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Dünndarmpouch nach restaurativer Proktokolektomie

Ileal pouch after restorative coloproctectomy

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Zusammenfassung

Die stetige Weiterentwicklung der Pouchchirurgie hat eine kontinenzerhaltende Therapie nach Koloproktektomie ermöglicht. Der ileoanale J‑Pouch ist heutzutage die Standardrekonstruktion nach restaurativer Koloproktektomie mit einem exzellenten funktionellen Langzeitergebnis. Unter Berücksichtigung relativer Kontraindikationen und bei geeigneter Patientenselektion kann eine Pouchanlage nicht nur bei der Colitis ulcerosa und der familiären adenomatösen Polyposis indiziert werden, sondern auch bei Patienten mit einer nicht fistulierenden Pankolitis Crohn. Aufgrund einer hohen Behandlungsdichte mit Immunsuppressiva ist das chirurgisch-therapeutische Regime in ein mehrzeitiges Vorgehen aufzugliedern, wobei nach aktuellen Daten ein modifiziertes zweizeitiges Prozedere zu favorisieren ist.

Abstract

The continuous development of pouch surgery has enabled continence-preserving treatment after coloproctectomy. The ileoanal J‑pouch is nowadays the standard reconstruction after restorative coloproctectomy with excellent functional long-term results. Taking the relative contraindications and a suitable patient selection into consideration, pouch placement can be indicated not only for ulcerative colitis and familial adenomatous polyposis, but also for patients with nonfistular Crohn’s disease. Due to a high treatment density with immunosuppressants, the surgical treatment regimen should be subdivided into a multistage procedure, whereby according to current data a modified two-stage procedure should be favored.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum für Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    S. Flemming, M. Kelm, C.-T. Germer &  A. Wiegering

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  1. S. Flemming
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  2. M. Kelm
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  3. C.-T. Germer
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  4. A. Wiegering
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Correspondence to A. Wiegering.

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S. Flemming, M. Kelm, C.-T. Germer und A. Wiegering geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Flemming, S., Kelm, M., Germer, CT. et al. Dünndarmpouch nach restaurativer Proktokolektomie. Chirurgie 93, 1030–1036 (2022). https://doi.org/10.1007/s00104-022-01708-6

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