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Anorektale Funktionsdiagnostik

Therapiealgorithmus bei Obstruktion und Inkontinenz

Anorectal functional diagnostics

Therapy algorithm for obstruction and incontinence

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Zusammenfassung

Die chirurgische Therapie der Beckenbodeninsuffizienz fokussiert sich im Wesentlichen auf zwei funktionelle Störungen, die Darmobstruktion und die Stuhlinkontinenz. Der Stellenwert der chirurgischen Therapie ist hier insbesondere nach Nichtansprechen der konservativen Möglichkeiten zu sehen. Die Differenzialindikation der operativen Verfahren basiert auf einer präzisen präoperativen Evaluation. Das Ausmaß der funktionellen Beeinträchtigung wird anhand einer ausführlichen Anamnese unter Verwendung krankheitsspezifischer Fragebögen bestimmt, gefolgt von einer klinisch-proktologischen Untersuchung mit digital-rektaler Untersuchung und starrer Prokto-/Rektoskopie. Bildgebende Verfahren (anorektale Endosonographie, dynamische Defäkographie) erfolgen ergänzend zur Visualisierung morphologischer, funktionell wirksamer Pathologien. Die Schwere der Beeinträchtigung und Ausprägung der morphologischen Pathologie bilden die Grundlage eines therapeutischen Algorithmus bei zunehmend differenzierten Operationsverfahren. Ziel dieser Übersicht ist die Darstellung der differenzierten Diagnostik bei Obstruktion und Stuhlinkontinenz für eine exakte Patientenselektion zur zielgerichteten Therapie.

Abstract

The surgical therapy of pelvic floor insufficiency is mainly focused on two functional disorders, outlet obstruction and fecal incontinence. Surgery becomes of special significance after ineffectiveness of conservative treatment options. The indications for surgical interventions should be based on a precise preoperative evaluation. The dimension of functional impairment will be primarily assessed by an accurate anamnesis, application of disease-specific scoring systems and the clinical proctological basic examination that includes digital rectal examination and proctoscopy/rectoscopy. Imaging procedures (anorectal endosonography and dynamic defecography) are carried out as adjuncts and contribute to a visualization of morphological changes. Severity and manifestation of morphological symptoms are essential for the therapeutic algorithm due to increasingly differentiated surgical strategies. Only a thorough diagnostic investigation and patient selection enable a targeted therapy of obstruction and fecal incontinence.

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Literatur

  1. Agachan F, Chen T, Pfeifer J et al (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685

    Article  PubMed  CAS  Google Scholar 

  2. Altomare DF, Spazzafumo L, Rinaldi M et al (2008) Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis 10:84–88

    PubMed  CAS  Google Scholar 

  3. Azpiroz F, Enck P, Whitehead WE (2002) Anorectal functional testing: review of collective experience. Am J Gastroenterol 97:232–240

    PubMed  Google Scholar 

  4. Barisic GI, Krivokapic ZV, Markovic VA, Popovic MA (2006) Outcome of overlapping anal sphincter repair after 3 months and after a mean of 80 months. Int J Colorectal Dis 21:52–56

    Article  PubMed  Google Scholar 

  5. Bordeianou L, Savitt L, Dursun A (2011) Measurements of pelvic floor dyssynergia: which test result matters? Dis Colon Rectum 54:60–65

    Article  PubMed  Google Scholar 

  6. Boenicke L, Kim M, Reibetanz J et al (2012) Stapled transanal rectal resection and sacral nerve stimulation –impact on faecal incontinence and quality of life. Colorectal Dis 14:480–489

    Article  PubMed  CAS  Google Scholar 

  7. Boenicke L, Jayne DG, Kim M et al (2011) What happens in stapled transanal rectum resection? Dis Colon Rectum 54:593–600

    Article  PubMed  Google Scholar 

  8. Boenicke L, Reibetanz J, Kim M et al (2012) Predictive factors for postoperative constipation and continence after stapled transanal rectal resection. Br J Surg 99:416–422

    Article  PubMed  CAS  Google Scholar 

  9. Bravo Gutierrez A, Madoff RD, Lowry AC et al (2004) Long-term results of anterior sphincteroplasty. Dis Colon Rectum 47:727–731

    Article  Google Scholar 

  10. Brouwer R, Duthie G (2010) Sacral nerve neuromodulation is effective treatment for fecal incontinence in the presence of a sphincter defect, pudendal neuropathy, or previous sphincter repair. Dis Colon Rectum 53:273–278

    Article  PubMed  Google Scholar 

  11. Camilleri M, Kerstens R, Rykx A, Vandeplassche L (2008) A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med 358:2344–2354

    Article  PubMed  CAS  Google Scholar 

  12. Chiarioni G, Salandini L, Whitehead WE (2005) Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology 129:86–97

    Article  PubMed  Google Scholar 

  13. Christensen P, Bazzocchi G, Coggrave M et al (2006) A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients. Gastroenterology 131:738–747

    Article  PubMed  Google Scholar 

  14. Christensen P, Krogh K, Buntzen S et al (2009) Long-term outcome and safety of transanal irrigation for constipation and fecal incontinence. Dis Colon Rectum 52:286–292

    Article  PubMed  Google Scholar 

  15. Corman ML, Carriero A, Hager T et al (2006) Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation. Colorectal Dis 8:98–101

    Article  PubMed  CAS  Google Scholar 

  16. Emmanuel AV, Roy AJ, Nicholls TJ, Kamm MA (2002) Prucalopride, a systemic enterokinetic, for the treatment of constipation. Aliment Pharmacol Ther 16:1347–1356

    Article  PubMed  CAS  Google Scholar 

  17. Heymen S, Scarlett Y, Jones K et al (2007) Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum 50:428–441

    Article  PubMed  Google Scholar 

  18. Isbert C, Kim M, Reibetanz J, Germer CT (2012) Stapled transanal resection for the treatment of obstructed defaecation syndrome. Zentralbl Chir 137:364–370

    Article  PubMed  CAS  Google Scholar 

  19. Isbert C, Reibetanz J, Jayne DG et al (2010) Comparative study of Contour Transtar and STARR procedure for the treatment of obstructed defecation syndrome (ODS) – feasibility, morbidity and early functional results. Colorectal Dis 12:901–908

    Article  PubMed  CAS  Google Scholar 

  20. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  PubMed  CAS  Google Scholar 

  21. Kamm MA, Dudding TC, Melenhorst J et al (2010) Sacral nerve stimulation for intractable constipation. Gut 59:333–340

    Article  PubMed  Google Scholar 

  22. Koch SM, Melenhorst J, Gemert WG van, Baeten CG (2008) Prospective study of colonic irrigation for the treatment of defaecation disorders. Br J Surg 95:1273–1279

    Article  PubMed  CAS  Google Scholar 

  23. Lehur PA, Stuto A, Fantoli M et al (2008) Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial. Dis Colon Rectum 51:1611–1618

    Article  PubMed  Google Scholar 

  24. Lembo A, Camilleri M (2003) Chronic constipation. N Engl J Med 349:1360–1368

    Article  PubMed  CAS  Google Scholar 

  25. Longo A III (2006) German-Italian Meeting of Coloproctologists, Rome

  26. Leroi AM, Parc Y, Lehur PA et al (2005) Study Group. Efficacy of sacral nerve stimulation for fecal incontinence. Ann Surg 242:662–669

    Article  PubMed  Google Scholar 

  27. Norton C, Cody JD (2012) Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev 7:CD002111

    PubMed  Google Scholar 

  28. Rao SS, Seaton K, Miller M et al (2007) Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol 5:331–338

    Article  PubMed  Google Scholar 

  29. Ratto C, Litta F, Parello A et al (2010) Sacral nerve stimulation is a valid approach in fecal incontinence due to sphincter lesions when compared to sphincter repair. Dis Colon Rectum 53:264–272

    Article  PubMed  Google Scholar 

  30. Reibetanz J, Boenicke L, Kim M et al (2011) Enterocele is not a contraindication to stapled transanal surgery for outlet obstruction: an analysis of 170 patients. Colorectal Dis 13:e131–136

    Article  PubMed  CAS  Google Scholar 

  31. Thekkinkattil DK, Lim M, Stojkovic SG et al (2008) A classification system for faecal incontinence based on anorectal investigations. Br J Surg 95:222–228

    Article  PubMed  CAS  Google Scholar 

  32. Tjandra JJ, Chan MK, Yeh CH, Murray-Green C (2008) Sacral nerve stimulation is more effective than optimal medical therapy for severe fecal incontinence: a randomized, controlled study. Dis Colon Rectum 51:494–502

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    M. Kim & C. Isbert

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  1. M. Kim
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  2. C. Isbert
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Correspondence to M. Kim.

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Kim, M., Isbert, C. Anorektale Funktionsdiagnostik. Chirurg 84, 7–14 (2013). https://doi.org/10.1007/s00104-012-2347-1

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  • DOI: https://doi.org/10.1007/s00104-012-2347-1

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