Das obstruktive Defäkationssyndrom – chirurgische Behandlungskonzepte

Zusammenfassung

Die chronische Obstipation beschreibt einen Symptomkomplex, hinter dem sich zahlreiche Diagnosen verstecken. Ihre Diagnose und Therapie benötigt eine interdisziplinäre Zusammenarbeit. Die operative Behandlung ist die Therapie der Wahl für strukturelle Ursachen. Für diese Übersicht wurde Literatur aufgearbeitet und eigene klinische Erfahrungen dokumentiert. Wichtigste Indikation zur Behandlung einer chronischen Obstipation ist der subjektive Leidensdruck des Patienten. Dieser kann durch klinische Scores objektiviert werden. Mit Hilfe apparativer Diagnostik z. B. Defäkographie lässt sich die Pathologie feststellen. Die chirurgische Behandlung dient der Wiederherstellung der Anatomie des Darms und ist somit die Therapie der Wahl bei strukturellen Veränderungen. Postoperative Ergebnisse werden durch Defäkographie und Lifestyle Skala kontrolliert und zeigen eine signifikante Beschwerdebesserung mit durchaus akzeptablen Komplikationen.

Chronic constipation is a symptom complex caused by a wide variety of diseases. Primary causes of constipation, including enterocele, rectocele, rectum prolaps and intussusception, involve changes of the bowel which either delay or prevent the passage of bowel content. This condition has been termed „obstructed defaecation syndrome” (ODS).

This article is based on clinical experience and a review of selected literature. The complexity of chronic constipation warrants interdisciplinary work-up and treatment. The diagnostic work-up includes taking a focus on the history of patientŽs complaints. This can be objectified using a standardized scoring system, e. g. Longo score. Gynaecological examinations must be performed on all female patients. Intraluminal abnormalities are best excluded by colonoscopy and rectoscopy. An abnormal score in combination with negative findings on endoscopy and gynaecologic examinations warrant a radiological assessment with a defaecogramm in symptomatic patients. Treatment is usually medical, involving changes in life style, bowel habits and the use of laxatives. Biofeedback has been shown to be effective in some patients. Surgery is indicated for selected patient who do not improve after medical treatment. A range of surgical procedures have been shown to be effective in the treatmetn of chronic constipation. The minimal invasive double stapled trans anal rectum resection (STARR procedure) has been proven effective in treating rectocele and rectum prolaps in selected patients. The advantages of the STARR procedure include: short hospital stay, reduced postoperative pain and an early return to work. We consider this procedure as safe and effective when performed by a well trained surgeon in selected patients.

Schlüsselwörter

obstruktives Defäkationssyndrom - STARR - Rektozele - Intussuszeption - Longo Score

Keywords

obstructed defaecation syndrome - STARR - rectocele - intussusception - Longo score

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