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Transabdominelle Verfahren bei funktionellen Darmerkrankungen

Transabdominal procedures for functional bowel diseases

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Zusammenfassung

Inkontinenz und Obstipation können im Rahmen einer Beckenbodendysfunktion auftreten. Rein morphologische Veränderungen ohne gravierende klinische Beschwerdesymptomatik stellen keine Operationsindikation dar. Bei den transabdominellen Operationsverfahren kann man Operationen mit einer dorsalen Pexie (mit oder ohne Darmresektion, mit oder ohne Netzimplantation) von Verfahren mit einer ventralen Pexie (mit Netz) unterscheiden. In Bezug auf Obstipationssymptomatik und Inkontinenz ist die reine dorsale Nahtrektopexie den anderen Verfahren unterlegen. Dorsale und ventrale Netzrektopexie und Resektionsrektopexie sind in Bezug auf die Verbesserung der Kontinenz gleichwertig. Die ventrale Netzrektopexie ohne dorsale Mobilisierung und die Resektionsrektopexie sind der dorsalen Netzrektopexie in Bezug auf die Verbesserung der Obstipationssymptomatik überlegen. Bei insgesamt schlechter Evidenzlage folgt die Behandlung pragmatischen Gesichtspunkten.

Abstract

Incontinence and constipation can occur in cases of pelvic floor dysfunction. Purely morphological changes without severe clinical symptoms are not an indication for surgery. Abdominal operations can be classified into procedures with dorsal (with or without bowel resection and with or without mesh implantation) and procedures with ventral rectopexy (with mesh). With respect to constipation and incontinence suture rectopexy alone is inferior to all other procedures. Dorsal and ventral mesh rectopexy and resection rectopexy are all comparable with respect to improvement of incontinence. Ventral rectopexy without dorsal mobilization and resection rectopexy are superior to mesh rectopexy with respect to constipation. Due to poor evidential status treatment is carried out from a pragmatic viewpoint.

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  1. Chirurgische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    P. Kienle & K. Horisberger

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  1. P. Kienle
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  2. K. Horisberger
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Correspondence to P. Kienle.

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Kienle, P., Horisberger, K. Transabdominelle Verfahren bei funktionellen Darmerkrankungen. Chirurg 84, 21–29 (2013). https://doi.org/10.1007/s00104-012-2349-z

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