Pouchrekonstruktion nach Rektumresektion

Zusammenfassung

Störungen der Kontinenzfunktion nach sphinktererhaltender Rektumresektion sind häufig und werden auch unter dem Begriff „Anteriores-Resektions-Syndrom” zusammengefasst. Für die postoperative Funktion ist das Resektionsausmaß besonders entscheidend, welches wiederum maßgeblich durch die Tumorlokalisation vorgegeben wird. Radiatio und Anastomosenkomplikationen sind weitere Determinanten der Funktionsleistung. Neben einer schonenden Operationstechnik kann der Chirurg jedoch durch die Wahl des Rekonstruktionsverfahrens entscheidenden Einfluss auf die Funktion nehmen. So haben zahlreiche, teils randomisierte Studien zeigen können, dass der koloanale J-Pouch die funktionellen Ergebnisse und damit auch die Lebensqualität der betroffenen Patienten, insbesondere in der frühen postoperativen Periode, verbessert. Als Alternativverfahren bietet sich der Koloplastie-Pouch an, insbesondere dann, wenn aus technischen Gründen ein J-Pouch nicht mit ausreichender Sicherheit konstruiert werden kann. Allerdings liegen für diesen Pouch noch deutlich weniger Daten vor, so dass eine abschließende Bewertung zzt. noch nicht möglich ist. In jedem Fall sollten die funktionellen Vorteile einer Pouchrekonstruktion genutzt werden, zumal es sich um ein Patientengut handelt, bei dem die Sphinkterfunktion aus Altersgründen häufig beeinträchtigt ist. Zudem muss berücksichtigt werden, dass aus onkologischen Gründen die Lebenserwartung dieser Patienten limitiert sein kann und daher ein möglichst optimales Frühresultat wünschenswert ist.

Abstract

Postoperative functional results following low rectal resection, also known as “anterior resection syndrome”, are often poor. Among others, important factors determining anorectal function are the length of the rectal remnant, radiation therapy and anastomotic complications. Apart from a meticulous operative technique, the mode of reconstruction can decisively influence postoperative function. Many randomized trials have established the functional superiority and improved quality of life of coloanal J-pouch reconstruction versus straight end-to-end anastomosis. If a J-pouch cannot be fashioned for technical reasons, the so called transverse coloplasty pouch should be considered as an alternative approach. However, conclusive data from large controlled trials with regard to this technique are still lacking. In general, pouch reconstruction results in an improved function most notably in an elderly population with an already altered anorectal physiology. Furthermore, some patients will have a substantially reduced life expectancy so that the best possible functional result is desireable in the early postoperative phase.

Schlüsselwörter

Tiefe anteriore Rektumresektion - anorektale Funktion - koloanaler J-Pouch - Koloplastie-Pouch - Ileozökale Interposition

Key words

Low rectal resection - anorectal function - coloanal J-pouch - transverse coloplasty pouch - ileocecal reservoir

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