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Komplikationen und Revisionsoperationen nach ileopouchanaler Rekonstruktion?

Complications and corrective surgery after ileal pouch-anal reconstruction?

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Zusammenfassung

Die Proktokolektomie mit ileo-J-pouchanaler/-rektaler Rekonstruktion ist die chirurgische Standardtherapie der Colitis ulcerosa, ausgewählter Fälle von Morbus Crohn, familiärer adenomatöser Polyposis (FAP) und des multilokulären Kolonkarzinoms. Obwohl sich diese Therapie in den letzten 40 Jahren immer weiterentwickelt hat, liegt die Erfolgsrate im Langzeitverlauf bei 80–90 % der behandelten Patienten. Die Gründe hierfür sind mannigfaltig: chronische Pouchitis, Inkontinenz, sekundäre Diagnose eines Morbus Crohn, Fisteln, schwere chirurgische Komplikationen, zu lang belassener Rektumstumpf, Fisteln, chronischer Abszess und chirurgisch technische Fehler. Diese Arbeit beschäftigt sich zum einen mit der Beherrschung der Akutkomplikationen und zum anderen mit dem Management der Langzeitkomplikationen. Einige der auslösenden Komplikationen für ein Pouchversagen bedeuten nicht generell das Versagen der Methode. Eine Korrektur, Fistelverschluss und in Einzelfällen auch eine komplette Pouchneuanlage können in ca. 75 % aller Fälle eine gute Pouchfunktion wiederherstellen. Verschiedene Indikationen, Techniken und Ergebnisse werden dargestellt.

Abstract

Proctocolectomy with ileal J‑pouch-anal and rectal reconstruction is the standard surgical treatment for ulcerative colitis, selected cases of Crohn’s disease, FAP and multilocular colon carcinoma. Although this treatment has been continuously developed over the last 40 years, the long-term success rate is 80–90% of the treated patients. The reasons for this are manifold: chronic pouchitis, incontinence, secondary diagnosis of Crohn’s disease, fistulas, severe surgical complications, rectal stump left for too long, chronic abscess and surgical technical errors. This article deals with the control of acute complications and with the management of long-term complications. Some of the triggering complications for pouch failure do not generally imply failure of the method. A correction, closure of the fistula and in individual cases also a completely new pouch creation can restore a good pouch function in about 75% of cases. Various indications, techniques and results are presented.

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  1. Allgemein‑, Viszeral‑, Tumor- und koloproktologische Chirurgie, Krankenhaus Porz am Rhein, Urbacher Weg 19, 51149, Köln, Deutschland

    Anton J. Kroesen

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Correspondence to Anton J. Kroesen.

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A.J. Kroesen gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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Kroesen, A.J. Komplikationen und Revisionsoperationen nach ileopouchanaler Rekonstruktion?. Chirurgie 93, 1037–1043 (2022). https://doi.org/10.1007/s00104-022-01688-7

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