Skip to main content

Advertisement

SpringerLink
Log in

Restaurative Proktokolektomie bei Colitis ulcerosa

Funktionelle Langzeitergebnisse und Lebensqualität

Restorative proctocolectomy for ulcerative colitis

Long-term functional results and quality of life

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Die restaurative Proktokolektomie mit ileoanaler Pouchanlage ist die chirurgische Standardtherapie der Colitis ulcerosa. Sie erlaubt neben der kompletten Entfernung des befallenen Kolorektums den Erhalt der Kontinenz und den Verzicht auf ein definitives Ileostoma. Funktionelle Ergebnisse und Aspekte der Lebensqualität sind bei diesem Eingriff von großer Bedeutung. Patienten haben nach einer restaurativen Proktokolektomie in der Regel eine Stuhlfrequenz von ca. 5–6/24 h, und die Kontinenzleistung ist bei über 90 % zufriedenstellend. Eine gute Pouchfunktion korreliert eng mit einer hohen Lebensqualität. Postoperative septische Komplikationen stellen das größte Risiko für eine schlechte Pouchfunktion bis hin zum Pouchverlust dar, deshalb wird die ileoanale Pouchanlage heute auch in den meisten Fällen unter Schutz eines protektiven Ileostomas durchgeführt. Die restaurative Proktokolektomie kann die präoperativ durch die Kolitisaktivität deutlich eingeschränkte Lebensqualität erheblich verbessern und auf das Niveau gesunder Vergleichspopulationen anheben. Damit steht mit der restaurativen Proktokolektomie ein chirurgisches Verfahren zur Verfügung, das exzellente Ergebnisse bezüglich Funktion und Lebensqualität bieten kann.

Abstract

Restorative proctocolectomy with ileo-pouch-anal anastomosis is the standard procedure for ulcerative colitis. It provides complete removal of the diseased colorectum, avoids permanent ileostomy and allows the preservation of continence. Functional results and quality of life after restorative proctocolectomy are of great importance. Patients usually have 5–6 bowel movements per day, and continence is satisfactory in more than 90% of patients. A good pouch function strongly correlates with high quality of life. Postoperative septic complications are the main risk factor for bad pouch function and pouch failure; therefore nowadays most procedures are performed with a covering ileostomy. Quality of life is usually impaired by active ulcerative colitis, and restorative proctocolectomy improves the quality of life up to the level of a healthy reference population. Taken together, restorative proctocolectomy provides excellent results concerning function and quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Andersson P, Norblad R, Söderholm JD et al (2014) Ileorectal anastomosis in comparison with ileal pouch anal anastomosis in reconstructive surgery for ulcerative colitis – a single institution experience. J Crohns Colitis 8:582–589

    Article  PubMed  Google Scholar 

  2. Bartels SA, Gardenbroek TJ, Aarts M et al (2015) Short-term morbidity and quality of life from a randomized clinical trial of close rectal dissection and total mesorectal excision in ileal pouch-anal anastomosis. Br J Surg 102:281–287

    Article  CAS  PubMed  Google Scholar 

  3. Berndtsson I, Lindholm E, Oresland T et al (2007) Long-term outcome after ileal pouch-anal anastomosis: function and health-related quality of life. Dis Colon Rectum 50:1545–1552

    Article  PubMed  Google Scholar 

  4. Brandsborg S, Nicholls RJ, Mortensen LS et al (2013) Restorative proctocolectomy for ulcerative colitis: development and validation of a new scoring system for pouch dysfunction and quality of life. Colorectal Dis 15:719–725

    Article  Google Scholar 

  5. de Buck van Overstraeten A, Wolthuis AM, Vermeire S et al (2014) Long-term functional outcome after ileal pouch anal anastomosis in 191 patients with ulcerative colitis. J Crohns Colitis 8:1261–1126

    Article  PubMed  Google Scholar 

  6. Carmon E, Keidar A, Ravid A et al (2003) The correlation between quality of life and functional outcome in ulcerative colitis patients after proctocolectomy ileal pouch anal anastomosis. Colorectal Dis 5:228–232

    Article  CAS  PubMed  Google Scholar 

  7. Cornish JA, Tan E, Teare J et al (2007) The effect of restorative proctocolectomy on sexual function, urinary function, fertility, pregnancy and delivery: a systematic review. Dis Colon Rectum 50:1128–1138

    Article  PubMed  Google Scholar 

  8. Davies RJ, O’Connor BI, Victor C et al (2008) A prospective evaluation of sexual function and quality of life after ileal pouch-anal anastomosis. Dis Colon Rectum 51:1032–1035

    Article  PubMed  Google Scholar 

  9. Delaney CP, Fazio VW, Remzi FH et al (2003) Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg 238:221–228

    PubMed  PubMed Central  Google Scholar 

  10. Dignass A, Preiss JC, Aust DE et al (2011) Aktualisierte Leitlinie zur Diagnostik und Therapie der Colitis ulcerosa 2011 – Ergebnisse einer Evidenzbasierten Konsensuskonferenz. Z Gastroenterol 49:1276–1341

    Article  CAS  PubMed  Google Scholar 

  11. Eypasch E, Williams JI, Wood-Dauphinee S et al (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–222

    Article  CAS  PubMed  Google Scholar 

  12. Fazio VW, O’Riordain MG, Lavery IC et al (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230:575–586

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Fazio VW, Kiran RP, Remzi FH et al (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257:679–685

    Article  PubMed  Google Scholar 

  14. van Gennep S, Sahami S, Buskens CJ et al (2017) Comparison of health-related quality of life and disability in ulcerative colitis patients following restorative proctocolectomy with ileal pouch-anal anastomosis versus anti-tumor necrosis factor therapy. Eur J Gastroenterol Hepatol 29:338–344

    Article  PubMed  Google Scholar 

  15. Hahnloser D, Pemberton JH, Wolff BG et al (2004) Pregnancy and delivery before and after ileal pouch-anal anastomosis for inflammatory bowel disease: immediate and long-term consequences and outcomes. Dis Colon Rectum 47:1127–1135

    Article  PubMed  Google Scholar 

  16. Hahnloser D, Pemberton JH, Wolff BG et al (2007) Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Br J Surg 94:333–340

    Article  CAS  PubMed  Google Scholar 

  17. Heuschen UA, Heuschen G, Rudek B et al (1998) Lebensqualität im Langzeitverlauf nach kontinenzerhaltender Proktocolektomie wegen Colitis ulcerosa und familiärer adenomatöser Polyposis. Chirurg 69:1052–1058

    Article  CAS  PubMed  Google Scholar 

  18. Hoda KM, Collins JF, Knigge KL et al (2008) Predictors of pouchitis after ileal pouch-anal anastomosis: a retrospective review. Dis Colon Rectum 51:554–560

    Article  PubMed  Google Scholar 

  19. Köhler LW, Pemberton JH, Zinsmeister AR et al (1991) Quality of life after proctocolectomy. A comparison of Brooke ileostomy, Kock pouch, and ileal pouch-anal anastomosis. Gastroenterology 101:679–684

    Article  PubMed  Google Scholar 

  20. Kuruvilla K, Osler T, Hyman NH (2012) A comparison of the quality of life of ulcerative colitis patients after IPAA vs ileostomy. Dis Colon Rectum 55:1131–1137

    Article  PubMed  Google Scholar 

  21. Larson DW, Davies MM, Dozois EJ et al (2008) Sexual function, body image, and quality of life after laparoscopic and open ileal pouch-anal anastomosis. Dis Colon Rectum 51:392–396

    Article  PubMed  Google Scholar 

  22. Leowardi C, Hinz U, Tariverdian M et al (2010) Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis. Langenbecks Arch Surg 395:49–56

    Article  PubMed  Google Scholar 

  23. Lichtenstein GR, Cohen R, Yamashita B, Diamond RH et al (2006) Quality of life after proctocolectomy with ileoanal anastomosis for patients with ulcerative colitis. J Clin Gastroenterol 40:669–677

    Article  PubMed  Google Scholar 

  24. Lorenzo G, Maurizio C, Maria LP et al (2016) Ileal pouch-anal anastomosis 20 years later: is it still a good surgical option for patients with ulcerative colitis? Int J Colorectal Dis 31:1835–1843

    Article  PubMed  Google Scholar 

  25. Lovegrove RE, Constantinides VA, Heriot AG et al (2006) A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients. Ann Surg 244:18–26

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lovegrove RE, Heriot AG, Constantinides V et al (2007) Meta-analysis of short-term and long-term outcomes of J, W and S ileal reservoirs for restorative proctocolectomy. Colorectal Dis 9:310–320

    Article  CAS  PubMed  Google Scholar 

  27. Lovegrove RE, Fazio VW, Remzi FH et al (2010) Development of a pouch functional score following restorative proctocolectomy. Br J Surg 97:945–951

    Article  CAS  PubMed  Google Scholar 

  28. da Luz Moreira A, Kiran RP, Lavery I (2010) Clinical outcomes of ileorectal anastomosis for ulcerative colitis. Br J Surg 97:65–69

    Article  PubMed  Google Scholar 

  29. Meijs S, Gardenbroek TJ, Sprangers MA et al (2014) Health-related quality of life and disability in patients with ulcerative colitis and proctocolectomy with ileoanal pouch versus treatment with anti-TNF agents. J Crohns Colitis 8:686–692

    Article  PubMed  Google Scholar 

  30. Mennigen R, Senninger N, Bruewer M et al (2012) Pouch function and quality of life after successful management of pouch-related septic complications in patients with ulcerative colitis. Langenbecks Arch Surg 397:37–44

    Article  PubMed  Google Scholar 

  31. Michelassi F, Lee J, Rubin M et al (2003) Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis: a prospective observational study. Ann Surg 238:433–441

    PubMed  PubMed Central  Google Scholar 

  32. Murphy PB, Khot Z, Vogt KN et al (2015) Quality of life after total Proctocolectomy with Ileostomy or IPAA: a systematic review. Dis Colon Rectum 58:899–908

    Article  PubMed  Google Scholar 

  33. Neumann PA, Mennigen RB, Senninger N et al (2012) Timing of restorative proctocolectomy in patients with medically refractory ulcerative colitis: the patient’s point of view. Dis Colon Rectum 55:756–761

    Article  PubMed  Google Scholar 

  34. Oresland T, Fasth S, Nordgren S et al (1989) The clinical and functional outcome after restorative proctocolectomy. A prospective study in 100 patients. Int J Colorectal Dis 4:50–56

    Article  CAS  PubMed  Google Scholar 

  35. Pemberton JH, Phillips SF, Ready RR et al (1989) Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis. Comparison of performance status. Ann Surg 209:620–626

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Robb B, Pritts T, Gang G et al (2002) Quality of life in patients undergoing ileal pouch-anal anastomosis at the University of Cincinnati. Am J Surg 183:353–360

    Article  PubMed  Google Scholar 

  37. Tariverdian M, Leowardi C, Hinz U et al (2007) Quality of life after restorative proctocolectomy for ulcerative colitis: preoperative status and long-term results. Inflamm Bowel Dis 13:1228–1235

    Article  PubMed  Google Scholar 

  38. Weston-Petrides GK, Lovegrove RE, Tilney HS et al (2008) Comparison of outcomes after restorative proctocolectomy with or without defunctioning ileostomy. Arch Surg 143:406–412

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland

    E. Rijcken, N. Senninger & R. Mennigen

Authors
  1. E. Rijcken
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Senninger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Mennigen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Rijcken.

Ethics declarations

Interessenkonflikt

E. Rijcken, N. Senninger und R. Mennigen geben an, dass kein Interessenkonflikt besteht.

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rijcken, E., Senninger, N. & Mennigen, R. Restaurative Proktokolektomie bei Colitis ulcerosa. Chirurg 88, 566–573 (2017). https://doi.org/10.1007/s00104-017-0441-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-017-0441-0

Schlüsselwörter

Keywords

Search

Navigation