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Viszeralchirurgie 2000; 35(1): 30-35
DOI: 10.1055/s-2000-11237
ORIGINALARBEIT
© Georg Thieme Verlag Stuttgart · New York

M. Crohn: Prinzipien der chirurgischen Therapie unter Berück-sichtigung des Stellenwertes laparoskopischer Verfahren

A. J. Kroesen, M. J. UtzigH. J. Buhr
  • Chirurgische Klinik und Poliklinik I: Abt. für Allgemein-, Gefäß- und Thoraxchirurgie, Univ.-Klinikum Benjamin Franklin, Freie Universität Berlin
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Publication History

Publication Date:
31 December 2000 (online)

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Zusammenfassung.

Die definitive Heilung des M. Crohn kann durch eine chirurgische Therapie nicht erreicht werden. Auf Grund seiner Neigung zur Rekurrenz und der häufigen Notwendigkeit einer Reoperation unterliegt die chirurgische Therapie besonderen Prinzipien. Da eine Rekurrenz durch eine ausgedehnte Resektion mit mikroskopisch Crohn-freien Absetzungsrändern nicht verhindert werden kann und die Rezidivhäufigkeit bei Crohn-befallenen Resektionsrändern nicht höher ist, sollte eine Resektion im makroskopisch gesunden Darm und maximal organerhaltend erfolgen. Im Gegensatz zur Karzinomchirurgie wird dabei der Darm wandnah skelettiert, eine Lymphadenektomie wird nicht durchgeführt. Anastomosen werden zur Vermeidung von Blindsackbildungen als End-zu-End-Anastomosen in einreihiger Nahttechnik unter Verwendung von resorbierbarem Nahtmaterial angelegt. Zur Therapie kurzstreckiger Stenosen hat sich die organerhaltende Strikturoplastik bewährt. Laparoskopische Techniken finden bei zunehmender Erfahrung und Sicherheit mehr und mehr Verbreitung. Bei Anwendung dieser Verfahren müssen aber im gleichen Maße wie bei offenen Operationstechniken die chirurgischen Prinzipien der Crohn-Therapie eingehalten werden.

Crohn's disease: patterns of surgical therapy in view of laparoscopical techniques.

Surgical therapy of Crohn's disease. Crohn's disease can neither be cured by surgery nor by medical therapy. After surgical therapy the recurrence rate is up to 50 % after 20 years. Surgery requires therefore special precautions. As recurrence is unaffected by the width of the margin of macroscopic bowel involvement the major principle of therapy is a minimallyresecting surgery. This concerns mainly strictures and stenosis. Strictures should therefore be treated by stricturoplasty, stenosis by limited resection with Crohn-free resection margins. Extensive resection should be avoided. Since several studies have demonstrated the feasibility and safety of laparoscopic techniques in Crohn's disease, these procedures have gained more and more acceptance. Nevertheless, laparoscopic surgery underlies the same rules as open surgery.

Schlüsselwörter

M. Crohn - Chirurgische Prinzipien - Laparoskopische Verfahren

Key words:

Crohn's disease - Surgery - Laparoscopic surgery

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Prof. Dr. med. H. J. Buhr

Chirurgische Klinik und Poliklinik IAllgemein-, Gefäß- und ThoraxchirurgieUniversitätsklinikum Benjamin Franklin

Hindenburgdamm 3012200 Berlin

Phone: Tel. 030/8445-2541

Fax: Fax 030/8445-2740

Email: E-mail: buhr@ukbf.fu-berlin.de

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