Ist nach tiefer anteriorer Rektumresektion eine kolonpouch-anale Anastomose empfehlenswert?

Zusammenfassung.

Einleitung: Eine komplette mesorektale Exzision beim Karzinom des mittleren und unteren Rektumdrittels macht eine komplette Entfernung des Rektumreservoirs notwendig. Die Anastomose kommt folglich als koloanale Anastomose unmittelbar suprasphinkter oder intersphinkter zu liegen. Die in dieser Weise operierten Patienten klagen häufig über eine hohe Stuhlfrequenz, imperativen Stuhldrang, Stuhlfragmentierung und Stuhlschmieren. Um diese Probleme zu lindern, wurde 1986 erstmals die koloanale Anastomose mit vorgeschaltetem Kolonpouch beschrieben. Methode: Alle relevanten Artikel bezogen auf das Thema Kolonpouch wurden ab dem Jahr 1986 herangezogen. Vorteile und Nachteile einer neorektalen Reservoirbildung wurden mit der geraden koloanalen Anastomosentechnik verglichen und bewertet. Ergebnisse: Die Konstruktion eines Kolonpouches nach tiefer anteriorer Rektumresektion reduziert die Stuhlfrequenz, die Häufigkeit der Stuhldrangepisoden und die Inzidenz an Inkontinenzproblemen. Die Pouchbildung kann jedoch zu Stuhlentleerungsstörungen führen und Einläufe oder Suppositorien notwendig machen. Die Wahl eines kurzen 5 - 7 cm langen Kolonpouchs minimiert die Evakuationsprobleme. Schlussfolgerung: Nach tiefer anteriorer Rektumresektion zeigen sich verglichen mit der koloanalen Anastomose übereinstimmend funktionelle Vorteile für die kolonpouch-anale Anastomose. Erste Langzeituntersuchungen zeigen die Vorteile des Kolonpouchs insbesondere im ersten postoperativen Jahr.

Is a colonpouch-anal anastomosis mandatory following low anterior resection?

Introduction: Total mesorectal excision (TME) in cancer of the middle and distal part of the rectum results in a complete resection of the rectal reservoir. The position of the anastomosis is close to the internal sphincter. Following this surgical procedure not few patients suffer on high stool frequency, urgency, stool fragmentation (clustering) and soiling in the postoperative period. In order to deminish this problems a colonic J pouch was introduced in 1986. Methods: All relevant articles identified in Medline databases were reviewed from 1986 to present. Functional results of the neorectal reservoir were reviewed and compared with the straight coloanal anastomotic technic. Results: The colonic J pouch has been shown to decrease stool frequency, urgency and continence problems. On the other hand a colonic pouch may increase the incidence of incomplete defecation. A small pouch design in the range of 5 - 7 cm minimizes evacuation problems. Conclusion: A colon pouch produces superior functional results compared with straight coloanal anastomosis following low anterior rectal excision. The functional superiority of the colon pouch was greatest at the first year postoperatively.

Schlüsselwörter:

Rektumkarzinom - Kolonpouch - Operationstechnik - Funktion - Totale mesorektale Exzision (TME)

Key words:

Rectal cancer - Colonic J Pouch - Total mesorectal excision (TME)

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