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 die perinealen Verfahren, wobei insbesondere die Operation nach Rehn-Delorme sowie die perineale Rektosigmoidektomie nach Altemeier detailliert diskutiert werden. Die perinealen Techniken können in Regional- oder Lokalananästhesie und - in geeigneten Fällen - durchaus ambulant durchgeführt werden. Generell sind diese Operationen mit wenig 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. Insbesondere die Operation nach Altemeier erfährt derzeit eine Renaissance, da neuere Studien eine verhältnismäßig geringe Rezidivrate bei ebenso niedriger Komplikationsdichte aufweisen. Zusammenfassend kann festgestellt werden, dass perineale Operationsverfahren zur chirurgischen Therapie des Rektumprolaps weiterhin einen festen Stellenwert in der Viszeralchirurgie haben.
Abstract
Two different approaches can be distinguished in the surgical treatment of rectal prolapse, i. e. the transabdominal route or perineal procedures. The following article deals with perineal procedures with a detailed discussion of the Delorme's operation and the perineal rectosigmoidectomy, also known as the Altemeier procedure. These operations can be performed using regional or local anaesthesia which make them suitable for outpatient procedures in well selected cases. 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 generally encountered more often following local techniques as compared with abdominal operations. Recent studies, however, have shown that the Altemeier operation can be carried out with minimal morbidity and low recurrence rate which explains the renewed interest in this technique. It can be concluded that perineal procedures remain important options in the surgical treatment of rectal rolapse and should be part of the armamentarium of colorectal surgeons.
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