Abdomino-rechts-thorakale Ösophagusresektion mit intrathorakaler Anastomose beim Barrett-Karzinom

We report outcomes of en bloc esophageal resection with a thoracoscopically assisted laparotomy approach. The operation data were as follows: 41 thoracoscopically assisted procedures, 41 intrathoracic anastomoses, conversion rate 0, 100% R0 resection rate, 25 (15-52) lymph node retrievals, leak rate 2, and one mortality. From these results we conclude that minimally invasive esophagectomy with high intrathoracic anastomosis is a safe procedure. The R0 resection rate, lymph node retrieval, and operating time are comparable with those of the open abdominothoracic approach.

Section: Patienten Und Methodenunclassified

“…Zunächst erfolgt die Fundektomie, eine radikale Lymphknotendissektion und die Magenschlauchbildung über eine mediane Oberbauchlaparotomie, in der von Siewert beschriebenen Technik [6,7,8] …”

Section: Chirurgische Technikunclassified

Thorakoskopisch-assistierte En-bloc-Ösophagektomie

Adolf

Frehner

Sterk

et al. 2009

“…Bei den abdomino-rechts-thorakalen Ösophagusresektionen mit intrathorakaler Anastomose wird die Rate der interventionsbedürftigen Insuffizienzen Grad 2 und 3 mit 5-14% angegeben [28]. Im Zentrum des Managements steht hier die Überbrü-ckung der Leckage durch endoskopisch platzierte selbstexpanierende gecoverte Stents.…”

Section: Insuffizienzen Nach Eingriffen Am Oberen Gi-traktunclassified

Spezielle Gesichtspunkte postoperativer Komplikationen in der Viszeralchirurgie

Bartels

2009

Self Cite

Postoperative complications occur in 10% of patients following major visceral surgery. Of these more than 80% are surgical complications, more than 70% are septic complications and more than 60% are related to anastomotic leakage which accounts for the majority of postoperative deaths. To achieve successful management, early diagnosis is mandatory in cases of deviations from the normal postoperative course. Sufficient external drainage of the leakage and prevention of further contamination across the leakage by gastrointestinal contents are the primary therapeutic goals. The spectrum of therapeutic options is different and depends on the location of the leakage in the gastrointestinal tract. In the surgical treatment of peritonitis, the fundamental requirements for successful management are early detection of persistent abdominal sepsis and of newly developing abdominal complications during the treatment. Furthermore early initiation of effective antibiotic concepts is mandatory.

“…Abschließend wird die Anastomose mit Pleura bedeckt und die Thoraxhöhle drainiert. Eine detaillierte Beschreibung der Technik findet sich in [5].…”

Section: How To Do Itunclassified

Ösophaguskarzinom

Siewert

2007

Esophageal cancer is more than ever a surgical problem. Modern diagnostic procedures facilitate individual staging, and risk analysis is important for adequate patient selection. Using both allows an individualized indication. Under multimodal therapeutic protocols, neoadjuvant treatment can best be evaluated and is recommended in locally advanced tumors: RCTx in SCC, and CTx in Barrett cancer. Here the Ivor-Lewis procedure is the surgical method of choice. Postoperative complications are always possible, but the management now is standardized and has largely decreased mortality.