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Alloplastisches Material in der Prolapschirurgie

Indikation und postoperatives Outcome der ventralen Rektopexie

Alloplastic material in prolapse surgery

Indications and postoperative outcome of ventral rectopexy

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Abstract

Hintergrund

Der Einsatz von Netzen gibt der Rektopexie durch mechanische Unterstützung sowie durch Induktion der Narbenbildung Stabilität. Ein Problem der herkömmlichen Rektopexieverfahren ist allerdings, dass viele Patienten postoperativ unter funktionellen Störungen wie Inkontinenz und v. a. Stuhlentleerungsstörungen leiden. Ursache ist die zur Netzeinlage erforderliche dorsale und laterale Mobilisation des Rektums, bei der die vegetativen Nerven häufig geschädigt werden. D´Hoore und Penninckx beschrieben im Jahr 2004 eine neue Technik der abdominellen Rektopexie mit Operation des Rektumprolapses unter Schonung der autonomen Nerven – die ventrale Rektopexie.

Fragestellung

Bietet die ventrale Rektopexie Vorteile bezüglich des funktionellen Outcomes, der Komplikations- und Rezidivrate?

Material und Methode

Darstellung und Auswertung der aktuellen Studienlage zur ventralen Rektopexie durch Recherche in medizinischen Datenbanken (PubMED, Medline).

Ergebnisse

Die ventrale Rektopexie zeichnet sich durch eine geringe Komplikationsrate und gute funktionelle Ergebnisse in Bezug auf die Verbesserung der Inkontinenz und Obstipationsneigung bzw. Stuhlentleerungsstörung auf. Als Indikation gilt der äußere Rektumprolaps. Aber auch der innere Rektumprolaps, die große Rektozele sowie die Enterozele mit konsekutivem obstruktivem Defäkationssyndrom stellen bei einem ausgewählten Patientenkollektiv relative Indikationen für die ventrale Rektopexie dar.

Schlussfolgerung

Um eine valide Einschätzung bezüglich der Wertigkeit des Verfahrens zu geben, ist es entscheidend, die derzeit fehlende Evidenz (Level 3), in Zukunft insbesondere durch prospektiv randomisierte Studien, die die ventrale Rektopexie mit anderen Operationsmethoden und auch mit nichtchirurgischen Behandlungsmethoden vergleichen, zu verbessern.

Abstract

Background

In rectopexy the use of meshes provides stability by mechanical support as well as by the induction of scar formation; however, one of the problems of conventional methods of mesh rectopexy is that many patients postoperatively suffer from functional disorders, such as fecal incontinence and stool evacuation disorders. One reason is the damage of vegetative nerves following dorsal and lateral mobilization of the rectum, which is required for positioning of the mesh. In 2004 D’Hoore and Penninckx first described the method of ventral rectopexy, a new technique of mesh rectopexy which allows preservation of the autonomic nerves.

Objective

Does ventral rectopexy provide advantages regarding functional outcome, complications and recurrence rates?

Material and methods

A search was carried out in the databases PubMed and Medline for studies on ventral rectoplexy. Presentation and analysis of the current state of relevant studies relating to ventral rectopexy.

Results

Ventral rectopexy is characterized by a low complication rate and good functional results in terms of improvement of incontinence, constipation and stool evacuation disorders. The indications for ventral rectopexy are considered in patients with external prolapse of the rectum. Also in a well-selected patient population internal prolapse, rectocele as well as enterocele accompanied by obstructive defecation syndrome represent relative indications for ventral rectopexy.

Conclusion

In order to obtain a valid assessment of the value of this procedure it is crucial to improve the current lack of evidence (level 3) by prospective randomized studies that compare ventral rectopexy with other surgical techniques and nonsurgical treatment options.

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Authors and Affiliations

  1. Abteilung für Chirurgie, Katharinen-Hospital, Obere Husemannstr. 2, 59423, Unna, Deutschland

    S. Kersting

  2. Abteilung für Koloproktologie, Prosper-Hospital, Recklinghausen, 45659, Deutschland

    K.-P. Jung & E. Berg

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Correspondence to S. Kersting.

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S. Kersting, K.-P. Jung und E. Berg geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Kersting, S., Jung, KP. & Berg, E. Alloplastisches Material in der Prolapschirurgie. Chirurg 88, 141–146 (2017). https://doi.org/10.1007/s00104-016-0264-4

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