Zusammenfassung
Fragestellung und Hintergrund
Rektumresektionen führen häufig zu veränderten Stuhlgewohnheiten und funktionellen Defiziten. Sind nun neorektale Pouchtechniken geeignet, eine optimale neorektale Funktion zu gewährleisten?
Material und Methode
Eigene klinische Forschungsergebnisse und die Essenz aus Metaanalysen zum Stellenwert von Kolonpouchtechniken werden dargestellt.
Ergebnisse
Alternativ zur einfachen koloanalen End-zu-End-Anastomose stehen im Wesentlichen die drei Kolonpouchvariationen Kolon-J-Pouch, Koloplastie und Seit-zu-End-Anastomose zur Verfügung. In zahlreichen Studien ist die Kolon-J-Pouch-Rekonstruktion am umfangreichsten untersucht, aber auch die Koloplastie und die End-zu-Seit-Anastomose zeigen funktionell günstige Effekte. Entsprechend der aktuellen Evidenzlage ist die Kolon-J-Pouch-Rekonstruktion zu bevorzugen.
Schlussfolgerung
Pouchverfahren zur Verbesserung der neorektalen Funktion haben sich bewährt. Die aktuelle Studienlage favorisiert das J-Pouch-Design zur neorektalen Rekonstruktion.
Abstract
Background and purpose
Rectal resection may impair bowel function. Are colonic pouch formation techniques appropriate to optimize neorectal function?
Patients and methods
The author presents his own results of clinical trials and the recommendations of meta-analyses regarding different colonic pouch designs.
Results
In general three variations of colonic pouch formations (colonic J-pouch, coloplasty, side-to-end anastomosis) are available. In most studies the colonic J-pouch was investigated. Coloplasty and the side-to-end anastomosis show favorable results. According to current scientific evidence the colonic J-pouch should be the preferred technique for neorectal reconstruction.
Conclusion
Colonic pouch operations are reliable techniques to optimize neorectal function. Currently scientific evidence favors the J-pouch design.
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Fürst, A. Kontinuitätswiederherstellung nach tiefer anteriorer Rektumresektion. coloproctology 32, 227–235 (2010). https://doi.org/10.1007/s00053-010-0120-9
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DOI: https://doi.org/10.1007/s00053-010-0120-9