Online-Kurs
20 Jahre laparoskopische Antireflux- und Hiatushernienchirurgie - Indikation, Verfahrenswahl und Komplikationsvermeidung
The concept of gastroesophageal reflux disease and the therapeutic concepts are recent events in the history of gastroesophageal physiopathology. Even now, no unique concept or surgical technique is generally accepted and a number of different antireflux procedures with numerous modifications are reported. The term „fundoplication“ is applied to different operations that often have nothing to do with the original description. The main reason is a serious lack of knowledge of the historical roots of many of these techniques. The best surgical technique for GERD, however, remains a subject of debate also some prospective randomized clinical studies are available.
This cme-paper is giving a review of the current concepts and techniques in antireflux surgery. Beginners in antireflux surgery are provided with a detailed description of all parts of the operation. Latest studies and recommendations and an analysis of our own patients will help the more experienced surgeon to reevaluate and optimize his own technique. Diagnostic procedures, indications, postoperative care and follow-up are of crucial importance. A profound knowledge of all standard procedures as well as of reasons to use modifications is important for our patients and for the surgeons, especially from the forensic point of view.
Inhalt dieses Kurses
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Abstract
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Einleitung
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Präoperative Diagnostik: Wie viel ist sinnvoll, wie viel notwendig?
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Anamnese und klinische Untersuchung
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Protonenpumpen-Inhibitoren-Test
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Endoskopie und Histologie
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24-Stunden-Ösophagus-pH-Metrie und Impedanz-Messung
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Ösophagus-Manometrie
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Röntgen (Bariumbreischluck)
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Indikationsstellung
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Operationstechnik
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Zugangswahl und Technik der Präparation
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Hiatusplastik
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Durchführung der Valvuloplastik
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Auswahl des optimalen Rekonstruktionsverfahrens
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Komplikationsvermeidung und Komplikationsmanagement
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Diagnostik und Indikationsstellung
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Technische Details
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Exposition des Hiatus oesophagei und Dissektion der Zwerchfellschenkel
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Fundusmobilisation und Manschettenanlage
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Der Operateur als „Risikofaktor"
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Re-Fundplikatio
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Postoperatives Management und Nachsorge
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Ausblick: Neue Techniken
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Literatur
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Die Autoren
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Evaluation
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Test