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Transanale Verfahren bei funktionellen Darmerkrankungen

Transanal procedure for functional bowel diseases

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Zusammenfassung

Die transanalen Operationsverfahren werden sekundär nach Ineffektivität oder Versagen der konservativen Therapie bei funktionellen Darmerkrankungen wie dem obstruktiven Defäkationssyndrom (ODS) eingesetzt. Als etablierte transanale Verfahren kommen zum Einsatz die transanale Rektozelenresektion (RR), die transanale Mukosaresektion beim inneren Rektumprolaps nach Rehn-Delorme (MR) und die transanale Staplerresektion des Rektums (STARR). Die Datenlage ist sowohl für die RR als auch die MR spärlich und von geringer Evidenz. Generell erweisen sich die Verfahren als wirksam in Bezug auf obstruktive Beschwerden wie die unvollständige und erschwerte Stuhlentleerung und die Digitation. Die STARR-Operation dagegen ist durch zahlreiche z. T. prospektiv-randomisierte Studien in ihrer Wirksamkeit zur Behandlung des ODS belegt. Die funktionellen Resultate in Bezug auf eine Verbesserung der Konstipation nach einem Jahr und im Langzeitverlauf (bis 68 Monate) zeigen ein Ansprechen von bis zu 90% bei einer Rezidivrate von 5–18%. Zusammenfassend stellt die STARR-Operation ein gut evaluiertes operatives Verfahren zur Behandlung eines konservativ refraktären ODS dar mit einer hohen primären Ansprechrate, einer akzeptablen Morbidität und nach ersten Analysen offenbar mit einem stabilen Langzeiteffekt.

Abstract

The transanal operative procedure for the treatment of obstructive defecation syndrome (ODS) can be secondarily applied in cases of failure or ineffectiveness of conservative treatment. Clinically established transanal procedures are rectocele resection (RR), mucosectomy for internal rectal prolapse according to the Rehn-Delorme procedure (MR) and stapled transanal rectal resection (STARR Contour Transtar). Only few studies have indicated the value of RR and MR in the treatment of obstructive diseases and in general study quality and evidence level are low. There might be an indication in rectocele-associated symptoms, such as incomplete evacuation, straining and digitation. In contrast the STARR procedure has been well characterized by a large number of high quality studies providing an elevated evidence level for the treatment of ODS. Functional results are available with a follow-up of 1 year up to 68 months postoperatively. Response rates of up to 90% were reported whereas recurrence rates were given as a maximum of 18% at 68 months follow-up. In summary the STARR procedure provides good functional results for conservative refractory outlet obstruction with minor morbidity and outcome seems to remain stable in the long-term follow-up.

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  1. Klinik & Poliklinik für Allgemein- und Viszeralchirurgie, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Zentrum Operative Medizin (ZOM), Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    C. Isbert & C.-T. Germer

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  1. C. Isbert
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  2. C.-T. Germer
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Correspondence to C. Isbert.

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Isbert, C., Germer, CT. Transanale Verfahren bei funktionellen Darmerkrankungen. Chirurg 84, 30–38 (2013). https://doi.org/10.1007/s00104-012-2350-6

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