Postoperative Komplikationen nach Darmresektionen bei Patienten mit Morbus Crohn: Risiko, Behandlung, Prävention

Zusammenfassung

Darmresektionen bei Patienten mit Morbus Crohn gehen mit einer erhöhten postoperativen Morbidität einher. Die Häufigkeit von postoperativen intraabdominellen septischen Komplikationen (Anastomoseninsuffizienz, intraabdominelle Abszesse, Darmfisteln, Peritonitis) liegt bei 5 – 30 %, wobei v. a. der präoperative Gewichtsverlust, langfristig bestehende therapierefraktäre Beschwerden sowie Vorliegen eines perforierenden Krankheitsphänotyps das Komplikationsrisiko erhöhen. Durch eine präoperative Ernährungstherapie, perkutane Abszessdrainagen, Absetzen der Steroide und prophylaktische Antibiotikagaben kann das postoperative Risiko möglicherweise reduziert werden, allerdings ist die Datenlage noch nicht ausreichend. Immunsuppressiva, insbesondere Azathioprin, müssen vor einer Darmresektion nicht abgesetzt werden. Postoperative intraabdominelle septische Komplikationen sind bei Patienten mit terminaler Ileitis langfristig mit weiteren Krankheitskomplikationen und Darmresektionen assoziiert. Die Prognose kann jedoch bei diesen Patienten verbessert werden, wenn die aufgetretenen Komplikationen mittels Schaffung einer Diskontinuitätssituation behandelt werden. Bei Patienten mit Crohn-Colitis führt die postoperative Morbidität nicht zwangsläufig zur Verschlechterung der Gesamtprognose.

Abstract

The postoperative morbidity rate following bowel resections for Crohn’s disease is higher than for other benign disease. The incidence of postoperative intraabdominal septic complications (anastomotic leak, bowel fistula, intraabdominal abscess, peritonitis) is 5 – 30 %. Preoperative weight loss, prolonged refractory symptoms and penetrating disease behaviour are significant determinants of postoperative complication risk. Preoperative enteral nutrition, antibiotics, percutaneous abscess drainage and cessation of steroids might reduce the risk of surgery, however, more evidence is needed. The intake of immunosuppressive agents (mainly, azathioprine) can be continued perioperatively. The occurrence of postoperative intraabdominal septic complications is associated with an increased risk of surgical recurrence in patients with terminal ileitis, however, the long-term prognosis could be improved in the latter patients by secondary fecal diversion. There is no association between postoperative morbidity and long-term outcome in patients with Crohn’s colitis.

Schlüsselwörter

Morbus Crohn - Chirurgie - Outcome

Key words

Crohn’s disease - surgery - outcome

• Literatur

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