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DOI: 10.1055/s-2005-836313
© Georg Thieme Verlag Stuttgart · New York
Therapeutische Strategie bei Anastomoseninsuffizienz nach tiefer anteriorer Rektumresektion
Therapeutic Strategy for Anastomotic Leakage Following Low Anterior ResectionPublication History
Publication Date:
02 March 2005 (online)
![](https://www.thieme-connect.de/media/viszeralchirurgie/200501/lookinside/thumbnails/10.1055-s-2005-836313-1.jpg)
Zusammenfassung
Einleitung: Die Anastomoseninsuffizienz (AI) nach tiefer anteriorer Rektumresektion ist eine Komplikation mit hoher Morbidität und Mortalität. Ziel der vorliegenden Untersuchung war es, die Ergebnisse einer standardisierten therapeutischen Strategie zu überprüfen. Patienten und Methode: Eingeschlossen wurden alle zwischen 1992 und 2002 elektiv operierten Patienten mit Rektumkarzinom. Es wurde eine tiefe anteriore Resektion mit totaler mesorektaler Exzision sowie eine Retroperitonealisierung der Anastomose durchgeführt. Ein protektives Stoma wurde primär nicht angelegt. Eine Leckage wurde mittels Endoskopie, Kolonkontrasteinlauf und Abdomen-CT diagnostiziert. Als „minor leakage” wurden Insuffizienzen eingestuft, die ohne operative Intervention behandelt werden konnten (CT-gesteuerte Drainage, endoskopische Behandlung mittels Vakuumdrainage (Endo-VAC) oder Spülung). Eine „major leakage” lag vor, wenn eine operative Therapie erforderlich wurde (protektive Ileostomie, Neuanlage der Anastomose oder Hartmann-Situation). Ergebnisse: Von 460 operierten Patienten entwickelten 47 (major leakage: 3,7 %, minor leakage: 6,5 %) eine Anastomoseninsuffizienz. 30 Patienten wurden konservativ mittels Endo-VAC (n = 21) bzw. CT-gesteuert eingelegter Drainagen (n = 9) therapiert. Operativ („major leakage”) wurden 17 Patienten behandelt (n = 9 nur Ileostomie, n = 8 Anastomosenneuanlage, n = 2 Hartmann-OP). Bei keinem Patienten trat eine Peritonitis auf. Die Letalität der Patienten mit Leckagen war im Vergleich zum Gesamtkollektiv nicht erhöht (4,3 % mit AI vs. 4,8 % ohne AI). Schlussfolgerung: Die Retroperitonealisierung der Anastomose erscheint als eine sinnvolles operatives Konzept, um eine Peritonitis und deletäre klinische Konsequenzen einer Anastomosenleckage zu verhindern. Das hier vorgestellte Therapiekonzept führte zu guten Resultaten bezüglich Morbidität und Letalität.
Abstract
Introduction: Anastomotic leakage (AL) following low anterior resection for rectal cancer is a complication with a high morbidity and mortality. Thoroughly evaluated treatment strategies do not exist. The aim of the study was to analyze the results of a standardized approach in anastomotic leakage. Methods: From January 1992 through December 2002 all patients with rectal cancer electively undergoing low anterior resection with retroperitonealization of the anastomosis were included. The diagnostic included laboratory parameters, endoscopy, contrast enema and abdominal CT scans. Minor leakage was defined as AL without necessity for surgical intervention (rectoscopic lavage, Endo-VAC and CT-guided drainage, respectively). A major leakage was treated by protective ileostomy, revision of the anastomosis with loop ileostomy or Hartmann's procedure. Results: In 460 patients (238 male, 222 female) a low anterior resection was performed. An anastomotic leakage was diagnosed in 47 patients (overall 10,2 %, 17 major leakages (3.7 %), 30 minor leakages (6.5 %)). 30 patients were treated conservatively by Endo-VAC (n = 21) and CT-guided insertion of a drainage (n = 9), respectively. 17 patients were treated operatively (8 anastomotic revision, 9 ileostomy alone). In 2 patients Hartmann's procedure was necessary. No patient developed a peritonitis. We observed no statistical difference concerning mortality rates between leakage and non-leakage group (4.3 % AL vs. 4.8 % non-AL). Conclusion: Retroperitonealization of the anastomosis appears to be a reasonable approach to prevent peritonitis in patients with anastomotic leakage following low anterior resection. The introduced treatment pattern lead to decent results in terms of mortality and anorectal function.
Schlüsselwörter
Rektumkarzinom - tiefe anteriore Resektion - Anastomoseninsuffizienz
Key words
Rectal cancer - low anterior resection - anastomotic leakage
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OA Dr. med. Christian Eckmann
Klinik für Chirurgie · Universitätsklinikum Schleswig-Holstein · Campus Lübeck
Ratzeburger Allee 160
23538 Lübeck
Phone: 04 51/5 00/36 22
Fax: 04 51/5 00/20 69
Email: chr.eckmann@gmx.de