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Die Geschichte der chirurgischen Therapie des externen Vollwandprolapses reicht bis in das 17. Jahrhundert zurück. Dabei war jahrzehntelang das transanale und/oder perineale Verfahren die bevorzugte Technik. Im Folgenden sollen die heute gebräuchlichen Verfahren in Bezug auf Indikation, Technik und Ergebnisse vorgestellt werden. Die Operationstechnik nach Rehn-Delorme eignet sich für betagte und hochbetagte Patienten, die mit minimalem Risiko behandelt werden sollen. Technisch wird dabei lediglich eine Mukosektomie mit anschließender Raffung der Rektumwand durchgeführt. Die transperineale Rektosigmoidresektion nach Altemeier dagegen beinhaltet eine Vollwandresektion mit entweder End-zu-End- oder Seit-zu-End-Anastomose, wobei zusätzliche eine Levatorenplastik erfolgen kann. Das Morbiditätsrisiko erscheint dabei höher, die Effektivität im Langzeitverlauf dagegen verbessert zu sein. In jüngster Zeit wurde das operative Spektrum durch die sog. perineale staplergestützte Prolapsresektion (PSP) ergänzt, die auf Radikalität und Levatorenplastik verzichtet. Aufgrund der nicht unerheblichen Rezidivrate im Langzeitverlauf eignet sie sich am ehesten für hochbetagte und multimorbide Patienten mit eingeschränkter Lebenserwartung.
coloproctology – Springer Journals
Published: May 30, 2018
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