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Hämorrhoidalleiden, Analfissur, Analabszess, Analfistel

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Evidenzbasierte Viszeralchirurgie benigner Erkrankungen

Part of the book series: Evidenzbasierte Chirurgie ((EC))

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Zusammenfassung

Die konventionelle Hämorrhoidektomie (KH) gilt als der Goldstandard bei der operativen Therapie des Hämorrhoidalleidens. Die Stapler-Hämorrhoidopexie (SH) ist mit weniger Schmerzen in der unmittelbaren postoperativen Phase als die KH verbunden, jedoch sind die Raten an Residualproplaps, Hämorrhoidalprolaps und Reinterventionen wegen Prolaps im weiteren Verlauf nach SH höher als nach KH. Analfissuren sind relativ häufig und manifestieren sich durch Schmerzen bei der Defäkation. Als erste Maßnahme sollte immer ein konservativer Therapieversuch erfolgen. Dazu stehen verschiedene Substanzen (Nitroglyceryl-Trinitrat, Diltiazem u. a.) zur Verfügung. Eine operative Therapie kommt bei Versagen aller konservativen Maßnahmen zur Anwendung. Standard ist die Fissurektomie. Abszesse der Analregion sind gekennzeichnet durch starke progrediente Schmerzen, die eine zeitnahe und ausreichende operative Drainage erfordern. Eine Fistelsuche sollte nur sehr vorsichtig durchgeführt werden. Analfisteln sind in den meisten Fällen die Folge eines anorektalen Abszesses mit persistierender oder iatrogen entstandener Verbindung zum Analkanal. Eine Heilung ist nur operativ möglich. Während oberflächliche Fisteln gespalten werden können, sollten bei allen höheren Fisteln Schließmuskel-schonende Verfahren zur Anwendung kommen. Ein Verfahren mit deutlichen Vorteilen konnte bisher nicht evaluiert werden, so dass immer eine Einzelfallentscheidung des erfahrenen Operateurs erforderlich ist. Mögliche Belastungen der Betroffenen durch wiederholte Eingriffe und Kontinenzstörungen sind nicht auszuschließen. Dem Sinus pilonidalis liegt eine akute oder chronische Entzündung im Fettgewebe der Rima ani zugrunde. Eine Heilung ist nur operativ möglich. Eine offene Wundbehandlung bei größeren Befunden geht mit einer sehr langen Wundbehandlung und Arbeitsunfähigkeit einher. Diese kann durch plastische Verfahren verkürzt werden. Die Mittelliniennaht sollte wegen der erhöhten Komplikations- und Rezidivrate nicht mehr angewendet werden.

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Authors and Affiliations

  1. End- und Dickdarmzentrum Essen, Rüttenscheider Straße 66, 45130, Essen, Deutschland

    A Ommer

  2. ehemaliger Wissenschaftlich Medizinischer, Direktor der Kreiskliniken Altötting-Burghausen, In den Grüben 144, 84489, Burghausen, Deutschland

    RT Grundmann

Authors
  1. A Ommer
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  2. RT Grundmann
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Correspondence to A Ommer .

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Editors and Affiliations

  1. Allgemein-,Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany

    Christoph-Thomas Germer

  2. Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany

    Tobias Keck

  3. ehem. Wissenschaftlich Medizinischer, Direktor Kreiskliniken Altötting-Burghausen, Burghausen, Germany

    Reinhart T. Grundmann

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Ommer, A., Grundmann, R. (2017). Hämorrhoidalleiden, Analfissur, Analabszess, Analfistel. In: Germer, CT., Keck, T., Grundmann, R. (eds) Evidenzbasierte Viszeralchirurgie benigner Erkrankungen. Evidenzbasierte Chirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-53553-0_11

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  • DOI: https://doi.org/10.1007/978-3-662-53553-0_11

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-53552-3

  • Online ISBN: 978-3-662-53553-0

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