{"id":4081,"date":"2023-04-04T13:46:30","date_gmt":"2023-04-04T11:46:30","guid":{"rendered":"http:\/\/berlin-boehm.de\/Kanty\/?p=4081"},"modified":"2023-04-04T13:46:31","modified_gmt":"2023-04-04T11:46:31","slug":"stomarueckverlagerung","status":"publish","type":"post","link":"http:\/\/berlin-boehm.de\/Kanty\/archive\/4081","title":{"rendered":"Stomar\u00fcckverlagerung"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_one_full-7acc1372e522d1472d3487e02738ae1c\">\n.flex_column.av-av_one_full-7acc1372e522d1472d3487e02738ae1c{\nbackground-color:#22689e;\n}\n<\/style>\n<div  class='flex_column av-av_one_full-7acc1372e522d1472d3487e02738ae1c av_one_full  avia-builder-el-0  el_before_av_hr  avia-builder-el-first  first flex_column_div  '     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-lg270zs8-b875f3087c85ac14795e53beac4f3976\">\n#top .av-special-heading.av-lg270zs8-b875f3087c85ac14795e53beac4f3976{\nmargin:20px 20px 20px 20px;\npadding-bottom:0;\ncolor:#ffffff;\n}\nbody .av-special-heading.av-lg270zs8-b875f3087c85ac14795e53beac4f3976 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n#top #wrap_all .av-special-heading.av-lg270zs8-b875f3087c85ac14795e53beac4f3976 .av-special-heading-tag{\npadding:5px 5px 5px 5px;\n}\n.av-special-heading.av-lg270zs8-b875f3087c85ac14795e53beac4f3976 .special-heading-inner-border{\nborder-color:#ffffff;\n}\n.av-special-heading.av-lg270zs8-b875f3087c85ac14795e53beac4f3976 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-lg270zs8-b875f3087c85ac14795e53beac4f3976 av-special-heading-h3 custom-color-heading blockquote classic-quote  avia-builder-el-1  avia-builder-el-no-sibling '><h3 class='av-special-heading-tag '  itemprop=\"headline\"  >Stomar\u00fcckverlagerung<\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><\/div><div  class='hr av-av_hr-91d7ccd583a503147498e120fee2ff9b hr-default  avia-builder-el-2  el_after_av_one_full  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><\/p>\n<section  class='av_textblock_section av-lg272vad-2f7600b25a75c1216b09226a8185f85d '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p>Darmvorbereitung. Vor der R\u00fcckverlagerung eines doppell\u00e4ufigen Stomas sollte der Darm ad\u00e4quat vorbereitet werden, um die Inzidenz von Wundinfektionen zu minimieren. Eine perioperative Antibiotikaprophylaxe gemeinsam mit einer sorgf\u00e4ltigen Operationstechnik tragen ebenfalls zu einer Infektionsverh\u00fctung bei.<\/p>\n<h4>Operation<\/h4>\n<p>Die Haut wird quer am Stoma inzidiert. Dabei sollte so viel gesunde Haut wie irgend m\u00f6glich erhalten bleiben, um einen sp\u00e4teren spannungsfreien Hautverschluss zu erm\u00f6glichen. Nach vollst\u00e4ndiger Mobilisation des Darmes wird die Er\u00f6ffnung entweder direkt verschlossen oder nach Resektion eine Anastomose angelegt. Neben der \u00fcblichen handgen\u00e4hten Anastomose hat sich die funktionelle End-zu-End-Anastomose mit dem geraden Klammernahtger\u00e4t bew\u00e4hrt. Dazu werden die beiden Darmschenkel antimesenterial aneinander gelegt und durch die Enterotomien ein Klammernahtger\u00e4t appliziert. Danach wird die Enterotomie mit einer Naht oder einem weiteren Klammernahtger\u00e4t verschlossen. Die Faszie wird vorzugsweise quer mit einer fortlaufenden resorbierenden Polydioxanon-Schlinge verschlossen. Das Subkutangewebe wird mit Einzeln\u00e4hten adaptiert, um den Hohlraum zu verkleinern. Eine Redon-Drainage wird f\u00fcr drei Tage eingelegt. Die Haut wird prim\u00e4r mit R\u00fcckstichn\u00e4hten verschlossen.<\/p>\n<div class=\"ir\">\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone  wp-image-3803\" src=\"http:\/\/berlin-boehm.de\/wp-content\/uploads\/2023\/04\/rueck1-138x300.jpg\" alt=\"\" width=\"215\" height=\"467\" srcset=\"http:\/\/berlin-boehm.de\/wp-content\/uploads\/2023\/04\/rueck1-138x300.jpg 138w, http:\/\/berlin-boehm.de\/wp-content\/uploads\/2023\/04\/rueck1.jpg 300w\" sizes=\"auto, (max-width: 215px) 100vw, 215px\" \/><img loading=\"lazy\" decoding=\"async\" class=\"alignnone  wp-image-3804\" src=\"http:\/\/berlin-boehm.de\/wp-content\/uploads\/2023\/04\/rueck2-175x300.jpg\" alt=\"\" width=\"237\" height=\"406\" srcset=\"http:\/\/berlin-boehm.de\/wp-content\/uploads\/2023\/04\/rueck2-175x300.jpg 175w, http:\/\/berlin-boehm.de\/wp-content\/uploads\/2023\/04\/rueck2.jpg 300w\" sizes=\"auto, (max-width: 237px) 100vw, 237px\" \/><\/p>\n<p class=\"caption\"><b><i>R\u00fcckverlagerung des Ileostomas durch Klammern\u00e4hte<\/i><\/b><\/p>\n<\/div>\n<h4>Komplikationen<\/h4>\n<p>Auch wenn die R\u00fcckverlagerung als kleiner Eingriff imponiert, enth\u00e4lt er doch alle Bestandteile eines schwierigen Darmeingriffes: Sorgf\u00e4ltige Pr\u00e4paration aus der Bauchdecke, Anfertigung einer intestinalen Anastomose und sorgf\u00e4ltiger schichtweiser Verschluss der Bauchdecke. Dementsprechend vielschichtig k\u00f6nnen auch die Komplikationen sein. Angefangen von einer Nachblutung, Anastomoseninsuffizienz, Hernie und Wundinfektion k\u00f6nnen alle Komplikationen auftreten, so dass der Patient gut \u00fcberwacht werden sollte.<\/p>\n<h4>Inkontinenz<\/h4>\n<p>Nach R\u00fcckverlegung eines protektiven Ileostomas nach koloanaler Anastomose ist h\u00e4ufig direkt postoperativ ein d\u00fcnnfl\u00fcssiger Stuhl nachweisbar, der aufgrund der geringen Compliance des Kolonreservoirs und der verminderten Verschlusskraft des Sphinkters zu einer partiellen oder kompletten Inkontinenz f\u00fchrt. Dem kann durch eine pr\u00e4operative Beckenbodengymnastik etwas vorgebeugt werden. Sehr hilfreich ist hier die Applikation von obstipierenden Substanzen wie Loperamid und die Gabe von Darmkeimen, um die Darmflora neu aufzubauen.<\/p>\n<\/div><\/section>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_themeisle_gutenberg_block_has_review":false,"footnotes":""},"categories":[34],"tags":[],"class_list":["post-4081","post","type-post","status-publish","format-standard","hentry","category-chirurgie"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Stomar\u00fcckverlagerung - Berliner Gelassenheit<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/berlin-boehm.de\/Kanty\/archive\/4081\" \/>\n<meta property=\"og:locale\" content=\"de_DE\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Stomar\u00fcckverlagerung - 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