Die laparoskopische Resektionsrektopexie zur Therapie des obstruktiven Defäkationssyndroms

Zusammenfassung

Die Outlet Obstruction ist eine Unterform der chronischen Obstipation. Fast immer sind Kombinationen von morphologischen Veränderungen des Beckens, des Beckenbodens und des Kolorektums nachzuweisen. Im Rahmen der Diagnostik gilt es, diejenigen Patienten zu identifizieren, die von einer operativen Therapie profitieren. Die Resektionsrektopexie versucht, die physiologische Anatomie und damit das funktionelle Zusammenspiel der beteiligten Strukturen wiederherzustellen, wobei die laparoskopische Technik die Vorteile der minimalinvasiven Chirurgie mit sich bringt. Neben der Erläuterung des eigenen operativen Vorgehens und des Algorithmus zur Indikationsstellung werden die Ergebnisse nach 19 Jahren eigener Erfahrung dargestellt. Innerhalb dieses Zeitraums wurden 264 Resektionsrektopexien in laparoskopischer Technik aufgrund einer Outlet Obstruction durchgeführt. Bei einer mittleren Dauer der Nachbeobachtung von 58,2 Monaten betrug die Rate der Besserung der Obstruktionsbeschwerden 79,5 % (n = 128 von n = 161 Nachbeobachtungen). Die vorliegenden Studien deuten darauf hin, dass die (laparoskopische) Resektionsrektopexie gegenüber nicht resezierenden Verfahren und Verfahren mit Implantation allogenen Materials zu besseren Ergebnissen führt. Voraussetzung ist hierbei eine korrekte Selektionierung der Patienten und die laparoskopische Expertise. Sowohl die perioperativen als auch die funktionellen Ergebnisse des eigenen Kollektivs untermauern die Vorteile der laparoskopischen Resektionsrektopexie bei Patienten mit einer Outlet Obstruction.

Abstract

Anorectal outlet obstruction constitutes one form of chronic constipation. Combinations of morphological alterations of the pelvis, the pelvic floor and the colorectum are nearly always evident. The goal of the diagnostic work-up is to identify those patients who will profit from a surgical intervention. Resection rectopexy aims at restoring the physiological anatomy thereby ameliorating the functional interaction of structures effected with the laparoscopic approach entailing all advantages of minimally invasive surgery. Besides a detailed description of the surgical technique used and an algorithm for indications to operate we present our results after 19 years of experience. Throughout this period, 264 laparoscopic resection rectopexies for outlet obstruction were performed. With a mean follow-up of 58.2 months the rate of improvement of obstructive symptoms was 79.5 % (n = 128 of 161 available for follow-up). Present studies suggest that (laparoscopic) resection rectopexy entails better results in comparison to non-resecting procedures and procedures with the implantation of allogenic material. Certainly, in order to achieve these results a correct patient selection and an expertise in laparoscopic surgery are essential. Both the perioperative and the functional results of our own collective fortify the advantages of laparoscopic resection rectopexy in patients with an outlet obstruction.

Schlüsselwörter

Resektionsrektopexie - obstruktives Defäkationssyndrom - Sigmoidozele - Laparoskopie

Key words

resection rectopexy - obstructive defaecation syndrome - sigmoidocele - laparoscopy

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