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Zentralbl Chir 2007; 132(4): 350-357
DOI: 10.1055/s-2007-981237
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© Georg Thieme Verlag Stuttgart · New York

Chirurgische Therapieoptionen beim Rektumprolaps - Indikation, Technik und Ergebnisse

Surgical Options in the Treatment of Rectal Prolapse: Indications, Techniques and ResultsM. Sailer1 , L. Bönicke2 , S. Petersen1
  • 1Klinik für Chirurgie, Bethesda - Allgemeines Krankenhaus Bergedorf, Hamburg
  • 2Chirurgische Klinik und Poliklinik I der Universität Würzburg, Würzburg
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Publication History

Publication Date:
27 August 2007 (online)

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Zusammenfassung

Zur chirurgischen Therapie des manifesten Rektumprolaps stehen grundsätzlich zwei verschiedene Zugangswege zur Verfügung, nämlich der transabdominelle und der sog. perineale. Die folgende Arbeit gibt eine Übersicht über beide Verfahren. Bei den abdominellen Operationen werden die ausschließlichen Rektopexietechniken den Ergebnissen der Resektionsrektopexie gegenübergestellt, wobei die laparoskopischen Operationsverfahren besonders berücksichtigt werden. Bei den perinealen Operationen werden insbesondere das Verfahren nach Rehn-Delorme sowie die Rektosigmoidektomie nach Altemeier dargestellt und diskutiert. Generell sind die perinealen Operationen mit weniger Komplikationen behaftet und eignen sich daher auch für betagte Patienten mit einem entsprechenden Risikoprofil. Dem gegenüber steht eine höhere Rezidivrate im Vergleich zu abdominellen Verfahren. Zusammenfassend kann festgestellt werden, dass sowohl perineale als auch abdominelle Operationsverfahren in der chirurgischen Therapie des Rektumprolaps weiterhin einen festen Stellenwert haben und entsprechen individuell indiziert werden müssen.

Abstract

Two different approaches can be distinguished in the surgical treatment of rectal prolapse, i. e. the transabdominal route and the perineal procedures. The following article deals with both operative options with a detailed discussion of the Delorme's operation and the perineal rectosigmoidectomy, also known as the Altemeier procedure for the perineal techniques. Regarding abdominal operations simple rectopexy is compared with operations including bowel resection including minimally invasive approaches. In general, perineal procedures for full-thickness rectal prolapse cause less morbidity compared with abdominal operations. They are especially indicated in the elderly and / or high-risk patients. Recurrences, on the other hand, are usually encountered more often following local techniques as compared with abdominal operations. It can be concluded that perineal as well as abdominal procedures remain important options in the surgical treatment of rectal prolapse and should be part of the armamentarium of colorectal surgeons.

Schlüsselwörter

Rektumprolaps - perineale Operationen - transabdominelle Operationen - Übersichtsartikel

Key words

rectal prolapse - perineal operations - abdominal operations - review article

Literatur

  • 1 Allen-Mersh T G, Turner M J, Mann C V. Effect of abdominal Ivalon rectopexy on bowel habit and rectal wall.  Dis Colon Rectum. 1990;  33 550-553
    CrossrefPubMedGoogle Scholar
  • 2 Altemeier W A, Culbertson W R, Schowengerdt C, Hunt J. Nineteen years experience with the one stage repair of rectal rolapse.  Ann Surg. 1971;  173 993-1006
    PubMedGoogle Scholar
  • 3 Altemeier W A, Ginsefi J, Hoxworth P. Treatment of extensive prolapse of the rectum in aged or debilitated patients.  Arch Surg. 1952;  65 72-80
    PubMedGoogle Scholar
  • 4 Arndt M, Pelster F W, Bunte H. [10 years experiences used resorbable synthetic mesh in treatment of rectal prolapse].  Helv Chir Acta. 1993;  59 707-711
    PubMedGoogle Scholar
  • 5 Ashari L H, Lumley J W, Stevenson A R, Stitz R W. Laparoscopically-assisted resection rectopexy for rectal prolapse: ten years' experience.  Dis Colon Rectum. 2005;  48 982-987
    CrossrefPubMedGoogle Scholar
  • 6 Azimuddin K, Khubchandani I, Rosen L, Stasik J, Riether R, Reed J. Rectal prolapse: a search for the “best operation”.  Am Surg. 2001;  67 622-627
    PubMedGoogle Scholar
  • 7 Bachoo P, Brazzelli M, Grant A. Surgery for complete rectal prolapse in adults (Cochrane review). The Cochrane Library, Issue 2, 2001
    Google Scholar
  • 8 Ballantyne G H. Laparoscopically assisted anterior resection for rectal prolapse.  Surg Laparosc Endosc. 1992;  2 230-236
    PubMedGoogle Scholar
  • 9 Berman I R. Sutureless laparoscopic rectopexy for procidentia. Technique and implications.  Dis Colon Rectum. 1992;  35 689-693
    CrossrefPubMedGoogle Scholar
  • 10 Blatchford G J, Perry R E, Thorson A G, Christensen M A. Rectal prolapse: rational therapy without foreign material.  Neth J Surg. 1989;  41 126-128
    PubMedGoogle Scholar
  • 11 Blatchford G J, Perry R E, Thorson A G, Christensen M A. Rectopexy without resection for rectal prolapse.  Am J Surg. 1989;  158 574-576
    CrossrefPubMedGoogle Scholar
  • 12 Boccasanta P, Venturi M, Reitano M C, Salamina G, Rosati R, Montorsi M, Fichera G, Strinna M, Peracchia A. Laparotomic vs. laparoscopic rectopexy in complete rectal prolapse.  Dig Surg. 1999;  16 415-419
    CrossrefPubMedGoogle Scholar
  • 13 Bonner C, Prohm P. Rektumprolaps: Laparoskopische Resektion und Ergebnisse.  Zentralbl Chir. 2003;  128 199-201
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Bruch H P, Herold A, Schiedeck T, Schwandner O. Laparoscopic surgery for rectal prolapse and outlet obstruction.  Dis Colon Rectum. 1999;  42 1189-1194
    CrossrefPubMedGoogle Scholar
  • 15 Carter A E. Rectosacral suture fixation for complete rectal prolapse in the elderly, the frail and the demented.  Br J Surg. 1983;  70 522-523
    CrossrefPubMedGoogle Scholar
  • 16 Chow P K, Ho Y H. Abdominal resection rectopexy versus Delorme's procedure. Comparison of clinical and physiological outcome.  Int J Colorectal Dis. 1996;  11 201-202
    CrossrefPubMedGoogle Scholar
  • 17 Corman M L. Rectal prolapse. Surgical techniques.  Surg Clin North Am. 1988;  68 1255-1265
    PubMedGoogle Scholar
  • 18 Deen K I, Grant E, Billingham C, Keighley M RB. Abdominal resection rectopexy with pelvic floor repair versus perianal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolpse.  Br J Surg. 1994;  81 302-304
    CrossrefPubMedGoogle Scholar
  • 19 Demirbas S, Akin M L, Kalemoglu M, Ogun I, Celenk T. Comparison of laparoscopic and open surgery for total rectal prolapse.  Surg Today. 2005;  35 446-452
    CrossrefPubMedGoogle Scholar
  • 20 D'Hoore A, Cadoni R, Penninckx F. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse.  Br J Surg. 2004;  91 1500-1501
    CrossrefPubMedGoogle Scholar
  • 21 Duthie G S, Bartolo D C. Abdominal rectopexy for rectal prolapse: a comparison of techniques.  Br J Surg. 1992;  79 107-113
    CrossrefPubMedGoogle Scholar
  • 22 Duthie G S, Bartolo D C. A comparison between Marlex and resection rectopexy.  Neth J Surg. 1989;  41 136-139
    PubMedGoogle Scholar
  • 23 Earnshaw J J, Hopkinson B R. Late results of silicon rubber perineal suture for rectal polapse.  Dis Colon Rectum. 1987;  30 86-88
    PubMedGoogle Scholar
  • 24 Friedman R, Muggia-Sullam M, Freund H R. Experience with one stage perineal repair of rectal prolapse.  Dis Colon Rectum. 1983;  26 789-791
    CrossrefPubMedGoogle Scholar
  • 25 Frykman H M, Goldberg S M. The surgical treatment of rectal procidentia.  Surg Gynecol Obstet. 1969;  129 1225-1230
    PubMedGoogle Scholar
  • 26 Frykman H M. Abdominal proctopexy and primary sigmoid resection for rectal procidentia.  Am J Surg. 1955;  90 780-789
    CrossrefPubMedGoogle Scholar
  • 27 Galili Y, Rabau M. Comparison of polyglycolic acid and polypropylene mesh for rectopexy in the treatment of rectal prolapse.  Eur J Surg. 1997;  163 445-448
    PubMedGoogle Scholar
  • 28 Gordon P H, Hoexter B. Complications of the Ripstein procedure.  Dis Colon Rectum. 1978;  21 277-280
    CrossrefPubMedGoogle Scholar
  • 29 Holmstrom B, Ahlberg J, Bergstrand O, Broden G, Ewerth S. Results of the treatment of rectal prolapse operated according to Ripstein.  Acta Chir Scand Suppl. 1978;  482 51-52
    PubMedGoogle Scholar
  • 30 Holmstrom B, Broden G, Dolk A. Results of the Ripstein operation in the treatment of rectal prolapse and internal rectal procidentia.  Dis Colon Rectum. 1986;  29 845-848
    PubMedGoogle Scholar
  • 31 Huber F T, Stein H, Siewert J R. Functional results after treatment of rectal prolapse with rectopexy and sigmoid resection.  World J Surg. 1995;  19 138-143
    CrossrefPubMedGoogle Scholar
  • 32 Hunt T M, Fraser I A, Maybury N K. Treatment of rectal prolapse by sphincteric support using silastic rods.  Br J Surg. 1985;  72 491-492
    PubMedGoogle Scholar
  • 33 Johansen O B, Wexner S D, Daniel N, Nogueras J J, Jagelman D G. Perineal rectosigmoidectomy in the ederly.  Dis Colon Rectum. 1993;  36 767-772
    CrossrefPubMedGoogle Scholar
  • 34 Kairaluoma M V, Viljakka M T, Kellokumpu I H. Open vs. laparoscopic surgery for rectal prolapse: a case-controlled study assessing short-term outcome.  Dis Colon Rectum. 2003;  46 353-360
    CrossrefPubMedGoogle Scholar
  • 35 Kariv Y, Delaney C P, Casillas S, Hammel J, Nocero J, Bast J, Brady K, Fazio V W, Senagore A J. Long-term outcome after laparoscopic and open surgery for rectal prolapse: a case-control study.  Surg Endosc. 2000;  20 35-42
    PubMedGoogle Scholar
  • 36 Keighley M R, Fielding J W, Alexander-Williams J. Results of Marlex mesh abdominal rectopexy for rectal prolapse in 100 consecutive patients.  Br J Surg. 1983;  70 229-232
    PubMedGoogle Scholar
  • 37 Kim D, Tsang C B, Wong W, Lowry A, Goldberg S, Madoff R. Complete rectal prolase: evolution of management and results.  Dis Colon Rectum. 1999;  42 460-469
    CrossrefPubMedGoogle Scholar
  • 38 Kimmins M H, Evetts B K, Isler J, Billingham R. The Altemeier repair: outpatient treatment of rectal prolapse.  Dis Colon Rectum. 2001;  22 565-570
    PubMedGoogle Scholar
  • 39 Korenkov M, Junginger T. Rektumprolaps bei Erwachsenen - Ursache, Diagnostik, Therapie.  Zentralbl Chir. 2005;  130 544-549
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Kuijpers J H, de Morree H. Toward a selection of the most appropriate procedure in the treatment of complete rectal prolapse.  Dis Colon Rectum. 1988;  31 355-357
    PubMedGoogle Scholar
  • 41 Kupfer C A, Goligher J C. One hundred consecutive cases of complete prolapse of the rectum treated by operation.  Br J Surg. 1970;  57 482-487
    PubMedGoogle Scholar
  • 42 Lechaux J P, Lechaux D, Perez M. Results of Delorme's procedure for rectal prolapse. Advantages of a modified technique.  Dis Colon Rectum. 1995;  38 301-307
    CrossrefPubMedGoogle Scholar
  • 43 Leenen L P, Kuijpers J H. Treatment of complete rectal prolapse with foreign material.  Neth J Surg. 1989;  41 129-131
    PubMedGoogle Scholar
  • 44 Luukkonen P, Mikkonen U, Jarvinen H. Abdominal rectopexy with sigmoidectomy vs. rectopexy alone for rectal prolapse: a prospective, randomized study.  Int J Colorectal Dis. 1992;  7 219-222
    CrossrefPubMedGoogle Scholar
  • 45 Madoff R D, Williams J G, Wong W D, Rothenberger D A, Goldberg S M. Long-term functional results of colon resection and rectopexy for overt rectal prolapse.  Am J Gastroenterol. 1992;  87 101-104
    PubMedGoogle Scholar
  • 46 Marchal F, Bresler L, Ayav A, Zarnegar R, Brunaud L, Duchamp C, Boissel P. Long-term results of Delorme's procedure and Orr-Loygue rectopexy to treat complete rectal prolapse.  Colon Rectum. 2005;  48 1785-1790
    CrossrefPubMedGoogle Scholar
  • 47 McKee R F, Lauder J C, Poon F W, Aitchison M A, Finlay I G. A prospective randomized study of abdominal rectopexy with and without sigmoidectomy in rectal prolapse.  Surg Gynecol Obstet. 1992;  174 145-148
    PubMedGoogle Scholar
  • 48 Morgan C N, Porter N H, Klugman D J. Ivalon (polyvinyl alcohol) sponge in the repair of complete rectal prolapse.  Br J Surg. 1972;  59 841-846
    PubMedGoogle Scholar
  • 49 Novell J R, Osborne M J, Winslet M C, Lewis A A. Prospective randomized trial of Ivalon sponge versus sutured rectopexy for full-thickness rectal prolapse.  Br J Surg. 1994;  81 904-906
    CrossrefPubMedGoogle Scholar
  • 50 Parks A G, Porter N H, Hardcastle J. The syndrome of the descending perineum.  Procee Roy Soc Med. 1966;  59 477-482
    PubMedGoogle Scholar
  • 51 Parks A G, Swash M, Urich H. Sphincter denervation in anorectal incontinence and rectal prolapse.  Gut. 1977;  18 656-665
    CrossrefPubMedGoogle Scholar
  • 52 Penfold J C, Hawley P R. Experiences of Ivalon-sponge implant for complete rectal prolapse at St. Mark's Hospital, 1960-70.  Br J Surg. 1972;  59 846-848
    PubMedGoogle Scholar
  • 53 Pescatori M, Interisano A, Stolfi V M, Zoffoli M. Delorme's operation and sphincteroplasty for rectal prolapse and fecal incontinence.  Int J Colorect Dis. 1998;  13 223-227
    CrossrefPubMedGoogle Scholar
  • 54 Plusa S M, Clarig J A, Balaij V. Physiological changes after Delorme's procedure for full thickness rectal prolapse.  Br J Surg. 1995;  82 1475-1478
    PubMedGoogle Scholar
  • 55 Purkayastha S, Tekkis P, Athanasiou T, Aziz O, Paraskevas P, Ziprin P, Darzi A. A comparison of open vs. laparoscopic abdominal rectopexy for full-thickness rectal prolapse: a meta-analysis.  Dis Colon Rectum. 2005;  48 1930-1940
    CrossrefPubMedGoogle Scholar
  • 56 Raftopoulos Y, Senagore A J, Di Giuro G, Bergamaschi R. Rectal Prolapse Recurrence Study Group . Recurrence rates after abdominal surgery for complete rectal prolapse: a multicenter pooled analysis of 643 individual patient data.  Dis Colon Rectum. 2005;  48 1200-1206
    CrossrefPubMedGoogle Scholar
  • 57 Ramanujam P S, Venkatesh K S, Fietz M J. Perineal excision of rectal procidentia in elderly high risk patients. A ten year experience.  Dis Colon Rectum. 1994;  37 1027-1030
    CrossrefPubMedGoogle Scholar
  • 58 Ripstein C B. Treatment of massive rectal prolapse.  Am J Surg. 1952;  83 68-71
    CrossrefPubMedGoogle Scholar
  • 59 Sainio A P, Halme L E, Husa A I. Anal encirclement with polypropelene mesh for rectal prolapse and incontinene.  Dis Colon Rectum. 1991;  34 905-908
    PubMedGoogle Scholar
  • 60 Salkeld G, Bagia M, Solomon M. Economic impact of laparoscopic versus open abdominal rectopexy.  Br J Surg. 2004;  91 1188-1191
    CrossrefPubMedGoogle Scholar
  • 61 Sayfan J, Pinho M, Alexander-Williams J, Keighley M R. Sutured posterior abdominal rectopexy with sigmoidectomy compared with Marlex rectopexy for rectal prolapse.  Br J Surg. 1990;  77 143-145
    CrossrefPubMedGoogle Scholar
  • 62 Selvaggi F, Scotto di Carlo E, Silvestril L, Festa L, Piegari V. Surgical treatment of rectal prolapse: A randomized study.  Br J Surg. 1993;  80 89
    CrossrefPubMedGoogle Scholar
  • 63 Senapati A, Nicholls R J, Phillips R K. Result of Delorme's procedure for rectal prolapse.  Dis Colon Rectum. 1994;  37 456-460
    CrossrefPubMedGoogle Scholar
  • 64 Solla J A, Rothenberger D A, Goldberg S M. Colonic resection in the treatment of complete rectal prolapse.  Neth J Surg. 1989;  41 132-135
    PubMedGoogle Scholar
  • 65 Solomon M J, Eyers A A. Laparoscopic rectopexy using mesh fixation with a spiked chromium staple.  Dis Colon Rectum. 1996;  39 279-284
    CrossrefPubMedGoogle Scholar
  • 66 Solomon M J, Young C J, Eyers A A, Roberts R A. Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse.  Br J Surg. 2002;  89 35-39
    CrossrefPubMedGoogle Scholar
  • 67 Speakman C T, Madden M V, Nicholls R J, Kamm M A. Lateral ligament division during rectopexy causes constipation but prevents recurrence: results of a prospective randomized study.  Br J Surg. 1991;  78 1431-1433
    CrossrefPubMedGoogle Scholar
  • 68 Sudeck P. Rektumprolapsoperation durch Auslösung des Rektum aus der Excavatio sacralis.  Zentralbl Chir. 1922;  20 698-699
    PubMedGoogle Scholar
  • 69 Theuerkauf Jr  F J, Beahrs O H, Hill J R. Rectal prolapse. Causation and surgical treatment.  Ann Surg. 1970;  171 819-835
    PubMedGoogle Scholar
  • 70 Tobin S A, Scott I H. Delorme operation for rectal prolapse.  Br J Surg. 1994;  81 1681-1684
    CrossrefPubMedGoogle Scholar
  • 71 Tsunoda A, Yasuda N, Yokoyama N, Kamiyama G, Kusano M. Delorme's procedure for rectal prolapse. Clinical and physiological analysis.  Dis Colon Rectum. 2003;  46 1260-1265
    CrossrefPubMedGoogle Scholar
  • 72 Watkins B P, Landercasper J, Belzer G E, Rechner P, Knudson R, Bintz M, Lambert P. Long-term follow-up of the modified Delorme procedure for rectal prolapse.  Arch Surg. 2003;  138 498-502
    PubMedGoogle Scholar
  • 73 Watts A M, Thompson M R. Evaluation of Delorme's procedure as a treatment for full thickness rectal prolapse.  Br J Surg. 2000;  87 218-222
    CrossrefPubMedGoogle Scholar
  • 74 Watts J D, Rothenberger D A, Goldberg S M. Rectal Prolaps. Butterworths, London 1985
    Google Scholar
  • 75 Wells C. New operation for rectal prolapse.  Proc R Soc Med. 1959;  52 602-603
    PubMedGoogle Scholar
  • 76 Williams J G, Rothenberger D A, Madoff R D, Goldberg S M. Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy.  Dis Colon Rectum. 1992;  35 830-834
    CrossrefPubMedGoogle Scholar
  • 77 Winde G, Reers B, Nottberg H, Berns T, Meyer J, Bunte H. Clinical and functional results of abdominal rectopexy with absorbable mesh-graft for treatment of complete rectal prolapse.  Eur J Surg. 1993;  159 301-305
    PubMedGoogle Scholar
  • 78 Yakut M, Kaymakcioglu N, Simsek A. Surgical treatment of rectal prolapse. A retrospective analysis of 94 cases.  Int Surg. 1998;  83 53-55
    PubMedGoogle Scholar
  • 79 Yoshioka K, Hyland G, Keighley M R. Anorectal function after abdominal rectopexy: parameters of predictive value in identifying return of continence.  Br J Surg. 1989;  76 64-68
    PubMedGoogle Scholar
  • 80 Yoshioka K, Ogunbiyi O A, Keighley M RB. Pouch perineal rectosigmoidectomy gives better functional results than conventional rectosigmoidectomy in elderly patients with rectal prolapse.  Br J Surg. 1998;  85 1525-1526
    CrossrefPubMedGoogle Scholar
  • 81 Zbar A, Takashima S, Hasegawa T, Kitabayashi K. Perineal rectosigmoidectomy (Altemeier's procedure): a review of physiology, technique and outcome.  Tech Coloproctol. 2002;  6 109-116
    CrossrefPubMedGoogle Scholar

Prof. Dr. M. Sailer

Bethesda - Allgemeines Krankenhaus · Bergedorf · Akad. Lehrkrankenhaus der Universität Hamburg

Glindersweg 80

21029 Hamburg

Phone: 0 40/7 25 54 12 10

Fax: 0 40/7 25 54 12 12

Email: sailer@bakb.net

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