2024-
2025
Spijsvertering -
Heelkunde
PROF DR D’HOORE
JOZEFIEN CEULEMANS
,Bariatrische en metabole heelkunde ................................................................................................................ 5
Inleiding .............................................................................................................................................................. 5
Prevalentie en incidentie ............................................................................................................................... 5
Type II diabetes.............................................................................................................................................. 5
Indicatie voor HK ........................................................................................................................................... 6
Types chirurgie ................................................................................................................................................... 6
Restrictief ...................................................................................................................................................... 6
Mason gastroplastie ................................................................................................................................. 6
Mc Lean adjustable gastric banding ......................................................................................................... 6
Sleeve gastrectomie .................................................................................................................................. 7
Malabsorptie: scopinaro ................................................................................................................................ 7
Gastric bypass ................................................................................................................................................ 7
Falen van ingreep .......................................................................................................................................... 8
Functioneel falen ...................................................................................................................................... 8
Complicaties .................................................................................................................................................. 8
Marginale ulcus ......................................................................................................................................... 8
Interne herniatie: ...................................................................................................................................... 8
Obstructie na gastric bypass ..................................................................................................................... 8
Dumping syndroom .................................................................................................................................. 9
Deficiënties ............................................................................................................................................... 9
Follow-up ............................................................................................................................................................ 9
Metabole veranderingen .................................................................................................................................... 9
Welke ingreep voor welke patiënt ................................................................................................................ 9
Nieuwe technieken ........................................................................................................................................... 10
Dundarm – Meckel – Appendix ...................................................................................................................... 10
Dunne darm ...................................................................................................................................................... 10
Congenitale aandoeningen .......................................................................................................................... 10
Divertikel van Meckel .................................................................................................................................. 11
Pathologie van de appendix ............................................................................................................................. 12
Anatomie en functie .................................................................................................................................... 12
Acute appendicitis ....................................................................................................................................... 12
Diagnose ...................................................................................................................................................... 12
Kliniek ..................................................................................................................................................... 12
Labo ........................................................................................................................................................ 13
Beeldvorming .......................................................................................................................................... 13
Alvarado score ........................................................................................................................................ 13
Differentieel diagnose ............................................................................................................................ 13
Behandeling ................................................................................................................................................. 14
Postoperatieve verwikkelingen ................................................................................................................... 14
Appendix neoplasie ..................................................................................................................................... 14
Mucineuze epitheliale neoplasie: ........................................................................................................... 14
NET, neuroendocriene tumor ................................................................................................................. 14
Enterobius vermicularies ............................................................................................................................. 14
Aandoeningen van de dunne darm .................................................................................................................. 15
Dundarm divertikels .................................................................................................................................... 15
Hamartomatous polyposis syndromes (AD) ................................................................................................ 15
Dunne darm tumoren .................................................................................................................................. 15
Goedaardige tumoren ............................................................................................................................ 15
, Kwaadaardige tumoren .......................................................................................................................... 15
Pathologie van de abdominale wand ............................................................................................................. 15
Congenitale defecten........................................................................................................................................ 15
Omphalocoele ............................................................................................................................................. 15
Gastroschisis ................................................................................................................................................ 16
Behandeling ............................................................................................................................................ 16
Hernia inguinalis .......................................................................................................................................... 16
Risico inklemming ................................................................................................................................... 17
Cyste van Nuck........................................................................................................................................ 17
Behandeling ............................................................................................................................................ 17
Hernia umbilicalis ........................................................................................................................................ 17
Urachus cyste/fistel vs open ductus ophalomesentericus .......................................................................... 17
Lies en dijbreuken ............................................................................................................................................. 17
Diagnose ................................................................................................................................................. 18
Ingeklemde breuk ........................................................................................................................................ 18
Hernia van richter ................................................................................................................................... 19
Electief herstel ............................................................................................................................................. 19
Bassini repair........................................................................................................................................... 19
Mesh ....................................................................................................................................................... 19
Stoppa repair .......................................................................................................................................... 19
Ambulante chirurgie ............................................................................................................................... 20
Hernia van spiegel ....................................................................................................................................... 20
Andere ......................................................................................................................................................... 20
Postop verwikkelingen na laparotomie ............................................................................................................ 20
Evisceratie.................................................................................................................................................... 20
Intra abdominale hypertensie ..................................................................................................................... 21
Eventratie .................................................................................................................................................... 21
Verwikkelingen buikwand chirurgie ................................................................................................................. 22
Spontaan rectus haematoma ........................................................................................................................... 22
Tumoren van buikwand .................................................................................................................................... 23
Umbilicaal endometrioom ........................................................................................................................... 23
Desmoid tumor ............................................................................................................................................ 23
Sister marie-joseph nodule .......................................................................................................................... 23
Port site metastasen .................................................................................................................................... 23
Infecties van de buikwand ................................................................................................................................ 23
Ischemisch darmlijden.................................................................................................................................... 23
Acute abdomen ................................................................................................................................................ 23
Lig arcuatum syndroom ............................................................................................................................... 24
Mesenterisch vork syndroom (Wilkie syndroom) ....................................................................................... 24
Mesenteriale ischemie ...................................................................................................................................... 24
Verschillende collateralen ...................................................................................................................... 25
Pathofysiologie ............................................................................................................................................ 25
Systemische effecten ................................................................................................................................... 25
Klinische bevindingen .................................................................................................................................. 25
Angor abdominalis .................................................................................................................................. 26
Diagnose chronische ischemie..................................................................................................................... 26
Acute mesenterische ischemie .................................................................................................................... 26
trombose ................................................................................................................................................ 26
Embool .................................................................................................................................................... 27
Veneuze thrombose ................................................................................................................................ 27
, Mesenteriële torsie ..................................................................................................................................... 28
Residuele short bowel ................................................................................................................................. 29
Ischemische colitis ....................................................................................................................................... 29
Klinisch beeld .......................................................................................................................................... 30
Behandeling ............................................................................................................................................ 30
Conclusie........................................................................................................................................................... 30
Colorectale tumoren ...................................................................................................................................... 30
Achtergrond...................................................................................................................................................... 31
Preoperatieve staging: cTNM ........................................................................................................................... 32
Laprascopische chirurgie ............................................................................................................................. 33
Kwaliteitscriteria van de resectie ................................................................................................................ 33
Therapie............................................................................................................................................................ 33
Adjuvante therapie ...................................................................................................................................... 33
Neodjuvante therapie.................................................................................................................................. 33
Totale neoadjuvante behandeling (TNT) ..................................................................................................... 34
Chirurgie voor rectum T .................................................................................................................................... 34
Rectum tumor.............................................................................................................................................. 35
TME ......................................................................................................................................................... 35
APRA ............................................................................................................................................................ 36
Exenteratie .................................................................................................................................................. 36
LARS ............................................................................................................................................................. 36
Watch and wait............................................................................................................................................ 37
Uiteindelijke behandeling ............................................................................................................................ 37
Metastasen ....................................................................................................................................................... 38
Palliatief ........................................................................................................................................................... 39
Profylactische chirurgie .................................................................................................................................... 39
Colon pathologie ............................................................................................................................................ 39
1. Colon obstructie ...................................................................................................................................... 39
Oorzaken ..................................................................................................................................................... 39
Kliniek .......................................................................................................................................................... 40
Diagnose ...................................................................................................................................................... 40
Behandeling ................................................................................................................................................. 40
2. Volvulus van het colon ............................................................................................................................ 41
Sigmoïd volvulus .......................................................................................................................................... 41
Caecum volvulus .......................................................................................................................................... 41
Midgut volvulus ........................................................................................................................................... 42
Ogilvie’s syndrome ...................................................................................................................................... 42
3. Endometriose .......................................................................................................................................... 42
Beeldvorming .............................................................................................................................................. 43
Complicaties ................................................................................................................................................ 43
Pathogenese ................................................................................................................................................ 43
4. Chirurgie bij verwikkelde diverticulose ................................................................................................... 44
Prevalentie – pathologie .............................................................................................................................. 44
Kliniek diverticulitis ...................................................................................................................................... 44
Behandeling ................................................................................................................................................. 44
Onverwikkelde ........................................................................................................................................ 44
Indicaties HK ........................................................................................................................................... 44
Peridiverticulair abces ............................................................................................................................ 45
Hichey IV ................................................................................................................................................. 45
2025
Spijsvertering -
Heelkunde
PROF DR D’HOORE
JOZEFIEN CEULEMANS
,Bariatrische en metabole heelkunde ................................................................................................................ 5
Inleiding .............................................................................................................................................................. 5
Prevalentie en incidentie ............................................................................................................................... 5
Type II diabetes.............................................................................................................................................. 5
Indicatie voor HK ........................................................................................................................................... 6
Types chirurgie ................................................................................................................................................... 6
Restrictief ...................................................................................................................................................... 6
Mason gastroplastie ................................................................................................................................. 6
Mc Lean adjustable gastric banding ......................................................................................................... 6
Sleeve gastrectomie .................................................................................................................................. 7
Malabsorptie: scopinaro ................................................................................................................................ 7
Gastric bypass ................................................................................................................................................ 7
Falen van ingreep .......................................................................................................................................... 8
Functioneel falen ...................................................................................................................................... 8
Complicaties .................................................................................................................................................. 8
Marginale ulcus ......................................................................................................................................... 8
Interne herniatie: ...................................................................................................................................... 8
Obstructie na gastric bypass ..................................................................................................................... 8
Dumping syndroom .................................................................................................................................. 9
Deficiënties ............................................................................................................................................... 9
Follow-up ............................................................................................................................................................ 9
Metabole veranderingen .................................................................................................................................... 9
Welke ingreep voor welke patiënt ................................................................................................................ 9
Nieuwe technieken ........................................................................................................................................... 10
Dundarm – Meckel – Appendix ...................................................................................................................... 10
Dunne darm ...................................................................................................................................................... 10
Congenitale aandoeningen .......................................................................................................................... 10
Divertikel van Meckel .................................................................................................................................. 11
Pathologie van de appendix ............................................................................................................................. 12
Anatomie en functie .................................................................................................................................... 12
Acute appendicitis ....................................................................................................................................... 12
Diagnose ...................................................................................................................................................... 12
Kliniek ..................................................................................................................................................... 12
Labo ........................................................................................................................................................ 13
Beeldvorming .......................................................................................................................................... 13
Alvarado score ........................................................................................................................................ 13
Differentieel diagnose ............................................................................................................................ 13
Behandeling ................................................................................................................................................. 14
Postoperatieve verwikkelingen ................................................................................................................... 14
Appendix neoplasie ..................................................................................................................................... 14
Mucineuze epitheliale neoplasie: ........................................................................................................... 14
NET, neuroendocriene tumor ................................................................................................................. 14
Enterobius vermicularies ............................................................................................................................. 14
Aandoeningen van de dunne darm .................................................................................................................. 15
Dundarm divertikels .................................................................................................................................... 15
Hamartomatous polyposis syndromes (AD) ................................................................................................ 15
Dunne darm tumoren .................................................................................................................................. 15
Goedaardige tumoren ............................................................................................................................ 15
, Kwaadaardige tumoren .......................................................................................................................... 15
Pathologie van de abdominale wand ............................................................................................................. 15
Congenitale defecten........................................................................................................................................ 15
Omphalocoele ............................................................................................................................................. 15
Gastroschisis ................................................................................................................................................ 16
Behandeling ............................................................................................................................................ 16
Hernia inguinalis .......................................................................................................................................... 16
Risico inklemming ................................................................................................................................... 17
Cyste van Nuck........................................................................................................................................ 17
Behandeling ............................................................................................................................................ 17
Hernia umbilicalis ........................................................................................................................................ 17
Urachus cyste/fistel vs open ductus ophalomesentericus .......................................................................... 17
Lies en dijbreuken ............................................................................................................................................. 17
Diagnose ................................................................................................................................................. 18
Ingeklemde breuk ........................................................................................................................................ 18
Hernia van richter ................................................................................................................................... 19
Electief herstel ............................................................................................................................................. 19
Bassini repair........................................................................................................................................... 19
Mesh ....................................................................................................................................................... 19
Stoppa repair .......................................................................................................................................... 19
Ambulante chirurgie ............................................................................................................................... 20
Hernia van spiegel ....................................................................................................................................... 20
Andere ......................................................................................................................................................... 20
Postop verwikkelingen na laparotomie ............................................................................................................ 20
Evisceratie.................................................................................................................................................... 20
Intra abdominale hypertensie ..................................................................................................................... 21
Eventratie .................................................................................................................................................... 21
Verwikkelingen buikwand chirurgie ................................................................................................................. 22
Spontaan rectus haematoma ........................................................................................................................... 22
Tumoren van buikwand .................................................................................................................................... 23
Umbilicaal endometrioom ........................................................................................................................... 23
Desmoid tumor ............................................................................................................................................ 23
Sister marie-joseph nodule .......................................................................................................................... 23
Port site metastasen .................................................................................................................................... 23
Infecties van de buikwand ................................................................................................................................ 23
Ischemisch darmlijden.................................................................................................................................... 23
Acute abdomen ................................................................................................................................................ 23
Lig arcuatum syndroom ............................................................................................................................... 24
Mesenterisch vork syndroom (Wilkie syndroom) ....................................................................................... 24
Mesenteriale ischemie ...................................................................................................................................... 24
Verschillende collateralen ...................................................................................................................... 25
Pathofysiologie ............................................................................................................................................ 25
Systemische effecten ................................................................................................................................... 25
Klinische bevindingen .................................................................................................................................. 25
Angor abdominalis .................................................................................................................................. 26
Diagnose chronische ischemie..................................................................................................................... 26
Acute mesenterische ischemie .................................................................................................................... 26
trombose ................................................................................................................................................ 26
Embool .................................................................................................................................................... 27
Veneuze thrombose ................................................................................................................................ 27
, Mesenteriële torsie ..................................................................................................................................... 28
Residuele short bowel ................................................................................................................................. 29
Ischemische colitis ....................................................................................................................................... 29
Klinisch beeld .......................................................................................................................................... 30
Behandeling ............................................................................................................................................ 30
Conclusie........................................................................................................................................................... 30
Colorectale tumoren ...................................................................................................................................... 30
Achtergrond...................................................................................................................................................... 31
Preoperatieve staging: cTNM ........................................................................................................................... 32
Laprascopische chirurgie ............................................................................................................................. 33
Kwaliteitscriteria van de resectie ................................................................................................................ 33
Therapie............................................................................................................................................................ 33
Adjuvante therapie ...................................................................................................................................... 33
Neodjuvante therapie.................................................................................................................................. 33
Totale neoadjuvante behandeling (TNT) ..................................................................................................... 34
Chirurgie voor rectum T .................................................................................................................................... 34
Rectum tumor.............................................................................................................................................. 35
TME ......................................................................................................................................................... 35
APRA ............................................................................................................................................................ 36
Exenteratie .................................................................................................................................................. 36
LARS ............................................................................................................................................................. 36
Watch and wait............................................................................................................................................ 37
Uiteindelijke behandeling ............................................................................................................................ 37
Metastasen ....................................................................................................................................................... 38
Palliatief ........................................................................................................................................................... 39
Profylactische chirurgie .................................................................................................................................... 39
Colon pathologie ............................................................................................................................................ 39
1. Colon obstructie ...................................................................................................................................... 39
Oorzaken ..................................................................................................................................................... 39
Kliniek .......................................................................................................................................................... 40
Diagnose ...................................................................................................................................................... 40
Behandeling ................................................................................................................................................. 40
2. Volvulus van het colon ............................................................................................................................ 41
Sigmoïd volvulus .......................................................................................................................................... 41
Caecum volvulus .......................................................................................................................................... 41
Midgut volvulus ........................................................................................................................................... 42
Ogilvie’s syndrome ...................................................................................................................................... 42
3. Endometriose .......................................................................................................................................... 42
Beeldvorming .............................................................................................................................................. 43
Complicaties ................................................................................................................................................ 43
Pathogenese ................................................................................................................................................ 43
4. Chirurgie bij verwikkelde diverticulose ................................................................................................... 44
Prevalentie – pathologie .............................................................................................................................. 44
Kliniek diverticulitis ...................................................................................................................................... 44
Behandeling ................................................................................................................................................. 44
Onverwikkelde ........................................................................................................................................ 44
Indicaties HK ........................................................................................................................................... 44
Peridiverticulair abces ............................................................................................................................ 45
Hichey IV ................................................................................................................................................. 45
