Abstract
Hintergrund
Der Einsatz von Netzen gibt der Rektopexie durch mechanische Unterstützung sowie durch Induktion der Narbenbildung Stabilität. Ein Problem der herkömmlichen Rektopexieverfahren ist allerdings, dass viele Patienten postoperativ unter funktionellen Störungen wie Inkontinenz und v. a. Stuhlentleerungsstörungen leiden. Ursache ist die zur Netzeinlage erforderliche dorsale und laterale Mobilisation des Rektums, bei der die vegetativen Nerven häufig geschädigt werden. D´Hoore und Penninckx beschrieben im Jahr 2004 eine neue Technik der abdominellen Rektopexie mit Operation des Rektumprolapses unter Schonung der autonomen Nerven – die ventrale Rektopexie.
Fragestellung
Bietet die ventrale Rektopexie Vorteile bezüglich des funktionellen Outcomes, der Komplikations- und Rezidivrate?
Material und Methode
Darstellung und Auswertung der aktuellen Studienlage zur ventralen Rektopexie durch Recherche in medizinischen Datenbanken (PubMED, Medline).
Ergebnisse
Die ventrale Rektopexie zeichnet sich durch eine geringe Komplikationsrate und gute funktionelle Ergebnisse in Bezug auf die Verbesserung der Inkontinenz und Obstipationsneigung bzw. Stuhlentleerungsstörung auf. Als Indikation gilt der äußere Rektumprolaps. Aber auch der innere Rektumprolaps, die große Rektozele sowie die Enterozele mit konsekutivem obstruktivem Defäkationssyndrom stellen bei einem ausgewählten Patientenkollektiv relative Indikationen für die ventrale Rektopexie dar.
Schlussfolgerung
Um eine valide Einschätzung bezüglich der Wertigkeit des Verfahrens zu geben, ist es entscheidend, die derzeit fehlende Evidenz (Level 3), in Zukunft insbesondere durch prospektiv randomisierte Studien, die die ventrale Rektopexie mit anderen Operationsmethoden und auch mit nichtchirurgischen Behandlungsmethoden vergleichen, zu verbessern.
Abstract
Background
In rectopexy the use of meshes provides stability by mechanical support as well as by the induction of scar formation; however, one of the problems of conventional methods of mesh rectopexy is that many patients postoperatively suffer from functional disorders, such as fecal incontinence and stool evacuation disorders. One reason is the damage of vegetative nerves following dorsal and lateral mobilization of the rectum, which is required for positioning of the mesh. In 2004 D’Hoore and Penninckx first described the method of ventral rectopexy, a new technique of mesh rectopexy which allows preservation of the autonomic nerves.
Objective
Does ventral rectopexy provide advantages regarding functional outcome, complications and recurrence rates?
Material and methods
A search was carried out in the databases PubMed and Medline for studies on ventral rectoplexy. Presentation and analysis of the current state of relevant studies relating to ventral rectopexy.
Results
Ventral rectopexy is characterized by a low complication rate and good functional results in terms of improvement of incontinence, constipation and stool evacuation disorders. The indications for ventral rectopexy are considered in patients with external prolapse of the rectum. Also in a well-selected patient population internal prolapse, rectocele as well as enterocele accompanied by obstructive defecation syndrome represent relative indications for ventral rectopexy.
Conclusion
In order to obtain a valid assessment of the value of this procedure it is crucial to improve the current lack of evidence (level 3) by prospective randomized studies that compare ventral rectopexy with other surgical techniques and nonsurgical treatment options.
Literatur
Corman ML (1988) Rectal prolapse. Surgical techniques. Surg Clin North Am 68(6):1255–1265
Ceci F, Spaziani E, Corelli S, Casciaro G, Martellucci A, Costantino A, Napoleoni A, Cipriani B, Nicodemi S, Di Grazia C, Avallone M, Orsini S, Tudisco A, Aiuti F, Stagnitti F (2013) Technique and outcomes about a new laparoscopic procedure: the Pelvic Organ Prolapse Suspension (POPS). G Chir 34(5–6):141–144
Ripstein CB (1952) Treatment of massive rectal prolapse. Am J Surg 83(1):68–71
Dechen J, Daniel M (1959) Surgical treatment of total prolapse of the rectum by rectopexy following the Orr-Loygue method; concerning two observations. Memoires 85(4–5):109–112
Wells C (1959) New operation for rectal prolapse. Proc R Soc Med 52:602–603
Deucher F (1960) Ventral rectopexy in the treatment of rectal prolapse. Helv Chir Acta 27:240–246
D’Hoore A, Cadoni R, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91(11):1500–1505
D’Hoore A, Penninckx F (2006) Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc 20(12):1919–1923
Tou S, Brown SR, Nelson RL (2015) Surgery for complete (full-thickness) rectal prolapse in adults. Cochrane Database Syst Rev 11:CD001758
Faucheron JL, Trilling B, Girard E, Sage PY, Barbois S, Reche F (2015) Anterior rectopexy for full-thickness rectal prolapse: Technical and functional results. World J Gastroenterol 21(16):5049–5055
Collinson R, Wijffels N, Cunningham C, Lindsey I (2009) Laparoscopic ventral rectopexy for internal rectal prolapse: short-term functional results. Colorectal Dis 12(2):97–104
Formijne Jonkers HA, Poierrie N, Draaisma WA, Broeders IA, Consten EC (2013) Laparoscopic ventral rectopexy for rectal prolapse and symptomatic rectocele: an analysis of 245 consecutive patients. Colorectal Dis 15(6):695–699
Portier G, Kirzin S, Cabarrot P, Queralto M, Lazorthes F (2011) The effect of abdominal ventral rectopexy on faecal incontinence and constipation in patients with internal intra-anal rectal intussusception. Colorectal Dis 13(8):914–917
Abet E, Lehur PA, Wong M, Rigaud J, Darnis E, Meurette G (2012) Sexual function and laparoscopic ventral rectopexy for complex rectocoele. Colorectal Dis 14(10):721–726
Wong M, Meurette G, Abet E, Podevin J, Lehur PA (2011) Safety and efficacy of laparoscopic ventral mesh rectopexy for complex rectocele. Colorectal Dis 13(9):1019–1023
Wong MT, Abet E, Rigaud J, Frampas E, Lehur PA, Meurette G (2011) Minimally invasive ventral mesh rectopexy for complex rectocoele: impact on anorectal and sexual function. Colorectal Dis 13(10):320–326
Mercer-Jones MA, D’Hoore A, Dixon AR, Lehur P, Lindsey I, Mellgren A, Stevenson AR (2013) Consensus on ventral rectopexy: report of a panel of experts. Colorectal Dis 16(2):82–88
Smart NJ, Pathak S, Boorman P, Daniels IR (2013) Synthetic or biological mesh use in laparoscopic ventral mesh rectopexy – a systematic review. Colorectal Dis 15(6):650–654
Ogilvie JW Jr., Stevenson AR, Powar M (2014) Case-matched series of a non-cross-linked biologic versus non-absorbable mesh in laparoscopic ventral rectopexy. Int J Colorectal Dis 29(12):1477–1483
Sileri P, Franceschilli L, de Luca E, Lazzaro S, Angelucci GP, Fiaschetti V, Pasecenic C, Gaspari AL (2012) Laparoscopic ventral rectopexy for internal rectal prolapse using biological mesh: postoperative and short-term functional results. J Gastrointest Surg 16(3):622–628
Wahed S, Ahmad M, Mohiuddin K, Katory M, Mercer-Jones M (2011) Short-term results for laparoscopic ventral rectopexy using biological mesh for pelvic organ prolapse. Colorectal Dis 14(10):1242–1247
Franceschilli L, Varvaras D, Capuano I et al (2015) Laparoscopic ventral rectopexy using biologic mesh for the treatment of obstructed defaecation syndrome and/or faecal incontinence in patients with internal rectal prolapse: a critical appraisal of the first 100 cases. Tech Coloproctol 19(4):209–219
Makela-Kaikkonen J, Rautio T, Paakko E et al (2016) Robot-assisted versus laparoscopic ventral rectopexy for external, internal rectal prolapse and enterocele: a randomised controlled trial. Colorectal Dis. doi:10.1111/codi.13309.
Mantoo S, Podevin J, Regenet N, Rigaud J, Lehur PA, Meurette G (2013) Is robotic-assisted ventral mesh rectopexy superior to laparoscopic ventral mesh rectopexy in the management of obstructed defaecation? Colorectal Dis 15(8):e469–e475
Mehmood RK, Parker J, Bhuvimanian L, Qasem E, Mohammed AA, Zeeshan M, Grugel K, Carter P, Ahmed S (2014) Short-term outcome of laparoscopic versus robotic ventral mesh rectopexy for full-thickness rectal prolapse. Is robotic superior? Int J Colorectal Dis 29(9):1113–1118
Wong MT, Meurette G, Rigaud J, Regenet N, Lehur PA (2011) Robotic versus laparoscopic rectopexy for complex rectocele: a prospective comparison of short-term outcomes. Dis Colon Rectum 54(3):342–346
Wijffels N, Cunningham C, Dixon A, Greenslade G, Lindsey I (2011) Laparoscopic ventral rectopexy for external rectal prolapse is safe and effective in the elderly. Does this make perineal procedures obsolete? Colorectal Dis 13(5):561–566
Gultekin FA, Wong MT, Podevin J, Barussaud ML, Boutami M, Lehur PA, Meurette G (2015) Safety of laparoscopic ventral rectopexy in the elderly: results from a nationwide database. Dis Colon Rectum 58(3):339–343
Badrek-Al Amoudi AH, Greenslade GL, Dixon AR (2013) How to deal with complications after laparoscopic ventral mesh rectopexy: lessons learnt from a tertiary referral centre. Colorectal Dis 15(6):707–712
Evans C, Stevenson AR, Sileri P, Mercer-Jones MA, Dixon AR, Cunningham C, Jones OM, Lindsey I (2015) A Multicenter collaboration to assess the safety of Laparoscopic ventral rectopexy. Dis Colon Rectum 58(8):799–807
Vujovic Z, Cuarana E, Campbell KL, Valentine N, Koch S, Ziyaie D (2015) Lumbosacral discitis following laparoscopic ventral mesh rectopexy: a rare but potentially serious complication. Tech Coloproctol 19(4):263–265
Mackenzie H, Dixon AR (2014) Proficiency gain curve and predictors of outcome for laparoscopic ventral mesh rectopexy. Surgery 156(1):158–167
Consten EC, van Iersel JJ, Verheijen PM, Broeders IA, Wolthuis AM, D’Hoore A (2015) Long-term outcome after Laparoscopic ventral mesh Rectopexy: an observational study of 919 consecutive patients. Ann Surg 262(5):742–747 (discussion 747–748)
Gouvas N, Georgiou PA, Agalianos C, Tan E, Tekkis P, Dervenis C, Xynos E (2015) Ventral colporectopexy for overt rectal prolapse and obstructed defaecation syndrome: a systematic review. Colorectal Dis 17(2):O34–46
Nazemi TM, Kobashi KC (2007) Complications of grafts used in female pelvic floor reconstruction: Mesh erosion and extrusion. Indian J Urol 23:153–160
Food and Drug Administration, HHS (2016) Obstetrical and Gynecological Devices: Reclassification of surgical mesh for transvaginal pelvic organ prolapse repair; final order. Fed Regist 81:353–361
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S. Kersting, K.-P. Jung und E. Berg geben an, dass kein Interessenkonflikt besteht.
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Kersting, S., Jung, KP. & Berg, E. Alloplastisches Material in der Prolapschirurgie. Chirurg 88, 141–146 (2017). https://doi.org/10.1007/s00104-016-0264-4
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DOI: https://doi.org/10.1007/s00104-016-0264-4