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Kontinuitätswiederherstellung nach tiefer anteriorer Rektumresektion

Neorektale Rekonstruktion durch J-Pouch, Koloplastie, Seit-zu-End- oder End-zu-End-Anastomose

Restoration of intestinal continuity after low anterior resection of the rectum

Neorectal reconstruction with J-pouch, coloplasty, side-to-end or end-to-end anastomosis

  • Originalarbeit
  • Published:
coloproctology Aims and scope

Zusammenfassung

Fragestellung und Hintergrund

Rektumresektionen führen häufig zu veränderten Stuhlgewohnheiten und funktionellen Defiziten. Sind nun neorektale Pouchtechniken geeignet, eine optimale neorektale Funktion zu gewährleisten?

Material und Methode

Eigene klinische Forschungsergebnisse und die Essenz aus Metaanalysen zum Stellenwert von Kolonpouchtechniken werden dargestellt.

Ergebnisse

Alternativ zur einfachen koloanalen End-zu-End-Anastomose stehen im Wesentlichen die drei Kolonpouchvariationen Kolon-J-Pouch, Koloplastie und Seit-zu-End-Anastomose zur Verfügung. In zahlreichen Studien ist die Kolon-J-Pouch-Rekonstruktion am umfangreichsten untersucht, aber auch die Koloplastie und die End-zu-Seit-Anastomose zeigen funktionell günstige Effekte. Entsprechend der aktuellen Evidenzlage ist die Kolon-J-Pouch-Rekonstruktion zu bevorzugen.

Schlussfolgerung

Pouchverfahren zur Verbesserung der neorektalen Funktion haben sich bewährt. Die aktuelle Studienlage favorisiert das J-Pouch-Design zur neorektalen Rekonstruktion.

Abstract

Background and purpose

Rectal resection may impair bowel function. Are colonic pouch formation techniques appropriate to optimize neorectal function?

Patients and methods

The author presents his own results of clinical trials and the recommendations of meta-analyses regarding different colonic pouch designs.

Results

In general three variations of colonic pouch formations (colonic J-pouch, coloplasty, side-to-end anastomosis) are available. In most studies the colonic J-pouch was investigated. Coloplasty and the side-to-end anastomosis show favorable results. According to current scientific evidence the colonic J-pouch should be the preferred technique for neorectal reconstruction.

Conclusion

Colonic pouch operations are reliable techniques to optimize neorectal function. Currently scientific evidence favors the J-pouch design.

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  1. Klinik für Chirurgie, Caritas-Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Deutschland

    A. Fürst

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Fürst, A. Kontinuitätswiederherstellung nach tiefer anteriorer Rektumresektion. coloproctology 32, 227–235 (2010). https://doi.org/10.1007/s00053-010-0120-9

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  • DOI: https://doi.org/10.1007/s00053-010-0120-9

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