Zusammenfassung
Bei 50 patienten wurde eine anteriore rektumresektion mit koloanaler anastomose durchgeführt. Hauptindikationen für diesen eingriff waren tiefsitzende rektumtumore und die strahlenproktitis.
Frühkomplikationen traten in 20% der Fälle auf, die letalität betrug 6%. Anastomosenfisteln und anastomosensstenosen waren die häufigsten spütkomplikationen (28%). Das onkologische ergebnis ist bis jetzt zufriedenstellend: Von 28 radikal operierten karzinomen trat nur in 1 fall ein Anastomosenrezidiv auf. Das funktionelle ergebnis war in 90% der Fälle zufriedenstellend, die dauer der erlangung einer verläßlichen sphinkterfunktion erforderte aber bis zu 12 monate.
Summary
Anterior resection with coloanal anastomosis was done in 50 patients. The main indications were distal rectal tumor and irradiation proctitis. Early complications appeared in 20%, letality was 6%. Late complications were mostly anastomotic fistula and stenosis (28%). Until now the oncological result is acceptable: out of 28 patients operated for cure only 1 developed recurrence at the anastomosis. The functional result was satisfying in 90% of the cases. However, the interval until reliable sphincter function was established, could last up to 12 months.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Babcock, W. W.: Radical single stage exstirpation for cancer of the large bowel. Surg. Gynecol. Obstet. 85, 1 (1945).
Bacon, H. E.: Evolution of sphincter muscle preservation and reestablishment of continuity in the operative treatment of rectal and sigmoidal cancer. Surg. Gynecol. Obstet. 81, 113 (1947).
Duthie, H. L., Benner, R. C.: The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal continence. Gut 4, 179 (1963).
Gaston, E. A.: Fecal continence following resection of various portions of the rectum and preservation of the anal sphincters. Surg. Gynecol. Obstet. 87, 669 (1948).
Gemsenjäger, E., Martina, B., Meier, A. L.: Vollständige Rektumentfernung mit Kontinenzerhaltung bei Rektumkarzinom. Schweiz. Med. Wschr. 114, 754 (1951).
Goligher, J. C., Dukes, C. E., Bussey, H. J. R.: Local recurrence after sphinctersaving excisions for carcinoma of the rectum and rectosigmoid. Br. J. Surg. 39, 199 (1951).
Goligher, J. C., Hughes, E. S. R.: Sensibility of the rectum and colon: its role in the mechanism of anal continence. Lancet 1, 543 (1951).
Goligher, J. C., Duthie, H. L., et al.: Abdominoanal pull-through excision for tumors of the midthird of the rectum. A comparison with low anterior resection. Br. J. Surg. 57, 323 (1965).
Hohenegg, J.: Beiträge zur Chirurgie des Rektums und der Beckenorgane. Wien. klin. Wschr. 2, 578 (1882).
Jeffery, P. J., Hawley, P. R., Parks, A. G.: Coloanal sleeve anastomosis in the treatment of diffuse cavernous haemangioma involving the rectum. Br. J. Surg. 63, 678 (1982).
Judd, W. W. H.: The transanal anastomosis: a sphinctersaving operation with improved continence. Dis. Colon Rectum 22, 102 (1979).
Keighley, M. R. B., Matheson, B.: Functional results of rectal excision and endoanal anastomosis. Br. J. Surg. 67, 757 (1980)
Lane, R. H. S., Parks, A. G.: Function of the anal sphincter following coloanal anastomosis. Br. J. Surg. 64, 596 (1977).
Lazhortes, F., Fages, P., Chiotasso, P., Lemozy, J., Bloom, E.: Resection of the rectum with construction of a colonic reservoir and coloanal anastomosis for carcinoma of the rectum. Br. J. Surg. 73, 136 (1986).
Localio, S. A., Eng, K., Goughe, T. H., Ranson, J. H. C.: Abdominosacral resection for carcinoma of the midrectum; 10 years experience. Ann. Surg. 188, 475 (1978).
Parc, R., Tiret, E., Frileux, P., Moszkowiski, E., Loygue, J.: Resection and coloanal anastomosis with colonic reservoir for rectal carcinoma. Br. J. Surg. 73, 139 (1986).
Parks, A. G.: Transanal technique in low rectal anastomosis. Proc. r. Soc. Med. 65, 47 (1972).
Parks, A. G., Allen, C. L. O., Frank, J. D., McPartlin, J. F.: A method of treating post-irradiation rectovaginal fistulas. Br. J. Surg. 65, 417 (1978).
Parks, A. G., Percy, J. P.: Resection and sutured coloanal anastomosis for rectal carcinoma. Br. J. Surg. 69, 301 (1982).
Parks, A. G.: Endoanal technique in low colonic anastomosis. Surg. Techn. 111, 63 (1977).
Pollet, W. C., Nicholls, R. J.: The relationship between the extent of the distal clearance and survival after local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann. Surg. 198, 159 (1983).
Schiessel, R., Wunderlich, M., Kovats, E., Raubs, R.: Sphinkteterhaltung beim Rektumkarzinom: Möglichkeiten und Grenzen der vorderen Resektion. Wien. klin. Wschr. 95, 769 (1983).
Schiessel, R., Wunderlich, M., Herbst, F.: Local recurrence of colorectal cancer: effects of early and aggressive surgery. Br. J. Surg. (in press).
Waneck, R., Lechner, G., Jantsch, H., Kovats, E., Schiessel, R.: Lateral distant view for improved accuracy in locating rectal tumors. A. J. R. 142, 519 (1984).
Wunderlich, M., Teleky, B., Schiessel, R.: Sphinkterfunktion nach coloanaler Anastomose. Langenbecks Arch. Chir. 367, 259 (1986).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Karner-Hanusch, J., Schiessel, R., Teleky, B. et al. Die koloanale anastomose . Acta Chir Austriaca 18, 487–491 (1986). https://doi.org/10.1007/BF02656383
Issue Date:
DOI: https://doi.org/10.1007/BF02656383