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Innere Hernien nach bariatrischer Chirurgie

Internal hernias after bariatric surgery

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Zusammenfassung

Hernien gehören zu den häufigsten Langzeitkomplikationen nach bariatrischen Eingriffen. Neben Narbenhernien, die nach konventioneller Adipositaschirurgie sehr häufig auftreten, stellen interne Hernien eine besondere Herausforderung nach bariatrischen Eingriffen dar. Das Auftreten innerer Hernien nach bariatrischen Eingriffen ist dabei häufiger als nach anderen Operationen am oberen Gastrointestinaltrakt. Innere Hernien sind nicht auf laparoskopische Verfahren limitiert, sondern werden auch nach konventionell durchgeführtem Roux-en-Y-Magenbypass beobachtet. Da die Inzidenz aber nach laparoskopischen Eingriffen deutlich gestiegen ist, ist von einer engen Assoziation an das minimalinvasive Verfahren auszugehen. Die klinischen Zeichen innerer Hernien ohne komplette Obstruktion sind häufig unspezifisch, und die richtige Diagnose kann nicht immer zeitnah gestellt werden. Neben den Aspekten der Prävention von inneren Hernien bei laparoskopischen Eingriffen behandeln wir in dieser Übersicht die Diagnostik und Therapie dieser Entität unter Berücksichtigung verschiedener innerer Hernienformen nach bariatrischen Eingriffen.

Abstract

Hernias are among the most common long-term complications after bariatric surgery. Besides incisional hernias, which occur very often after conventional open bariatric surgery, internal hernias after bariatric surgery constitute a special challenge. The incidence of internal hernias after bariatric surgery is more common than for other upper gastrointestinal tract operations. Internal hernias are not limited to laparoscopic procedures but are also observed after conventional open gastric bypass surgery. As the incidence is significantly increased after laparoscopic interventions, there seems to be a close association with minimally invasive procedures. The clinical symptoms of internal hernias without complete obstruction are non-specific and the correct diagnosis is often not straightforward. In addition to the aspects of prevention of internal hernias in laparoscopic surgery, this article discusses the diagnosis and treatment, taking into account the various forms of internal hernia after bariatric operations.

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Correspondence to W.K. Karcz.

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W.K. Karcz, K. Blazejczyk, U.F. Wellner und T. Keck geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Karcz, W., Blazejczyk, K., Wellner, U. et al. Innere Hernien nach bariatrischer Chirurgie. Chirurg 86, 855–860 (2015). https://doi.org/10.1007/s00104-015-0046-4

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