Divertikulitis: OP-Indikation und Zeitpunkt des operativen Eingriffs

Zusammenfassung

Voraussetzung für das Stellen einer Operationsindikation bei der Divertikelkrankheit des Kolons ist die Kenntnis des Spontanverlaufs der Erkrankung in Abhängigkeit des Ausprägungsgrades sowie des Verlaufs nach konservativer und operativer Therapie. Darüber hinaus ist ein prätherapeutisch anwendbares Klassifikationssystem der Divertikelkrankheit für eine stadienabhängige chirurgische Therapie unverzichtbar. Die blande Divertikulose (Stadium 0) und die unkomplizierte Divertikulitis (Stadium I) stellen in der Regel keine OP-Indikation dar. Bei bestimmten Risikogruppen (z. B. immunsupprimierte Patienten) sollte bereits nach dem ersten entzündlichen Schub einer unkomplizierten Divertikulitis operiert werden. Bei Vorliegen einer akuten komplizierten Divertikulitis (Stadium II) ist generell eine OP-Indikation gegeben. In Abhängigkeit von Art der Komplikation und klinischem Bild ist der OP-Zeitpunkt für die akute komplizierte Divertikulitis notfallmäßig oder frühelektiv nach initial konservativer und/oder interventioneller Therapie festzulegen. Die chronisch-rezidivierende Divertikulitis (Stadium III) kann ebenfalls eine OP-Indikation darstellen. Der OP-Zeitpunkt sollte nach individuellen Gesichtspunkten unter Berücksichtigung des Beschwerdebildes und der Komorbidität festgelegt werden. Eine generelle Empfehlung zur elektiven Intervalloperation nach dem zweiten entzündlichen Schub kann nach derzeitigem Kenntnisstand nicht mehr gegeben werden.

Abstract

The indication for surgery in diverticular disease is based on knowledge of the natural history of the disease, its course after conservative and operative therapy and the individual risk factors for complicated diverticular disease. Clinically pragmatic pretreatment staging is thus a prerequisite for stage-adapted therapy. Elective sigmoid colectomy is not indicated for bland diverticulosis or after recovery from acute uncomplicated diverticulitis. However immunosuppressed or immunocompromised patients are more likely to fail medical management. For these patients surgery is recommended after recovery from first attack of uncomplicated diverticulitis. Furthermore surgery is generally indicated for acute complicated diverticulitis. Decisive in establishing the indication for surgery is therefore the precise pretherapeutic differentiation of complicated and uncomplicated diverticulitis. Depending on the type of complication and the clinical appearance, the time for surgery of acute complicated diverticulitis is fixed on an emergency or early elective basis following initial conservative and/or interventional therapy. Chronically recurrent diverticulitis may be likewise an indication for elective sigmoid colectomy. The decision to recommend surgery should be influenced by the age and medical condition of the patient as well as by the frequency and serverity of the attacks. The number of attacks of uncomplicated diverticulitis is not necessarily a factor in defining the indication for surgery.

Schlüsselwörter

OP-Indikation bei Kolondivertikelkrankheit - OP-Zeitpunkt bei Kolondivertikelkrankheit - unkomplizierte Divertikulitis - komplizierte Divertikulitis - chronisch rezidivierende Divertikulitis

Key words

indication for surgery of colonic diverticular disease - time for surgery of colonic diverticular disease - uncomplicated diverticulitis - complicated diverticulitis - chronically recurrent diverticulitis

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