Laparoskopische Therapie bei chronisch-entzündlichen Darmerkrankungen

Zusammenfassung

Patienten mit chronisch-entzündlichen Darmerkrankungen profitieren in besonderer Weise von der Reduktion des Zugangstraumas, der schnelleren postoperativen Rekonvaleszenz und der besseren Kosmetik nach laparoskopischen Operationen. Häufigste laparoskopische Operationen sind die Ileozökalresektion und die Stomaanlage bei M. Crohn, die im Vergleich zur offenen Operation keine erhöhten Komplikationsraten aufweisen. Bei der Colitis ulcerosa ist die restaurative Proktokolektomie mit ileumpouchanaler Anastomose (alternativ mit endständiger Ileostomie) die chirurgische Standardtherapie, wobei der zeitliche Mehraufwand bei der laparoskopischen Operation mit dem potenziellen Nutzen für die Patienten korrelieren sollte. Generell bleiben durch den Einsatz der laparoskopischen Chirurgie die OP-Indikationen unberührt, nur der Zugangsweg ändert sich. Es muss jedoch gewährleistet bleiben, dass der laparoskopische Eingriff genauso sicher ist wie die konventionelle Operation - und die Ergebnisse in Zentren laparoskopischer Chirurgie belegen dies.

Abstract

Potential benefits of laparoscopic surgery in patients with inflammatory bowel disease include reduction of surgical trauma, fast recovery and improved cosmesis when compared to conventional approach. Most common laparoscopic procedures include ileocecal resection and stoma creation for Crohn's disease. Data of comparative studies have shown that laparoscopic resection is not associated with increased morbidity rates. Focussing on ulcerative colitis, restorative proctocolectomy with ileal-pouch-anal anastomosis is the standard therapy for refractory disease. However, the advantages of laparoscopic surgery have to compete with the increased operative times. In general, the indication for surgery has not changed with the application of laparoscopy. It remains a fundamental principle that laparoscopic surgery for inflammatory bowel disease has to be safe and effective when compared to open surgery, and the published results of specialized centers provide comparable data.

Schlüsselwörter

M. Crohn - Colitis ulcerosa - Laparoskopie - Ileozökalresektion - Stomaanlage - Proktokolektomie

Key words

Crohn's disease - ulcerative colitis - laparoscopy - ileocecal resection - stoma creation - proctocolectomy

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