Differenzierte chirurgische Strategie bei anorektalemMorbus-Crohn-Befall

Zusammenfassung.

In den letzten Jahren hat sich in koloproktologisch aktiven Zentren der Therapieansatz bei komplizierten anorektalen Crohn-Fisteln von einem konservativ abwartenden zu einem selektiv-operativen Vorgehen geändert. Die früher häufig als definitive Therapie verwendete Fadendrainage ist dabei Teil eines Therapiekonzeptes, das letztlich den operativen Verschluss der Fistel durch endoanale Verschiebelappen-Techniken zum Ziel hat. In geübten Händen lassen sich so Raten der kontinenten Langzeit-Heilung von bis zu 85% erreichen - gelegentlich auch unter Anlage einer vorübergehenden Deviationsileostomie. Bei Patienten mit langjährigem anorektalen Crohn-Befall scheint ein gesteigertes Risiko für die Entwicklung eines Karzinoms vorzuliegen, in Fisteln findet sich dabei gehäuft ein Plattenepithelkarzinom. Die Therapieempfehlung unterliegt dabei den gleichen onkologischen Grundsätzen wie bei nicht Crohn-assoziierten Karzinomen.

Schlüsselwörter:

Anorektaler Morbus Crohn - Fadendrainage - Verschiebelappen - Crohn-assoziiertes Karzinom

Surgical strategies for anorectal crohn's disease.

In recent years, surgeons treating complicated cases of anorectal Crohn's disease have shifted from a cautious conservative to a selective surgical approach. The former concept of seton drainage as the main treatment has now been intregrated with the aim of surgical closure of the fistula by endoanal advancement flap. In experienced hands rates of longterm continence up to 85% can be reached - occasionally including the temporary deviation ileostomy. Patients with a long history of anorectal Crohn's disease seem at higher risk for developing squamous cell carcinoma in the fistula region. Treatment recommendations are based on the same oncological principles as for carcinomas not associated with Crohn's disease.

Key words:

Anorectal crohn's disease - Seton-drainage - Advancement-flap - Crohn associated carcinoma

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