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Transverser Koloplastik-Pouch nach tiefer anteriorer Resektion

Frühpostoperative Ergebnisse

The transverse coloplasty pouch after low anterior resection: early postoperative results

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Zusammenfassung

Einleitung

Als das am weitesten verbreitete Verfahren des Mastdarmreservoirersatzes nach tiefer anteriorer Resektion gilt der Kolon-J-Pouch (CJP), der trotz frühfunktional guter Ergebnisse im Langzeitverlauf zur Entleerungsstörung neigt. Mit dem von uns entwickelten „Transversen Koloplastik-Pouch“ (TCP) konnten ähnlich gute frühfunktionelle Ergebnisse unter Vermeidung der Pouch-Entleerungsstörung erzielt werden.

Methoden

Zwischen dem 01.10.2001 und dem 31.05.2003 wurden insgesamt 201 Patienten mit einem Rektumtumor operiert. Darunter waren 82 Patienten, die einen TCP erhielten.

Ergebnisse

Die Bildung des TCP war technisch immer ohne Probleme möglich. Bei 24/82 Patienten (28%) wurden Komplikationen, darunter 7 Anastomoseninsuffizienzen (8,5%) und 2 Nachblutungen beobachtet. Operative Revisionen erfolgten in 7 Fällen (8,5%).

Schlussfolgerung

Der TCP ist ein sicheres Verfahren, das sich in kurzer Zeit weltweit etabliert hat. Er stellt eine Alternative zum Standard-J-Pouch-Verfahren (CJP) dar.

Abstract

Introduction

A colon J pouch (CJP) still represents the standard rectal reservoir after low anterior resection. Though the CJP shows favourable early functional results, pouch evacuation problems tend to occur in the long term. The transverse coloplasty pouch (TCP), developed by our group allows comparable early functional results while avoiding evacuation problems. We report our experience with the TCP at the University Hospital of Heidelberg, Germany, and examine the risk of anastomotic leaks with this technique.

Methods

Between 1 October 2001 and 31 May 2003, 201 patients with rectal tumours underwent resection. Eighty-two patients with formation of TCP were enrolled in the study.

Results

During the creation of the TCP, no technical problems occurred, and the overall morbidity was 28%, including anastomotic leaks in seven patients (8.5%) and bleeding in two. The reoperation rate was 8.5%. An association between postoperative morbidity and preoperative radiation therapy could not be established. The hospital mortality rate was 3.6%.

Conclusions

The use of TCP is a safe procedure which has gained worldwide acceptance in a short time, representing a technically straightforward procedure. Independently of patient size, habitus, and bulkiness of the colon, a TCP can always be performed after low rectal resection.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Unfallchirurgie, Ruprecht-Karls-Universität Heidelberg

    A. Ulrich, J. Weitz & M. W. Büchler

  2. Klinik für Allgemein- und Viszeralchirurgie, Universität Lausanne, Lausanne, Schweiz

    K. Z’graggen & B. Schmied

  3. Klinik für Allgemein- und Viszeralchirurgie, Universität Lausanne, Rue du Bugnon 46, 1011, Lausanne, Schweiz

    K. Z’graggen

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  1. A. Ulrich
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Ulrich, A., Z’graggen, K., Schmied, B. et al. Transverser Koloplastik-Pouch nach tiefer anteriorer Resektion. Chirurg 75, 430–435 (2004). https://doi.org/10.1007/s00104-003-0807-3

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