Skip to main content
SpringerLink
Log in

Kontinente Stuhlreservoire – eine chirurgische Herausforderung

Continent ileoanal reservoir – a surgical challenge

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Durch Optimierung der operativen Techniken werden heutzutage Patienten mit einem tief sitzenden Rektumkarzinom durch eine tiefe anteriore Rektumresektion mit koloanaler Anastomose unter Vermeidung eines permanenten Stomas behandelt. Zur Vermeidung hoher Stuhlfrequenzen und einer eingeschränkten Kontinenz mit imperativem Stuhldrang wurde als Rektumersatz die koloanale Pouchoperation (KPA) entwickelt.

Patienten mit einer Colitis ulcerosa oder einer familiären adenomatösen Poliposis coli (FAP) erhalten heutzutage zur definitiven Therapie ihrer Grunderkrankung eine Proktokolektomie. Die Kontinuität wird mit einer ileoanalen Pouchanlage wieder hergestellt.

In diesem Beitrag werden für den Kolon-J-Pouch und den ileoanalen Pouch die Operationsindikationen und die pathophysiologischen Veränderungen beschrieben. Außerdem erfolgen Erläuterungen zu den operativen Techniken beider Verfahren und es werden Vergleiche der funktionellen Ergebnisse mit anderen Rekonstruktionsmöglichkeiten unter Verwendung eigener Ergebnisse durchgeführt und diskutiert.

Abstract

The optimization of surgical techniques has made it possible to now treat patients with deep-seated rectal cancer by performing deep anterior rectal resection with coloanal anastomosis while avoiding a permanent stoma. To prevent a high bowel movement frequency and limited continence with an imperative need to empty the bowel, the coloanal pouch operation was developed to construct a rectal substitute.

Nowadays, patients with ulcerative colitis or familial adenomatous polyposis of the colon undergo proctocolectomy as the definitive treatment for their underlying disease. Continuity is restored by creating an ileoanal reservoir.

This contribution describes the surgical indications and pathophysiological changes for the colon J-pouch and ileoanal reservoir. In addition, explanations of the surgical techniques for both procedures are presented. The functional results are compared with those of other reconstruction options and discussed, taking our own results into consideration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Becker JM, Raymond JL (1986) Ileal-pouch-anal anastomosis. A single surgeon‘s experience with 100 consecutive cases. Ann Surg 204: 375–383

    Article  PubMed  CAS  Google Scholar 

  2. Buhr HJ, Heuschen UA, Stern J, Herfarth C (1993) Continence preserving operation after proctocolectomy. Indications, technique and results. Chirurg 64: 601–613

    PubMed  CAS  Google Scholar 

  3. Buhr HJ, Heuschen UA, Stern J, Herfarth C (1994) Technique and results of the ileoanal pouch after proctocolectomy. Zentralbl Chir 119: 867–877

    PubMed  CAS  Google Scholar 

  4. Dehni N, Tiret E, Singland JD et al. (1998) Long-term functional outcome after low anterior resection: comparison of low colorectal anastomosis and colonic J-pouch-anal anastomosis. Dis Colon Rectum 41: 817–823

    Article  PubMed  CAS  Google Scholar 

  5. Fazio VW, Ziv Y, Church JM et al. (1995) Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 222: 120–127

    Article  PubMed  CAS  Google Scholar 

  6. Fazio VW, O’Riordain MG, Lavery IC et al. (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230: 575–584

    Article  PubMed  CAS  Google Scholar 

  7. Furst A, Burghofer K, Hutzel L, Jauch KW (2002) Neorectal reservoir is not the functional principle of the colonic J-pouch: the volume of a short colonic J-pouch does not differ from a straight coloanal anastomosis. Dis Colon Rectum 45: 660–667

    Article  PubMed  Google Scholar 

  8. Halbook O, Sjodahl R (1997) Comparison between the colonic J pouch-anal anastomosis and healthy rectum: clinical and physiological function. Br J Surg 84: 1437–1441

    Article  Google Scholar 

  9. Heuschen UA, Autschbach F, Allemeyer EH et al. (2001) Long-term follow-up after ileoanal pouch procedure: algorithm for diagnosis, classification, and management of pouchitis. Dis Colon Rectum 44: 487–499

    Article  PubMed  CAS  Google Scholar 

  10. Heuschen UA, Hinz U, Allemeyer EH et al. (2001) One- or two-stage procedure for restorative proctocolectomy: rationale for a surgical strategy in ulcerative colitis. Ann Surg 234: 788–794

    Article  PubMed  CAS  Google Scholar 

  11. Heuschen UA, Hinz U, Allemeyer EH et al. (2002) Risk factors for ileoanal J pouch-related septic complications in ulcerative colitis and familial adenomatous polyposis. Ann Surg 235: 207–216

    Article  PubMed  Google Scholar 

  12. Ho YH, Tan M, Seow-Choen F (1996) Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonic J pouch anastomoses. Br J Surg 83: 978–980

    Article  PubMed  CAS  Google Scholar 

  13. Huber FT, Herter B, Siewert JR (1999) Colonic pouch vs. side-to-end anastomosis in low anterior resection. Dis Colon Rectum 42: 896–902

    Article  PubMed  CAS  Google Scholar 

  14. Kroesen AJ, Stern J, Herfarth C (1994) Kontinenzerhaltende Colon- und Ileumreservoire im funktionellen Vergleich. Langenbecks Arch Chir Kongressbd 1994(Suppl): 330–335

    Google Scholar 

  15. Kroesen AJ, Runkel N, Buhr HJ (2003) Manometric analysis of anal sphincter damage after ileal pouch-anal anastomosis. Int J Colorectal Dis 14: 114–118

    Article  Google Scholar 

  16. Lee SJ, Park YS (1998) Serial evaluation of anorectal function following low anterior resection of rectum. Int J Colorectal Dis 13: 241–246

    Article  PubMed  CAS  Google Scholar 

  17. Leong AF, Seow-Choen F, Tang CL (1998) Diminutive cancers of the colon and rectum: comparison between flat and polypoid cancers. Int J Colorectal Dis 13: 151–153

    Article  PubMed  CAS  Google Scholar 

  18. Lin JK, Wang HS, Yang SH et al. (2002) Comparison between straight and J-pouch coloanal anastomoses in surgery for rectal cancer. Surg Today 32: 487

    Article  PubMed  Google Scholar 

  19. Machado M, Nygren J, Goldman S, Ljungqvist O (2003) Similar outcome after colonic pouch and side-to-end anastomosis in low anterior resection for rectal cancer: a prospective randomized trial. Ann Surg 238: 214–220

    PubMed  Google Scholar 

  20. Mantyh CR, Hull TL, Fazio VW (2001) Coloplasty in low colorectal anastomosis: manometric and functional comparison with straight and colonic J-pouch anastomosis. Dis Colon Rectum 44: 37–42

    Article  PubMed  CAS  Google Scholar 

  21. Petersen S, Freitag M, Hellmich G, Ludwig K (1998) Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer. Int J Colorectal Dis 13: 160–163

    Article  PubMed  CAS  Google Scholar 

  22. Sailer M, Debus ES, Fuchs KH et al. (2000) Comparison of anastomotic microcirculation in coloanal J-pouches versus straight and side-to-end coloanal reconstruction: an experimental study in the pig. Int J Colorectal Dis 15: 114–117

    Article  PubMed  CAS  Google Scholar 

  23. Schwandner O, Schiedeck TH, Killaitis C, Bruch HP (1999) A case-control-study comparing laparoscopic versus open surgery for rectosigmoidal and rectal cancer. Int J Colorectal Dis 14: 158–163

    Article  PubMed  CAS  Google Scholar 

  24. Shafik A, Doss S, Asaad S, Ali YA (1999) Rectosigmoid junction: anatomical, histological and radiological studies with spezial reference to a sphincter function. Int J Colorectal Dis 14: 237–244

    Article  PubMed  CAS  Google Scholar 

  25. Wang JY, You YT, Chen HH et al. (1997) Stapled colonic J-pouch-anal anastomosis without a diverting colostomy for rectal carcinoma. Dis Colon Rectum 40: 30–34

    Article  PubMed  CAS  Google Scholar 

  26. Willis S, Kasperk R, Braun J, Schumpelick V (2001) Comparison of colonic J-pouch reconstruction and straight coloanal anastomosis after intersphincteric rectal resection. Langenbecks Arch Surg 386: 193–199

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Abteilung für Viszeral- und Thoraxchirurgie, Chirurgischen Klinik I, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    U. Zurbuchen, A.J. Kroesen &  H.J. Buhr

Authors
  1. U. Zurbuchen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A.J. Kroesen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H.J. Buhr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H.J. Buhr.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zurbuchen, U., Kroesen, A. & Buhr, H. Kontinente Stuhlreservoire – eine chirurgische Herausforderung. Urologe 47, 18–24 (2008). https://doi.org/10.1007/s00120-007-1603-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-007-1603-3

Schlüsselwörter

Keywords

Search

Navigation