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Transtar™-Operation bei Rektozele und obstruktivem Defäkationssyndrom

Transtar™ operation for rectocele and obstructed defecation syndrome

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Zusammenfassung

Die Contour®-Transtar™-Operation ist eine methodische Weitentwicklung der konventionellen transanalen Stapler-Resektion des Rektums (STARR) zur Behandlung eines obstruktiven Defäkationssyndroms (ODS) und/oder eines externen Rektumprolapses. Im Gegensatz zum konventionellen STARR wird dabei ein einzelner offen-gebogener Stapler verwendet, mit dem die Rektumwand zirkulär durchtrennt und anastomosiert wird. Hierdurch wird eine Monoblockresektion mit uneingeschränktem Resektionsausmaß möglich. Die Datenlage muss hinsichtlich der Indikationen ODS und externer Rektumprolaps unterschiedlich betrachtet werden. Generell erweist sich das Verfahren sowohl in monozentrischen als auch in multizentrischen Studien als effektiv zur Behandlung des ODS bei Intussuszeption und Rektozele. Im Vergleich zum konventionellen STARR sind die Resektate dabei größer und die funktionelle Wirksamkeit vergleichbar. Im prospektiv-randomisierten Vergleich ist darüber hinaus eine höhere Effektivität im Langzeitverlauf dokumentiert. Bezüglich des externen Prolapses bestehen Machbarkeitsstudien mit geringer Morbidität, allerdings deuten erste Langzeitstudien auf eine hohe Rezidivhäufigkeit von >40 % hin.

Abstract

The Contour® Transtar™ operation represents a further methodological development of conventional transanal stapled rectal resection (STARR) for the treatment of obstructed defecation syndrome (ODS) and/or full thickness rectal prolapse. In contrast to the conventional STARR technique a specially designed single curved stapler is used with which the rectal wall is incised in a circular fashion and anastomosed. This results in a monoblock resection with almost unlimited extent of resection. In multicenter studies the procedure has generally been shown to be effective for treatment of ODS with intussusception and rectocele. In comparison to conventional STARR the resected tissue samples are larger and the functional effectiveness is comparable. Furthermore, data from prospective randomized trials revealed higher effectiveness in long-term follow-up. With reference to full thickness rectal prolapse, feasibility studies have been performed which showed low morbidity but long-term follow-up studies suggest a high recurrence rate of >40 %.

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  1. Klinik & Allgemein-, Viszeral- und koloproktologische Chirurgie, Ev. Amalie Sieveking-Krankenhaus, Haselkamp 33, 22359, Hamburg, Deutschland

    C. Isbert

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Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Isbert, C. Transtar™-Operation bei Rektozele und obstruktivem Defäkationssyndrom. Chirurg 87, 924–932 (2016). https://doi.org/10.1007/s00104-016-0298-7

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  • DOI: https://doi.org/10.1007/s00104-016-0298-7

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