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Langzeitergebnisse nach transanaler Rektumwandresektion mittels Stapler bei der obstruktiven Defäkationsstörung

Long-term results of stapled transanal rectal resection in obstructive defecation syndrome

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  • Published:
coloproctology Aims and scope

Zusammenfassung

Fragestellung und Hintergrund

Rektozele und distale Rektumintussuszeption stellen mögliche organische Ursachen der obstruktiven Defäkationsstörung dar und können nach Ausschöpfung konservativer Therapiemaßnahmen operativ korrigiert werden. Als neues Behandlungskonzept wurde die transanale Rektumwandresektion mit dem Stapler (STARR-Operation) eingeführt. In der vorliegenden Studie werden erstmals Langzeitergebnisse dieses Verfahrens vorgestellt.

Patienten und Methodik

Im Zeitraum von Januar 2003 bis Februar 2007 wurde bei 19 Patienten (17 weiblich, 2 männlich, Alter 53±12 Jahre) eine STARR-Operation durchgeführt. Die Operationsindikation bestand in einer ausgeprägten, konservativ ausbehandelten Stuhlentleerungsstörung auf dem Boden einer symptomatischen Rektozele und/oder distalen Intussuszeption.

Ergebnisse

Der mittlere Nachuntersuchungszeitraum aller Patienten betrug 60±17 Monate (35–82 Monate). Der Defäkationsscore (0–20 Punkte) sank von 13,4±3,4 präoperativ auf 3,7±2,7 nach 3 Monaten und stieg bei der letzten Nachuntersuchung leicht auf 4,8±3,6 an. Bei 16 Patienten (84,2%) ließ sich die obstruktive Defäkationsstörung deutlich bessern. Auch im Langzeitverlauf konnten diese positiven Ergebnisse erhalten werden. Über eine leichte Verschlechterung der Kontinenz im Sinne einer Dranginkontinenz berichteten 6 Patienten (31,6%). Betroffen waren hiervon insbesondere Patienten mit präoperativ normaler Kontinenz. Erneute prozedurbezogene anale Eingriffe erfolgten bei 3 Patienten (15,8%)

Schlussfolgerung

Auch im Langzeitverlauf erweist sich die transanale Rektumwandresektion als eine effektive Therapie der obstruktiven Defäkationsstörung. Festzuhalten ist jedoch eine nicht unerhebliche Anzahl von operativen Revisionen und Patienten mit persistierender Dranginkontinenz.

Abstract

Background and Purpose

Rectocele and distal rectal intussusception are potential organic causes of obstructive defecation syndrome and can be corrected surgically once conservative treatment measures have been exhausted. Stapled transanal rectal resection (STARR procedure) was introduced as a new treatment approach. This study presents the first long-term results of this procedure.

Patients and Methods

A STARR procedure was performed in 19 patients (17 female, 2 male, age 53±12 years) between January 2003 and February 2007. The surgical indication was a severe, conservatively treated stool evacuation disorder secondary to symptomatic rectocele and/or distal intussusception.

Results

The mean follow-up period for all patients was 60±17 months (35–82 months). The defecation score (0–20 points) decreased from a preoperative 13.4±3.4 to 3.7±2.7 after 3 months and increased slightly to 4.8±3.6 by the time of the final follow-up examination. In 16 patients (84.2%), the obstructive defecation syndrome was significantly improved. These positive results were maintained also in the long term. Slight worsening of continence in terms of urge incontinence was reported by 6 patients (31.6%). The patients most affected were those with normal continence preoperatively. Procedure-related anal reoperations were required in 3 patients (15.8%)

Conclusion

Even in the long term, transanal rectal wall resection seems to be an effective therapy for obstructive defecation syndrome. However, it is associated with a substantial number of reoperations and of patients with persistent urge incontinence.

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  1. Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Evang. Huyssens Stiftung, Henricistr. 92, 45136, Essen, Deutschland

    A. Ommer, T. Rolfs & M.K. Walz

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Ommer, A., Rolfs, T. & Walz, M. Langzeitergebnisse nach transanaler Rektumwandresektion mittels Stapler bei der obstruktiven Defäkationsstörung. coloproctology 32, 171–179 (2010). https://doi.org/10.1007/s00053-010-0089-4

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