Chirurgische Therapieoptionen beim Rektumprolaps - Indikation, Technik und Ergebnisse

Zusammenfassung

Zur chirurgischen Therapie des manifesten Rektumprolaps stehen grundsätzlich zwei verschiedene Zugangswege zur Verfügung, nämlich der transabdominelle und der sog. perineale. Die folgende Arbeit gibt eine Übersicht über beide Verfahren. Bei den abdominellen Operationen werden die ausschließlichen Rektopexietechniken den Ergebnissen der Resektionsrektopexie gegenübergestellt, wobei die laparoskopischen Operationsverfahren besonders berücksichtigt werden. Bei den perinealen Operationen werden insbesondere das Verfahren nach Rehn-Delorme sowie die Rektosigmoidektomie nach Altemeier dargestellt und diskutiert. Generell sind die perinealen Operationen mit weniger Komplikationen behaftet und eignen sich daher auch für betagte Patienten mit einem entsprechenden Risikoprofil. Dem gegenüber steht eine höhere Rezidivrate im Vergleich zu abdominellen Verfahren. Zusammenfassend kann festgestellt werden, dass sowohl perineale als auch abdominelle Operationsverfahren in der chirurgischen Therapie des Rektumprolaps weiterhin einen festen Stellenwert haben und entsprechen individuell indiziert werden müssen.

Abstract

Two different approaches can be distinguished in the surgical treatment of rectal prolapse, i. e. the transabdominal route and the perineal procedures. The following article deals with both operative options with a detailed discussion of the Delorme's operation and the perineal rectosigmoidectomy, also known as the Altemeier procedure for the perineal techniques. Regarding abdominal operations simple rectopexy is compared with operations including bowel resection including minimally invasive approaches. In general, perineal procedures for full-thickness rectal prolapse cause less morbidity compared with abdominal operations. They are especially indicated in the elderly and / or high-risk patients. Recurrences, on the other hand, are usually encountered more often following local techniques as compared with abdominal operations. It can be concluded that perineal as well as abdominal procedures remain important options in the surgical treatment of rectal prolapse and should be part of the armamentarium of colorectal surgeons.

Rektumprolaps - perineale Operationen - transabdominelle Operationen - Übersichtsartikel

rectal prolapse - perineal operations - abdominal operations - review article

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