Chirurgische Operationsverfahren zur Therapie der Rektozele

Zusammenfassung

Zur chirurgischen Therapie der Rektozele sind mehrere Verfahren beschrieben: Transvaginale hintere Plastik, perinealer Zugang, transanaler Zugang. Der Verschluss der Rektozele durch die hintere Plastik sollte nur bei ausschließlichem Vorhandensein der Rektozele erfolgen. Bei Intussuszeption des Rektums und Rektozele (ODS) stellt die STARR-Operation das bessere Verfahren dar. Wichtig ist jedoch eine subtile Diagnostik der Rektumentleerungsstörung mit Endoskopie, dynamischem Defäkogramm und, falls möglich, dynamischem MRT. Eine Kolondarstellung zur Diagnostik der Enterozele ist wünschenswert.

Abstract

The surgical treatment for the rectocele offers several methods: transvaginal approach, perineal approach, transanal approach. These methods should be used if the rectocele is the only pathology. In presence of rectocele and rectal intussusception the STARR procedure is the method of choice. It is important to have a subtile preoperative diagnostic done as: dynamic defecatography, dynamic MRI, rigid endoscopy of the rectum, X-ray study of the colon for enterocele.

Schlüsselwörter

Rektozele - STARR-OP - Intussuszeption - ODS

Key words

rectocele - STARR procedure - intussusception - ODS

Literatur

• 1 Longo A. Treatment of hemorrhoid disease by reduction of mucosa and hemorrhoid prolapse with a circular-suturing device: a new procedure. In: Proceedings of the Sixth World Congress of Endoscopic Surgery. Rome 1998; 777-784
• 2 Corman M L, Gravié J-F, Hager T. et al . Stapled haemorrhoidopexy: a consensus position paper by an international working party - indications, contra-indications and technique.  Colorectal Dis. 2003;  5 304-310
• 3 Longo A. Obstructed defecation because of rectal pathologies. Novel surgical treatment: stapled transanal resection (STARR). Annual Cleveland Florida Colorectal Disease Symposium 2004
• 4 Boccasanta P, Venturi M, Salamina G. et al . New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial.  Int J Colorectal Dis. 2004;  19 359-369
• 5 Nystrom P, Hager T, Pigot F. et al .Stapled transanal repair of rectocoel and intussusception with defactory obstruction. Annual Meeting of the American Society of Colon and Rectal Surgeons, Philadelphia 2005
• 6 Block J R. Transrectal repair of rectocele using obliterative suture.  Dis Colon Rectum. 1986;  29 707-711
• 7 Khubchandani I T, Sheets J A, Stasik J J, Hakki A R. Endorectal repair of rectocele.  Dis Colon Rectum. 1983;  26 792-796
• 8 Schapayak S. Transrectal repair of rectocele: an extended armamentarium of colorectal surgeons. A report of 335 cases.  Dis Colon Rectum. 1985;  28 422-433
• 9 Pescatori M, Favetta U, Dedola S, Orsini S. Transanal stapled excision of rectal mucosal prolapse.  Tech Coloproctol. 1997;  1 96-98
• 10 Altomare D F, Rinaldi M, Veglia A, Petrolino M, De Fazio M, Sallustio P L. Combined perineal and endorectal repair of rectocele by circular stapler: a novel surgical technique.  Dis Colon Rectum. 2002;  45 1549-1552
• 11 Boccasanta P, Ventrui M, Calabrò G. et al . Which surgical approach for rectocele? A multicentric report form Italian coloproctologists.  Tech Coloproctol. 2001;  5 147-154
• 12 Lau C W, Heymen S, Alabaz O, Iroatulam A J, Wexner S D. Prognostic significance of rectocele, intussusception, and abnormal perineal descent in biofeedback treatment for constipated patients with paradoxical puborectalis contraction.  Dis Colon Rectum. 2000;  43 478-482
• 13 Mimura T, Roy A J, Storrie J B, Kamm M A. Treatment of impaired defecation associated with rectocele by behavioral retraining (biofeedback).  Dis Colon Rectum. 2000;  43 1267-1272
• 14 Brieger G M, Kordan A R, Houghton C R. Abdominoperineal repair of pulsion rectocele.  J Obstet Gynaecol Res. 1996;  22 151-156
• 15 Gosselink M J, Hop W C, Schouten W R. Rectal compliance in females with obstructed defecation.  Dis Colon Rectum. 2001;  44 971-977