Advertisement

Stomachirurgie bei Patienten mit M. Crohn

  • Igors IesalnieksEmail author
Chapter
  • 33 Downloads

Zusammenfassung

Viele Patienten mit M. Crohn werden im Laufe der Erkrankung temporär oder permanent zu Stomaträgern. Die temporäre Stomaanlage bei perianalen Crohn-Fisteln führt selten zu einer anhaltenden Remission, welche auch nach der Stomarückverlagerung anhält. Pankolitis-Crohn ist eine häufige Indikation der (Prokto-)Kolektomie und endständigen Ileostomie. Die meisten dieser Patienten profitieren dramatisch von der Operation, bei gleichzeitiger Ileitis sind die klinischen und chirurgischen Rezidive am Ileostoma häufig. Eine zweizeitige ileokolische Resektion sollte ausschließlich in besonders schweren (Not-)Fällen durchgeführt werden, da die Rückverlagerung des endständigen Ileostomas bei M.-Crohn-Patienten mit einer erheblichen Anastomosenkomplikationsrate einhergeht. Die Lebensqualität von betroffenen Patienten mit permanentem Stoma kann durch gehäuft auftretende depressive Verstimmungen und Angstsymptome negativ beeinflusst werden.

Literatur

  1. Abdalla MI, Sandler RS, Kappelman MD, Martin CF, Chen W, Anton K, Long MD (2016) The impact of ostomy on quality of life and functional status of Crohn’s disease patients. Inflamm Bowel Dis 22(11):2658–2664CrossRefGoogle Scholar
  2. Agarwal A, Andrews JM (2013) Systematic review: IBD-associated pyoderma gangrenosum in the biologic era, the response to therapy. Aliment Pharmacol Ther 38(6):563–572CrossRefGoogle Scholar
  3. Alves A, Panis Y, Bouhnik Y et al (2007) Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn’s disease: a multivariate analysis in 161 consecutive patients. Dis Colon Rectum 50:331–336CrossRefGoogle Scholar
  4. Amiot A, Gornet JM, Baudry C, Munoz-Bongrand N, Auger M, Simon M, Allez M, Cattan P, Sarfati E, Lémann M (2011) Crohn’s disease recurrence after total proctocolectomy with definitive ileostomy. Dig Liver Dis 43(9):698–702CrossRefGoogle Scholar
  5. Ananthakrishnan AN, Gainer VS, Cai T, Perez RG, Cheng SC, Savova G, Chen P, Szolovits P, Xia Z, De Jager PL, Shaw S, Churchill S, Karlson EW, Kohane I, Perlis RH, Plenge RM, Murphy SN, Liao KP (2013) Similar risk of depression and anxiety following surgery or hospitalization for Crohn’s disease and ulcerative colitis. Am J Gastroenterol 108(4):594–601CrossRefGoogle Scholar
  6. de Groof EJ, van der Meer JHM, Tanis PJ, de Bruyn JR, van Ruler O, D’Haens GRAM, van den Brink GR, Bemelman WA, Wildenberg ME, Buskens CJ (2018) Persistent mesorectal inflammatory activity is associated with complications after proctectomy in Crohn’s disease. J Crohns Colitis. 2018 Sep 10.  https://doi.org/10.1093/ecco-jcc/jjy131. [Epub ahead of print]CrossRefGoogle Scholar
  7. El-Hussuna A, Krag A, Olaison G, Bendtsen F, Gluud LL (2013) The effect of anti-tumor necrosis factor alpha agents on postoperative anastomotic complications in Crohn’s disease: a systematic review. Dis Colon Rectum. 56(12):1423–1433CrossRefGoogle Scholar
  8. Fumery M, Dulai PS, Meirick P, Farrell AM, Ramamoorthy S, Sandborn WJ, Singh S (2017) Systematic review with meta-analysis: recurrence of Crohn’s disease after total colectomy with permanent ileostomy. Aliment Pharmacol Ther 45(3):381–390CrossRefGoogle Scholar
  9. Galandiuk S, Kimberling J, Al-Mishlab TG, Stromberg AJ (2005) Perianal Crohn disease: predictors of need for permanent diversion. Ann Surg 241(5):796–801CrossRefGoogle Scholar
  10. Gu J, Stocchi L, Kiran RP, Shen B, Remzi FH (2014) Do clinical characteristics of de novo pouch Crohn’s disease after restorative proctocolectomy affect ileal pouch retention? Dis Colon Rectum 57(1):76–82CrossRefGoogle Scholar
  11. Hain E, Maggiori L, Orville M, Tréton X, Bouhnik Y, Panis Y. (2019) Diverting stoma for refractory ano-perineal Crohn’s disease, is it really useful in the anti-TNF era? A multivariate analysis in 74 consecutive patients. J Crohns Colitis. 2018 Nov 19.  https://doi.org/10.1093/ecco-jcc/jjy195. [Epub ahead of print]CrossRefGoogle Scholar
  12. Holubar SD, Holder-Murray J, Flasar M, Lazarev M (2015) Anti-Tumor necrosis factor-α antibody therapy management before and after intestinal surgery for inflammatory bowel disease: A CCFA position paper. Inflamm Bowel Dis 21(11):2658–2672CrossRefGoogle Scholar
  13. Iesalnieks I, Glaß H, Kilger A et al (2009) Perianale Crohn-Fisteln – Ergebnisse der Behandlung in einer interdisziplinären Sprechstunde. Chirurg 80:549–558CrossRefGoogle Scholar
  14. Iesalnieks I, Hoene M, Bittermann T, Schlitt HJ, Hackl C (2018a) Mechanical bowel preparation (MBP) Prior to elective colorectal resections in Crohn’s disease patients. Inflamm Bowel Dis 24(4):908–915CrossRefGoogle Scholar
  15. Iesalnieks I, Spinelli A, Frasson M, Di Candido F, Scheef B, Horesh N, Iborra M, Schlitt HJ, El-Hussuna A (2018b) Risk of postoperative morbidity in patients having bowel resection for colonic Crohn’s disease. Tech Coloproctol. 2018 Dec 12.  https://doi.org/10.1007/s10151-018-1904-0 [Epub ahead of print]CrossRefGoogle Scholar
  16. Iesalnieks I, Kilger A, Glass H, Müller-Wille R, Klebl F, Ott C, Strauch U, Piso P, Schlitt HJ, Agha A (2008) Intraabdominal septic complications following bowel resection for Crohn’s disease: detrimental influence on long-term outcome. Int J Colorectal Dis 23(12):1167–1174CrossRefGoogle Scholar
  17. Iesalnieks I, Kilger A, Kalisch B, Obermeier F, Schlitt HJ, Agha A (2011) Treatment of the anastomotic complications in patients with Crohn’s disease. Int J Colorectal Dis 26(2):239–244.  https://doi.org/10.1007/s00384-010-1031-5CrossRefGoogle Scholar
  18. Kasparek MS, Glatzle J, Temeltcheva T, Mueller MH, Koenigsrainer A, Kreis ME (2007) Long-term quality of life in patients with Crohn’s disease and perianal fistulas: influence of fecal diversion. Dis Colon Rectum 50(12):2067–2074CrossRefGoogle Scholar
  19. Korelitz BI, Cheskin LJ, Sohn N, Sommers SC (1985) The fate of the rectal segment after diversion of the fecal stream in Crohn’s disease: its implications for surgical management. J Clin Gastroenterol 7(1):37–43CrossRefGoogle Scholar
  20. Knowles SR, Wilson J, Wilkinson A, Connell W, Salzberg M, Castle D, Desmond P, Kamm MA (2013) Psychological well-being and quality of life in Crohn’s disease patients with an ostomy: a preliminary investigation. J Wound Ostomy Continence Nurs 40(6):623–629CrossRefGoogle Scholar
  21. Longo WE, Oakley JR, Lavery IC, Church JM, Fazio VW (1992) Outcome of ileorectal anastomosis for Crohn’s colitis. Dis Colon Rectum 35(11):1066–1071CrossRefGoogle Scholar
  22. Martí-Gallostra M, Myrelid P, Mortensen N, Keshav S, Travis SP, George B (2017) The role of a defunctioning stoma for colonic and perianal Crohn’s disease in the biological era. Scand J Gastroenterol 52(3):251–256CrossRefGoogle Scholar
  23. Morris A, Leach B (2017) A qualitative exploration of the lived experiences of patients before and after ileostomy creation as a result of surgical management for Crohn’s disease. Ostomy Wound Manage 63(1):34–39PubMedGoogle Scholar
  24. Morris MS, Graham LA, Chu DI et al (2015) Oral antibiotic bowel preparation significantly reduces surgical site infection rates and readmission rates in elective colorectal surgery. Ann Surg 261:1034–1040CrossRefGoogle Scholar
  25. Morar PS, Hodgkinson JD, Thalayasingam S, Koysombat K, Purcell M, Hart AL, Warusavitarne J, Faiz O (2015) Determining predictors for intra-abdominal septic complications following ileocolonic resection for Crohn’s disease-considerations in pre-operative and peri-operative optimisation techniques to improve outcome. J Crohns Colitis 9(483–91):7Google Scholar
  26. Myrelid P, Söderholm JD, Olaison G, Sjödahl R, Andersson P (2012) Split stoma in resectional surgery of high-risk patients with ileocolonic Crohn’s disease. Colorectal Dis 14:188–193CrossRefGoogle Scholar
  27. Post S, Herfarth C, Schumacher H et al (1995) Experience with ileostomy and colostomy in Crohn’s disease. Br J Surg 82:1629–1633CrossRefGoogle Scholar
  28. Sjödahl RI, Myrelid P, Söderholm JD (2003) Anal and rectal cancer in Crohn’s disease. Colorectal Dis 5:490–495CrossRefGoogle Scholar
  29. Ten Hove JR, Bogaerts JMK, Bak MTJ, Laclé MM, Meij V, Derikx LAAP, Hoentjen F, Mahmmod N, van Tuyl SA, Oldenburg B (2018 ) Malignant and nonmalignant complications of the rectal stump in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2018 Aug 1.  https://doi.org/10.1093/ibd/izy253 [Epub ahead of print]CrossRefGoogle Scholar
  30. Wexner SD, Ruiz DE, Genua J, Nogueras JJ, Weiss EG, Zmora O (2008) Gracilis muscle interposition for the treatment of rectourethral, rectovaginal, and pouch-vaginal fistulas: results in 53 patients. Ann Surg 248(1):39–43CrossRefGoogle Scholar
  31. Yamamoto T, Allan RN, Keighley MR (2000) Effect of fecal diversion alone on perianal Crohn’s disease. World J Surg 24:1258–1262CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2020

Authors and Affiliations

  1. 1.Klinik für Allgemein-, Viszeral-, Endokrine und Minimal-Invasive ChirurgieKlinikum BogenhausenMünchenDeutschland

Personalised recommendations