Tailored Approach in der Therapie der Hämorrhoidalleiden

Zusammenfassung

Das symptomatische Hämorrhoidalleiden ist einer der häufigsten Gründe für das Aufsuchen einer koloproktologischen Einrichtung. Neben der typischen Anamnese ist der Untersuchungsbefund inkl. Proktoskopie wegweisend. Die überwiegende Mehrheit der Patienten kann konservativ mit sehr gutem Ergebnis hinsichtlich der Lebensqualität behandelt werden. Insbesondere durch Basistherapie mit Stuhlregulation, korrektem Stuhlverhalten und Sklerosierungstherapie kann stadienunabhängig eine gute Symptomkontrolle erreicht werden. Bei Versagen der konsequenten konservativen Therapie stehen verschiedene operative Verfahren zur Verfügung. Entscheidend für die Auswahl des Verfahrens ist der individuelle Befund des Patienten im Sinne eines Tailored Approachs. Neben den klassischen segmental resezierenden sowie zirkulär pexierenden Operationen gehören auch neuere, z. T. weniger invasive Methoden wie Hämorrhoidalarterienligatur mit und ohne Rectoanal Repair (HAL-RAR), Infrarottherapie (IRT), Lasertherapie (LT) und Radiofrequenzablation (RFA) zum chirurgischen Repertoire. Blutung, Schmerz, Inkontinenz sowie Rezidiv stellen mögliche Risiken der operativen Therapie dar.

Abstract

One of the most common reasons to consult a coloproctologist is symptomatic haemorrhoids. Typical signs and symptoms as well as a specialised examination, including proctoscopy, are essential for the correct diagnosis. The vast majority of patients can be treated conservatively with excellent results in terms of quality of life. Sclerotherapy provides good control of symptoms at any stage of haemorrhoidal disease. If conservative treatment fails, there are various surgical options. A tailored approach is mandatory. Besides well-known procedures such as Fergusson, Milligan-Morgan procedure or haemorrhoidopexy (Longo) there are less invasive options such as HAL-RAR, IRT, LT and RFA. Postoperative bleeding, pain and faecal incontinence are rare complications after surgery.

Schlüsselwörter

chirurgische Therapie - Tailored Approach - Hämorrhoiden - konservative Therapie

Keywords

hemorrhoids - conservativ therapy - surgery - tailored approach

Publikationsverlauf

Eingereicht: 05. März 2023

Angenommen nach Revision: 28. März 2023

Artikel online veröffentlicht:
02. Juni 2023

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