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Indikation, Technik und Ergebnisse der STARR-Operation

Indications, technique and results of the STARR procedure

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Zusammenfassung

Die rektale Intussuszeption und die ventrale Rektozele sind häufige Befunde, die mit einem obstruktiven Defäkationssyndrom (ODS) assoziiert sein können. Nach frustraner konservativer Therapie kann ein chirurgischer Eingriff erörtert werden. Die STARR-Operation (transanale Stapler-Resektion des distalen Rektums) stellt hierbei eine transanale Operationsmethode mit zwei zirkulären Klammernahtgeräten (PPH01) dar, bei der eine Vollwandresektion des distalen Rektums vorderwand- und hinterwandseitig durchgeführt wird. Sowohl retrospektive und prospektive Studien als auch die Daten des Deutschen STARR-Registers zeigten, dass die STARR-Operation eine sichere und effektive Therapieoption beim ODS infolge einer rektalen Intussuszeption im Kurzzeitverlauf darstellt. Jedoch wurden auch enttäuschende funktionelle Ergebnisse hinsichtlich Stuhlinkontinenz bzw. Urge-Inkontinenz, schwere Komplikationen sowie hohe Raten an Revisionsoperationen nach STARR publiziert. Die adäquate Differenzialdiagnostik und Therapie bleiben generell eine Herausforderung beim ODS infolge einer rektalen Intussuszeption, wobei die Patientenselektion der entscheidende Faktor für einen potenziellen Therapieerfolg der STARR-Operation ist. Vor diesem Hintergrund versucht diese Übersicht, Indikationen, chirurgische Technik, Ergebnisse, Kontroversen und aktuelle Trends der „herkömmlichen“ STARR-Operation mit zwei Zirkularstaplern (PPH01) zusammenzufassen und zu bewerten.

Abstract

Rectal intussusception and ventral rectocele are frequent morphological findings in patients suffering from obstructed defecation syndrome (ODS). After failed conservative treatment a surgical option can be discussed. Surgical approaches include the stapled transanal rectal resection (STARR) procedure, which is performed as a transanal approach by using two circular (PPH01) staplers for ventral and dorsal full-thickness resection of the distal rectum. Both retrospective and prospective studies as well as data from the German STARR registry demonstrated that the STARR procedure is safe and effective for symptom improvement and resolution in ODS associated with rectal intussusception in the short-term; however, disappointing functional results, particularly related to fecal incontinence and urgency, severe complications and high rates of revision surgery have also been documented. In general, based on the diagnostic and therapeutic challenges in ODS related to rectal intussusception, patient selection for STARR seems to be the key for success; therefore, this review summarizes and evaluates the indications, surgical technique, results, controversies and current trends of the “conventional” STARR procedure using two circular (PPH01) staplers.

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O. Schwandner und P. Hillemanns geben an, dass kein Interessenkonflikt besteht.

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

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Schwandner, O., Hillemanns, P. Indikation, Technik und Ergebnisse der STARR-Operation. Chirurg 87, 909–917 (2016). https://doi.org/10.1007/s00104-016-0265-3

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