Systematik und stadienadaptierte Therapie von Analstenosen

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• 作者：Prof. Dr. H.-R. Raab ; D. Antolovic ; F. Alfarawan ; A. Troja…
• 关键词：Analstenose ; Stadieneinteilung ; Analplastik ; 脛tiologie ; H盲morrhoidektomie ; Anal sphincter ; Classification ; Anal surgery ; Etiology ; Hemorrhoidectomy
• 刊名：Der Gastroenterologe
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：10
• 期：3
• 页码：203-209
• 全文大小：394 KB
• 参考文献：1.Alver O, Ersoy YE, Aydemir I et al (2008) Use of 鈥瀐ouse鈥?advancement flap in anorectal diseases. World J Surg 32:2281鈥?286View Article PubMed
  2.Angelchik PD, Harms BA, Starling JR (1993) Repair of anal stricture and mucosal ectropion with Y-V or pedicle flap anoplasty. Am J Surg 166:55鈥?9View Article PubMed
  3.Bouchard D, Abramowitz L, Castinel A et al (2013) One-ear outcome of haemorrhoidectomy: a prospective ulticenre French study. Colorectal Dis 15:719鈥?26View Article PubMed
  4.Bouguen G, Siproudhis L, Bretagne JF et al (2010) Nonfistulizing perianal Crohn鈥檚 disease: clinical features, epidemiology, and treatment. Inflamm Bowel Dis 16:1431鈥?442View Article PubMed
  5.Brisinda G (2000) How to treat haemorrhoids. Prevention is best; haemorrhoidectomy needs skilled operators. BMJ 321:582鈥?83View Article PubMed Central PubMed
  6.Brisinda G, Vanella S, Cadeddu F et al (2009) Surgical treatment of anal stenosis. World J Gastroenterol 15:1921鈥?928View Article PubMed Central PubMed
  7.Brochard C, Siproudhis L, Wallenhorst T et al (2014) Anorectal stricture in 102 patients with Crohn鈥檚 disease: natural history in the era of biologics. Aliment Pharmacol Ther 40:796鈥?03View Article PubMed
  8.Casadesus D, Villasana LE, Diaz H et al (2007) Treatment of anal stenosis: a 5-year review. ANZ J Surg 77:557鈥?59View Article PubMed
  9.De Zoeten EF, Pasternak BA, Mattei P et al (2013) Diagnosis and treatment of perianal Crohn disease: NASPGHAN clinical report and consensus statement. J Pediatr Gastroenterol Nutr 57:401鈥?12View Article
  10.Habr-Gama A, Sobrado CW, De Araujo SE et al (2005) Surgical treatment of anal stenosis: assessment of 77 anoplasties. Clinics 60:17鈥?0View Article PubMed
  11.Katdare MV, Ricciardi R (2010) Anal stenosis. Surg Clin North Am 90:137鈥?45 (Table of Contents)View Article PubMed
  12.Khubchandani IT (1994) Anal stenosis. Surg Clin North Am 74:1353鈥?360PubMed
  13.Kumar A, Daga R, Vijayaragavan P et al (2011) Anterior resection for rectal carcinoma 鈥?risk factors for anastomotic leaks and strictures. World J Gastroenterol 17:1475鈥?479View Article PubMed Central PubMed
  14.Liberman H, Thorson AG (2000) How I do it. Anal stenosis. Am J Surg 179:325鈥?29View Article PubMed
  15.Manfredelli S, Montalto G, Leonetti G et al (2012) Conventional (CH) vs. stapled hemorrhoidectomy (SH) in surgical treatment of hemorrhoids. Ten years experience. Ann Ital Chir 83:129鈥?34PubMed
  16.Maria G, Alfonsi G, Nigro C et al (2001) Whitehead鈥檚 hemorrhoidectomy. A useful surgical procedure in selected cases. Tech Coloproctol 5:93鈥?6View Article PubMed
  17.Maria G, Brisinda G, Civello IM (1998) Anoplasty for the treatment of anal stenosis. Am J Surg 175:158鈥?60View Article PubMed
  18.Milsom JW, Mazier WP (1986) Classification and management of postsurgical anal stenosis. Surg Gynecol Obstet 163:60鈥?4PubMed
  19.Ommer A, Wenger FA, Rolfs T et al (2008) Continence disorders after anal surgery 鈥?a relevant problem? Int J Colorectal Dis 23:1023鈥?031View Article PubMed
  20.Ravo B, Amato A, Bianco V et al (2002) Complications after stapled hemorrhoidectomy: can they be prevented? Tech Coloproctol 6:83鈥?8View Article PubMed
  21.Rondelli F, Mariani L, Tassi A et al (2011) Closed hemorrhoidectomy with linear stapler: a consecutive series of 300 patients. In Vivo 25:1003鈥?007PubMed
  22.Shawki S, Costedio M (2013) Anal fissure and stenosis. Gastroenterol Clin North Am 42:729鈥?58View Article PubMed
  23.Thin NN, Carrington EV, Grimmer K et al (2011) Advancement anoplasty and sacral nerve stimulation: an effective combination for radiation-induced anal stenosis. Int J Colorectal Dis 26:211鈥?13View Article PubMed
  24.Wolff BG, Culp CE (1988) The Whitehead hemorrhoidectomy. An unjustly maligned procedure. Dis Colon Rectum 31:587鈥?90View Article PubMed
  25.Wronski K, Bocian R (2012) Surgical excision of extensive anal condylomata is a safe operation without risk of anal stenosis. Postepy Hig Med Dosw 66:153鈥?57
  
• 作者单位：Prof. Dr. H.-R. Raab (1)
  D. Antolovic (1)
  F. Alfarawan (1)
  A. Troja (1)
  H. Bruns (1)
  
  1. Universit盲tsklinik f眉r Allgemein- und Viszeralchirurgie, Klinikum Oldenburg, Medizinischer Campus der Carl von Ossietzky-Universit盲t, Rahel-Straus-Str. 10, 26133, Oldenburg, Deutschland
  
• 刊物主题：Gastroenterology; General Practice / Family Medicine; Internal Medicine; Hepatology; Infectious Diseases; Oncology;
• 出版者：Springer Berlin Heidelberg
• ISSN：1861-969X

文摘

Background Anal stenoses can be classified as acute, chronic, primary and secondary and lead to relevant impairment of the affected patients. While primary anal stenosis is usually congenital, secondary stenosis occurs as a result of chronic inflammatory processes of the anal canal or following therapeutic, especially proctologic procedures, or after radiation. Other causes include chronic laxative abuse or infection. Etiology In up to 90% of cases, chronic anal stenosis is secondary to hemorrhoidectomy. It occurs during the postoperative course in up to 10% of hemorrhoidectomies. Careful patient selection for anal surgery and an optimal proctology surgical technique are therefore the best prevention. Specifically, when performing a hemorrhoidectomy, tissue damage should be limited to achieve the best possible anoderm. Stapled hemorrhoidectomy is still controversial, and it is probably advantageous only in selected patients. Treatment A detailed history as well as physical and digital rectal examinations are essential for the success of anal stenosis treatment. Measurement of the residual diameter of the anal canal with Hegar dilators improves objectivity and comparability. A diet high in fiber is recommended for anal stenoses of all stages, which facilitates defecation and results in softer stools. Incidentally, stage-adapted treatment of anal stenoses taking into account the etiology has been proven. Surgical treatment is only indicated in higher-grade stenosis, which are generally treated with anoplasty. Supportive dietary measures should be continued postoperatively. In addition, the use of an anal dilators by the patient can help improve surgical success.