International Journal of Colorectal Disease

, Volume 28, Issue 1, pp 127–138

Appendectomy in Germany—an analysis of a nationwide survey 2011/2012

  • Dirk Rolf Bulian
  • Jürgen Knuth
  • Axel Sauerwald
  • Michael Alfred Ströhlein
  • Rolf Lefering
  • Jörg Ansorg
  • Markus Maria Heiss
Original Article

Abstract

Introduction

Although appendectomies are frequently performed and new procedural techniques have emerged, no nationwide analysis exists after the cessation of the German quality control in 2004.

Methods

One thousand eight hundred seventy surgical hospitals in Germany were asked to answer questions anonymously concerning the size of the department, applied procedural techniques, various technical details, as well as the approach to the intraoperative finding of an inconspicuous appendix.

Results

We received 643 questionnaires (34.4 %) for evaluation. Almost all hospitals (95.5 %) offer laparoscopic appendectomy (LA), 15.4 % offer single-port (SPA), and 2.2 % (hybrid-) NOTES technique (NA). LA is the standard procedure in 85.2 % of male and in 89.1 % for female patients. In an open procedure (OA), the appendix and mesoappendix are mostly ligated (93.8 and 91.5 %). A Veress needle and open access are employed equally for LA. In 66.6 % of LA, the appendix is divided using an Endo-GIA, the mesoappendix in 45.5 % with bipolar coagulation. Almost half of the hospitals routinely flush the site in OA and LA. In open surgery with an inconspicuous appendix but a pathological finding elsewhere in the abdomen, it is resected “en principe” in 64.7 % and in the absence of any pathological finding in 91.2 %. For laparoscopic procedures, the numbers are 54.8 and 88.4 %.

Conclusions

Most German hospitals perform appendectomies laparoscopically regardless of patients’ gender. Usage of an Endo-GIA is widely established. SPA has not gained much acceptance, nor is NA widely used yet. In the absence of any pathological findings in particular, the macroscopically inconspicuous appendix results in an appendectomy “en principe” in most German hospitals.

Keywords

Survey Appendectomy/methods Appendicitis/surgery Laparoscopy/methods Laparoscopic Open Single port NOTES Surgical technique 

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Dirk Rolf Bulian
    • 1
  • Jürgen Knuth
    • 1
  • Axel Sauerwald
    • 2
  • Michael Alfred Ströhlein
    • 1
  • Rolf Lefering
    • 3
  • Jörg Ansorg
    • 4
  • Markus Maria Heiss
    • 1
  1. 1.Department of Abdominal, Vascular and Transplant Surgery, Cologne-Merheim Medical CenterWitten/Herdecke UniversityCologneGermany
  2. 2.Department for Obstetrics and Gynaecology HolweideCologneGermany
  3. 3.Institute for Research in Operative MedicineWitten/Herdecke UniversityCologneGermany
  4. 4.Professional Association of German Surgeons (BDC)BerlinGermany

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