraesophageal hernias: operation or observation?. Ann Surg 2002; 236: 492
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 24 Watson DI, Jamieson GG. Antireflux surgery in the laparoscopic era. Br J Surg 1998; 85: 1173-1184
    CrossrefPubMedGoogle Scholar
  • 25 Arnaund JP, Pessaux P, Ghavami B et al. Laparoscopic fundoplication for gastroesophageal reflux. Multicenter study of 1470 cases. Chirurgie 1999; 124: 516-522
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 30 Wiechmann RJ, Ferguson MK, Naunheim K et al. Laparoscopic management of giant paraesophageal herniation. Ann Thorac Surg 2001; 71: 1080-1086
    CrossrefPubMedGoogle Scholar
  • 31 Carlson MA, Richards CG, Frantzides CT. Laparoscopic prosthetic reinforcement of hiatal herniorrhaphy. Dig Surg 1999; 16: 407-410
    CrossrefPubMedGoogle Scholar
  • 32 Champion JK, Rock D. Laparoscopic mesh cruroplasty for large paraesophageal hernias. Surg Endosc 2003; 17: 551-553
    CrossrefPubMedGoogle Scholar
  • 33 Frantzides CT, Richards CG, Carlson MA. Laparoscopic repair of large hiatal hernia with polytetrafluoroethylene. Surg Endosc 1999; 13: 906-908
    CrossrefPubMedGoogle Scholar
  • 34 Huntington TR. Laparoscopic mesh repair of the esophageal hiatus. J Am Coll Surg 1997; 184: 399-400
    PubMedGoogle Scholar
  • 35 Kuster GG, Gilroy S. Laparoscopic technique for repair of paraesophageal hiatal hernias. J Laparoendosc Surg 1993; 3: 331-338
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 44 Schildberg CW, Perrakis A, Croner R et al. Ergebnisse der operativen Therapie großer Hiatushernien. Zentralbl Chir 2014; 139: 66-71
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 45 Scheuerlein H, Rauchfuss F, Dittmar Y et al. Modifizierte Netzimplantation bei großer paraösophagealer Typ-III-Hernie. Zentralbl Chir 2011; 136: 625-628
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 48 Tatum RP, Shalhub S, Oelschlager BK et al. Complications of PTFE mesh at the diaphragmatic hiatus. J Gastrointest Surg 2008; 12: 953-957
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar