Skip to main content
SpringerLink
Log in

Rektumprolaps

Abdominelles oder lokales Vorgehen

Rectal prolapse

Abdominal or local approach

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

Zusammenfassung

Die chirurgische Behandlung des Rektumvollwandvorfalls zielt auf morphologische Korrektur und Funktionserhalt. Es gib keine eindeutige Methode der Wahl; eine Vielzahl von Operationen steht zur Verfügung. Abdominelle Verfahren unterscheiden sich hinsichtlich des Zugangsweges und der Art und Weise der Mobilisation und Fixation des reponierten Rektums sowie durch begleitende Resektion. Lokale (perineale/transanale) Techniken plikieren oder resezieren. Die Verfahrenswahl orientiert sich an der Belastbarkeit des Patienten, den Ergebnissen der Methoden im Hinblick auf Rezidivraten, Morbidität und der präoperativen sowie postoperativ zu erwartenden Funktion. Abdominelle Verfahren sind eher bei belastbaren Patienten angebracht, lokale Verfahren bei älteren. Die Übersichtsarbeit beschreibt vergleichend die Unterschiede der Techniken im Hinblick auf die Rezidivrate, die Morbidität und das funktionelle Ergebnis.

Abstract

Surgical treatment of rectal prolapse aims to correct morphology and restore function. Many techniques are available, but none can be considered a gold standard. Abdominal approaches differ with regard to abdominal access, extent of rectal mobilisation, technique of rectal pexy, and concomitant sigmoid resection. Local (perineal/transanal) procedures plicate or resect the rectum. The choice of operative approach is based on the patient‘s condition and expected outcome of the procedure, e.g. recurrence rate, morbidity, and function. Abdominal operations are favored in fit patients, while local procedures are considered for the elderly and frail. This review compares differences in the most common techniques, focussing on recurrence, morbidity, and functional outcome.

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

Literatur

  1. Altemeier WA, Giuseffi J, Hoxworth P (1952) Treatment of extensive prolapse of the rectum in aged or debilitated patients. AMA Arch Surg 65: 72–80

    PubMed  CAS  Google Scholar 

  2. Bachoo P, Brazzelli M, Grant A (2001) Surgery for complete rectal prolapse in adults (Cochrane Review). Cochran Libary, Issue 2

  3. Broden B, Snellman B (1968) Procidentia of the rectum studied with cineradiography. A contribution to the discussion of causative mechanism. Dis Colon Rectum 11: 330–347

    Article  PubMed  CAS  Google Scholar 

  4. Bruch HP, Herold A, Schiedeck T, Schwandner O (1999) Laparoscopic surgery for rectal prolapse and outlet obstruction. Dis Colon Rectum 42: 1189–1194; discussion 1194–1195

    Article  PubMed  CAS  Google Scholar 

  5. Corman ML (1988) Rectal prolapse. Surgical techniques. Surg Clin North Am 68: 1255–1265

    PubMed  CAS  Google Scholar 

  6. D’Hoore A, Cadoni R, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91: 1500–1505

    Article  Google Scholar 

  7. Delomre R (1900) Surle traitment des prolapses du rectum totaux pour lèxcision de la muscueuse rectale ou rectocolique. Bull Mem Soc Chir Paris 266: 499–518

    Google Scholar 

  8. Duthie GS, Bartolo DC (1992) Abdominal rectopexy for rectal prolapse: a comparison of techniques. Br J Surg 79: 107–113

    Article  PubMed  CAS  Google Scholar 

  9. Frykman HM (1955) Abdominal proctopexy and primary sigmoid resection for rectal procidentia. Am J Surg 90: 780–789

    Article  PubMed  CAS  Google Scholar 

  10. Holmstrom B, Broden G, Dolk A (1986) Results of the Ripstein operation in the treatment of rectal prolapse and internal rectal procidentia. Dis Colon Rectum 29: 845–848

    Article  PubMed  CAS  Google Scholar 

  11. Jarrett ME, Matzel KE, Stosser M et al. (2005) Sacral nerve stimulation for fecal incontinence following surgery for rectal prolapse repair: a multicenter study. Dis Colon Rectum 48: 1243–1248

    Article  PubMed  Google Scholar 

  12. Kariv Y, Delaney CP, Casillas S et al. (2006) Long-term outcome after laparoscopic and open surgery for rectal prolapse: a case-control study. Surg Endosc 20: 35–42

    Article  PubMed  CAS  Google Scholar 

  13. Kuijpers HC (1992) Treatment of complete rectal prolapse: to narrow, to wrap, to suspend, to fix, to encircle, to plicate or to resect? World J Surg 16: 826–830

    Article  PubMed  CAS  Google Scholar 

  14. Kuijpers JH, Morree H de (1988) Toward a selection of the most appropriate procedure in the treatment of complete rectal prolapse. Dis Colon Rectum 31: 355–357

    Article  PubMed  CAS  Google Scholar 

  15. Luukkonen P, Mikkonen U, Jarvinen H (1992) Abdominal rectopexy with sigmoidectomy vs. rectopexy alone for rectal prolapse: a prospective, randomized study. Int J Colorectal Dis 7: 219–222

    Article  PubMed  CAS  Google Scholar 

  16. Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140: 63–73

    Article  PubMed  Google Scholar 

  17. Marchal F, Bresler L, Ayav A et al. (2005) Long-term results of Delorme’s procedure and Orr-Loygue rectopexy to treat complete rectal prolapse. Dis Colon Rectum 48: 1785–1790

    Article  PubMed  Google Scholar 

  18. Mollen RM, Kuijpers JH, Hoek F van (2000) Effects of rectal mobilization and lateral ligaments division on colonic and anorectal function. Dis Colon Rectum 43: 1283–1287

    Article  PubMed  CAS  Google Scholar 

  19. Nicholls RJ (1994) Rectal prolapse and the solitary ulcer syndrome. Ann Ital Chir 65: 157–162

    PubMed  CAS  Google Scholar 

  20. Novell JR, Osborne MJ, Winslet MC, Lewis AA (1994) Prospective randomized trial of Ivalon sponge versus sutured rectopexy for full-thickness rectal prolapse. Br J Surg 81: 904–906

    Article  PubMed  CAS  Google Scholar 

  21. Oliver GC, Vachon D, Eisenstat TE et al. (1994) Delorme’s procedure for complete rectal prolapse in severely debilitated patients. An analysis of 41 cases. Dis Colon Rectum 37: 461–467

    Article  PubMed  CAS  Google Scholar 

  22. Ripstein CB (1952) Treatment of massive rectal prolapse. Am J Surg 83: 68–71

    Article  PubMed  CAS  Google Scholar 

  23. Speakman CT, Madden MV, Nicholls RJ, Kamm MA (1991) Lateral ligament division during rectopexy causes constipation but prevents recurrence: results of a prospective randomized study. Br J Surg 78: 1431–1433

    Article  PubMed  CAS  Google Scholar 

  24. Sudeck P (1922) Rektumprolapsoperation durch Auslösung des Rektum aus der Excavatio sacralis. Zentralbl Chir 20: 698–699

    Google Scholar 

  25. Watts AM, Thompson MR (2000) Evaluation of Delorme’s procedure as a treatment for full-thickness rectal prolapse. Br J Surg 87: 218–222

    Article  PubMed  CAS  Google Scholar 

  26. Wells C (1959) New operation for rectal prolapse. Proc R Soc Med 52: 602–603

    PubMed  CAS  Google Scholar 

  27. Williams JG, Rothenberger DA, Madoff RD, Goldberg SM (1992) Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. Dis Colon Rectum 35: 830–834

    Article  PubMed  CAS  Google Scholar 

  28. Winde G, Reers B, Nottberg H et al. (1993) Clinical and functional results of abdominal rectopexy with absorbable mesh-graft for treatment of complete rectal prolapse. Eur J Surg 159: 301–305

    PubMed  CAS  Google Scholar 

  29. Yakut M, Kaymakcioglu N, Simsek A et al. (1998) Surgical treatment of rectal prolapse. A retrospective analysis of 94 cases. Int Surg 83: 53–55

    PubMed  CAS  Google Scholar 

  30. Yoshioka K, Ogunbiyi OA, Keighley MR (1998) Pouch perineal rectosigmoidectomy gives better functional results than conventional rectosigmoidectomy in elderly patients with rectal prolapse. Br J Surg 85: 1525–1526

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Chirurgische Klinik mit Poliklinik, Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland

    K.E. Matzel, S. Heuer & W. Zhang

Authors
  1. K.E. Matzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Heuer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K.E. Matzel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matzel, K., Heuer, S. & Zhang, W. Rektumprolaps. Chirurg 79, 444–451 (2008). https://doi.org/10.1007/s00104-008-1546-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-008-1546-2

Schlüsselwörter

Keywords

Search

Navigation