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Stenosen und Ulzerationen nach bariatrischen Eingriffen

Stenosis and ulceration after bariatric surgery

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Zusammenfassung

Hintergrund

In unserer Gesellschaft steigt die Zahl der adipösen Patienten an, die wegen schwerwiegender Folgeerkrankungen einen adipositaschirurgischen Eingriff benötigen. Trotz Standardisierung dieser Operationen können Komplikationen wie Stenosen und Ulzerationen nach Magenbypass (RYGB) und Schlauchmagen (SG) auftreten.

Methoden

Unter Einbeziehung der aktuellen Literatur mit randomisierten klinischen Studien, Reviews, Einzelfallberichten und Expertenmeinungen wird ein Komplikationsmanagement entwickelt und vorgestellt.

Ergebnisse und Schlussfolgerung

Stenosen treten mit einer Häufigkeit von 0,1–3,9 % bei der SG und 3–27 % beim RYGB auf. Sie sind meist Folge einer fehlerhaften Operationstechnik oder Mikroinsuffizienz. Ulzerationen finden sich vor allem nach RYGB in 2–12 % der Fälle. Ursächlich kommen Fremdkörperreaktionen, lokale Ischämien, peptische Läsionen und Mikroinsuffizienzen infrage.

Das therapeutische Vorgehen hängt von der Lokalisation und Genese der Striktur ab. Endoskopische Interventionen führen bei Stenosen meist zum Erfolg. Selten ergibt sich hier eine Indikation zur operativen Revision. Auch Ulzerationen können in der Regel konservativ behandelt werden. Eine operative Intervention ergibt sich bei akuten Notfällen wie Perforation oder Blutung.

Abstract

Introduction

The increasing number of morbidly obese patients leads to a rising number of bariatric procedures in Germany. The operative techniques are highly standardized but such a standardization is lacking for the management of postoperative complications such as stenosis and ulceration after Roux-en-Y gastric bypass (RYGB) surgery and sleeve gastrectomy (SG).

Methods

The current literature is reviewed and a complication management is developed and presented in this article.

Results and conclusion

Postoperative stenoses occure with a frequency of 0.1–3.9 % after SG and 3–27 % after RYGB. Stenosis is secondary to inadequate surgical technique or microinsufficiency. Ulcers can be due to reaction to foreign body, local ischemia, peptic lesion, fistula and microinsufficiency.

Conclusion

Endoscopic interventions are successful in most cases for stenosis after RYGB and for short stenoses after SG. After SG long stenoses require redo surgery and conversion to RYGB. Ulcers can be managed by medication with the exception of perforation and hemorrhage, which require emergency laparoscopy.

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Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, Schwarzwald-Baar Klinikum VS GmbH, Klinikstr.1, 78052, Villingen-Schwenningen, Deutschland

    S. Müller & N. Runkel

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  1. S. Müller
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Correspondence to S. Müller.

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S. Müller und N. Runkel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Müller, S., Runkel, N. Stenosen und Ulzerationen nach bariatrischen Eingriffen. Chirurg 86, 841–846 (2015). https://doi.org/10.1007/s00104-015-0060-6

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