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Extralevatorische abdominoperineale Exstirpation (ELAPE)

Extralevator abdominoperineal excision. German version

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coloproctology Aims and scope

Zusammenfassung

Die extra-levatorische abdomino-perineale Rektumexstirpation (ELAPE) stellt ein Operationsverfahren dar, welches eine Lösung für die enttäuschenden Ergebnisse der konventionellen abdomino-perinealen Rektumexstirpation (APE) in Bezug auf die Rate an unbeabsichtigten Rektumperforationen, positiven zirkumferentiellen Resektionsrändern (CRM) und Lokalrezidiven bietet. Das wichtigste Prinzip dieser Operation ist es, die Präparationsebene von der Risikozone für Perforationen und positiven CRM, dem anorektalen Übergang, nach außen zu verschieben. Erreicht wird dies durch die Resektion des M. levator ani, dessen Außenseite die Präparation bis nah an seinen Ursprung heran folgt. Im anterioren Resektionsgebiet kann präzise durch den komfortablen Zugang mittels Klappmesserposition operiert werden. Alle diese Maßnahmen sind darauf gerichtet, eine Taille im Bereich des anorektalen Überganges zu vermeiden. In diesem Beitrag wird das Verfahren inklusive Strategien zum Verschluss des resultierenden Defektes detailliert beschrieben. In einem kurzen Literaturüberblick werden die Resultate der ELAPE diskutiert.

Zusammenfassung. Die perineale Phase der ELAPE ist hochstandardisiert und kann Schritt-für-Schritt vermittelt werden. Durch die ELAPE werden die Raten an unbeabsichtigter Rektumperforation, positivem CRM und Lokalrezidiven beim Rektumkarzinom verringert.

Abstract

Extralevator abdominoperineal excision (ELAPE) has been introduced to alleviate the disappointing results of conventional abdominoperineal excision (APE) with respect to inadvertent bowel perforation, positive circumferential resection margins (CRM), and local recurrence rates. The main principle of this operation is to shift the resection plane away from the anorectal junction, which is the area at highest risk of perforation and CRM positivity. This is accomplished by resection of the levator ani muscle, which is followed at its outer surface close to its origin at the pelvic side wall. The anterior region is also addressed with comfortable access to the dissection area by placement of the patient in prone jackknife position. All measures aim to avoid a waist at the anorectal junction. This article describes the procedure in detail, including strategies to close the perineal defect. In a brief review of the literature, the favorable results of ELAPE are discussed.

Conclusion. It can be concluded that the perineal phase of ELAPE is highly standardized and can be taught in a step-by-step fashion. There is evidence that ELAPE results in lower rates of inadvertent bowel perforations, lower rates of positive CRM, and lower rates of local recurrence.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral und Thoraxchirurgie, Krankenhaus Dresden-Friedrichstadt, Friedrichstr. 41, 01067, Dresden, Deutschland

    Sigmar Stelzner

  2. Department of Surgery, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 118 83, Stockholm, Schweden

    Torbjörn Holm

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  1. Sigmar Stelzner
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Correspondence to Sigmar Stelzner or Torbjörn Holm.

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Interessenkonflikt

S. Stelzner und T. Holm geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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Stelzner, S., Holm, T. Extralevatorische abdominoperineale Exstirpation (ELAPE). coloproctology 43 (Suppl 1), 1–10 (2021). https://doi.org/10.1007/s00053-019-00422-y

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