Zusammenfassung
Die chirurgische Therapie der Beckenbodeninsuffizienz fokussiert sich im Wesentlichen auf zwei funktionelle Störungen, die Darmobstruktion und die Stuhlinkontinenz. Der Stellenwert der chirurgischen Therapie ist hier insbesondere nach Nichtansprechen der konservativen Möglichkeiten zu sehen. Die Differenzialindikation der operativen Verfahren basiert auf einer präzisen präoperativen Evaluation. Das Ausmaß der funktionellen Beeinträchtigung wird anhand einer ausführlichen Anamnese unter Verwendung krankheitsspezifischer Fragebögen bestimmt, gefolgt von einer klinisch-proktologischen Untersuchung mit digital-rektaler Untersuchung und starrer Prokto-/Rektoskopie. Bildgebende Verfahren (anorektale Endosonographie, dynamische Defäkographie) erfolgen ergänzend zur Visualisierung morphologischer, funktionell wirksamer Pathologien. Die Schwere der Beeinträchtigung und Ausprägung der morphologischen Pathologie bilden die Grundlage eines therapeutischen Algorithmus bei zunehmend differenzierten Operationsverfahren. Ziel dieser Übersicht ist die Darstellung der differenzierten Diagnostik bei Obstruktion und Stuhlinkontinenz für eine exakte Patientenselektion zur zielgerichteten Therapie.
Abstract
The surgical therapy of pelvic floor insufficiency is mainly focused on two functional disorders, outlet obstruction and fecal incontinence. Surgery becomes of special significance after ineffectiveness of conservative treatment options. The indications for surgical interventions should be based on a precise preoperative evaluation. The dimension of functional impairment will be primarily assessed by an accurate anamnesis, application of disease-specific scoring systems and the clinical proctological basic examination that includes digital rectal examination and proctoscopy/rectoscopy. Imaging procedures (anorectal endosonography and dynamic defecography) are carried out as adjuncts and contribute to a visualization of morphological changes. Severity and manifestation of morphological symptoms are essential for the therapeutic algorithm due to increasingly differentiated surgical strategies. Only a thorough diagnostic investigation and patient selection enable a targeted therapy of obstruction and fecal incontinence.
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Kim, M., Isbert, C. Anorektale Funktionsdiagnostik. Chirurg 84, 7–14 (2013). https://doi.org/10.1007/s00104-012-2347-1
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DOI: https://doi.org/10.1007/s00104-012-2347-1
Schlüsselwörter
- Obstruktives Defäkationssyndrom
- Stuhlinkontinenz
- Beckenbodeninsuffizienz
- Therapiealgorithmus
- Chirurgische Therapie