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Ileoanale Pouch-Operation

Ileo pouch-anal anastomosis

  • Schwerpunkt: Postoperative Syndrome und Operationsfolgen
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Die Proktokolektomie und Anlage eines ileoanalen Pouches ist bei Patienten mit Colitis ulcerosa (CU) bzw. familiärer adenomatöser Polyposis (FAP), die einer operativen Therapie bedürfen, die Therapie der Wahl. Als häufigste postoperative Komplikation ist die idiopathische Pouchitis zu beobachten, die bei bis zu 50% der Patienten mit zugrunde liegender CU, aber nur bei 5% der Patienten mit FAP auftritt. Die klinischen Symptome der Erkrankung sind unspezifisch. Von der idiopathischen Pouchitis sind postoperative Komplikationen (Stenosen, Fisteln etc.) durch endoskopische Untersuchungen des Pouches und in einzelnen Fällen durch Endosonographie oder MRT des Beckens abzugrenzen. Zur Therapie der idiopathischen Pouchitis werden Antibiotika, üblicherweise Metronidazol oder Ciprofloxazin, eingesetzt. Probiotika wie VSL#3® können ein Wiederauftreten der Pouchitis verhindern. Insgesamt sind auch bei Langzeitbeobachtung über 20 Jahre der klinische Verlauf und die Funktionalität bei Pouch-Trägern als sehr gut zu bezeichnen.

Abstract:

Restorative proctocolectomy with an ileal pouch-anal anastomosis is the treatment of choice in patients with ulcerative colitis (UC) and familial adenomatous polyposis requiring surgical therapy. Pouchitis is the most frequent complication, occurring in up to 50% of patients with underlying UC. Clinical symptoms of the disease are non-specific. Moreover, surgical complications must be differentiated from idiopathic pouchitis using pouchoscopy, endoscopic ultrasound or MRI of the pelvis in certain cases. The therapy for idiopathic pouchitis, its etiology and pathophysiology being unclear, is based on antibiotic treatment, usually with metronidazole or ciprofloxacin. Probiotics such as VSL#3® can be used to prevent relapse. In summary, the clinical and functional outcomes are excellent and stable for 20 years after surgery.

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  1. Abteilung für Gastroenterologie, Hepatologie und Infektiologie, Friedrich-Schiller-Universität, Erlanger Allee 101, 07740, Jena, Deutschland

    A. Stallmach & C. Schmidt

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  1. A. Stallmach
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  2. C. Schmidt
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Correspondence to A. Stallmach.

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Stallmach, A., Schmidt, C. Ileoanale Pouch-Operation. Internist 48, 606–612 (2007). https://doi.org/10.1007/s00108-007-1835-8

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  • DOI: https://doi.org/10.1007/s00108-007-1835-8

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