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coloproctology

, Volume 41, Issue 1, pp 13–21 | Cite as

Operative Therapie der Colitis ulcerosa

Indikation, Ausmaß und Techniken
  • C. HolmerEmail author
  • M. E. Kreis
Leitthema
  • 39 Downloads

Zusammenfassung

Hintergrund

Im Gegensatz zum Morbus Crohn ist der intestinale Befall der Colitis ulcerosa durch eine Proktokolektomie heilbar. Die ileoanale Pouchanlage stellt ein sphinktererhaltendes Verfahren dar, was insbesondere für die häufig jungen Patienten hinsichtlich ihrer Lebensqualität entscheidend ist.

Ziel der Arbeit

Die wesentlichen Aspekte der operativen Therapie der Colitis ulcerosa werden erläutert.

Material und Methoden

Relevante Arbeiten wurden selektioniert und weiterführende Recherchen anhand der Literaturverzeichnisse unternommen.

Ergebnisse

Neben dem therapierefraktären Verlauf als häufigste Operationsindikation stellt die Entwicklung von intraepithelialen Neoplasien oder Karzinomen eine weitere wichtige Indikation dar. Die Proktokolektomie mit ileoanaler Pouchanlage hat sich als Standardoperation durchgesetzt, wenngleich das terminale Ileostoma hinsichtlich der Lebensqualität vergleichbar ist. Insbesondere in der Notfallsituation, bei langfristiger Steroideinnahme sowie Biologikatherapie sollte die restaurative Proktokolektomie als dreizeitiges Verfahren durchgeführt werden. Die Kolektomie mit einer Ileorektostomie sollte selektionierten Ausnahmefällen vorbehalten sein. Hinsichtlich funktioneller Ergebnisse scheint die Stapler-Anastomose unter Belassung der analen Transitionalzone bei der pouchanalen Anastomose tendenziell besser zu sein als die Handnaht mit Mukosektomie. Die minimal-invasiven Techniken haben gegenüber der konventionellen Operation insbesondere im frühpostoperativen Verlauf Vorteile.

Schlussfolgerung

Die restaurative Proktokolektomie mit ileoanaler Pouchanlage hat sich als Standardverfahren bei der operativen Behandlung der Colitis ulcerosa etabliert, womit eine hohe Lebensqualität mit einem Kontinenzerhalt bei einem Großteil der Patienten erreicht wird.

Schlüsselwörter

Operationsindikation Therapierefraktärer Verlauf Proktokolektomie Lebensqualität Ileoanaler Pouch 

Surgical treatment of ulcerative colitis

Indications, extent and techniques

Abstract

Background

In contrast to Crohn’s disease the intestinal involvement of ulcerative colitis is curable by proctocolectomy. The ileoanal pouch anastomosis is also a sphincter-preserving procedure, which is crucial for the quality of life, especially for the often young patients.

Objective

The main aspects of elective surgery for ulcerative colitis are discussed.

Material and methods

Relevant studies were selected and further research based on the reference lists was undertaken.

Results

In addition to the treatment-refractory course as the most common indication for surgery, the development of intraepithelial neoplasms and carcinomas are further important indications. Proctocolectomy with an ileoanal pouch anastomosis has become standard procedure, although the terminal ileostomy is comparable in terms of quality of life. Restorative proctocolectomy should be performed as a three-stage procedure, especially in emergency situations, long-term steroid use and treatment with biologicals. Colectomy with ileorectostomy should be reserved for selected exceptional cases. With respect to functional results the stapled anastomosis, leaving the anal transitional zone in the pouch-anal anastomosis, tends to be better than hand suturing with mucosectomy. Minimally invasive techniques have advantages over conventional surgery, especially in the early postoperative course.

Conclusion

Restorative proctocolectomy with ileoanal pouch anastomosis has become the standard procedure for the surgical treatment of ulcerative colitis, providing a high quality of life with continence preservation in the majority of patients.

Keywords

Treatment refractory course Indications for surgery Proctocolectomy Quality of life Ileoanal pouch 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Holmer und M. E. Kreis geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Allgemein‑, Viszeral- und GefäßchirurgieCharité – Universitätsmedizin Berlin, Campus Benjamin FranklinBerlinDeutschland

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