Zusammenfassung
Die akute Appendizitis ist mit über 130.000 Appendektomien im Jahr der häufigste viszeralchirurgische Notfalleingriff in Deutschland. Die Frage nach dem Operationsverfahren muss daher in regelmäßigen Abständen diskutiert werden. Laparoskopische Operationen werden mittlerweile von allen chirurgischen Abteilungen in Deutschland angeboten. Besonders in Krankenhäusern mit Schwerpunkt in der minimal-invasiven Chirurgie wird die laparoskopische Appendektomie (LA) als Standardverfahren angegeben. Knapp 30 Jahre nach Einführung der LA entsteht der Eindruck, dass nur noch in wenigen Fällen eine offene Appendektomie (OA) durchgeführt wird. Tatsächlich wurden 2006 in Deutschland aber 46% aller Appendektomien konventionell durchgeführt. Dieser hohe Prozentsatz belegt, dass die OA nach wie vor das Standardverfahren in vielen chirurgischen Abteilungen in Deutschland ist. Anhand der Ergebnisse der Literatur gibt es bestimmte Situationen, in denen die OA vorteilhaft sein kann. Kleinkinder (unter 5 Jahre) haben durch ihre kleine Abdominalhöhle schwierige Grundvoraussetzungen für eine LA, sodass meistens eine OA als das Verfahren der Wahl gilt. In der Schwangerschaft birgt eine OA ein niedrigeres Risiko für den Fetus als die LA. Die Kostenanalyse zeigt, dass die OA die finanziell günstigere Methode für das Krankenhaus (Materialkosten) ist, während die LA durch den früheren Wiedereintritt der Patienten in die Arbeitswelt die volkswirtschaftlich bessere Variante ist. Aufgrund der schnellen Rekonvaleszenz der Patienten nach einer Appendektomie sind die Unterschiede der beiden Verfahren nur marginal. In verschiedenen Subgruppenanalysen zeigen sich aber Vorteile für die einzelnen Verfahren. Die möglichen Subgruppen, die von einer OA profitieren könnten, werden hier besprochen.
Abstract
Acute appendicitis is the most common emergency visceral surgical procedure in Germany with 130,000 appendectomies. The question of which operational procedure should be used must therefore be discussed at regular intervals. In many centers of minimal invasive surgery, laparoscopic appendectomy (LA) is the standard procedure. Nearly 30 years after introduction of LA, it is believed that open appendectomy (OA) is needed only on rare occasions, but the actual percentage of OAs carried out in 2006 was 46% of all appendectomies. This high percentage documents that OA is still the standard procedure in many German hospitals. A review of the literature shows that there are still some situations in which OA is superior to LA. Infants younger than 5 years old have a more difficult basic requirement for LA due to the small abdominal cavity, therefore OA is the procedure of choice in most cases. During pregnancy OA has a lower risk for the fetus than LA. Cost analyses show that OA is less expensive for the hospital in material costs, whereas LA is the better economic choice due to an earlier return to work. In summary, there are only marginal differences between the two procedures since both offer a fast patient recovery. Advantages in favor of both LA and OA exist in subgroup analyses and the possible subgroups that can benefit from OA are discussed in this article.
Literatur
McBurney C (1889) Experience with early operative interference in cases of disease of the vermiform appendix. NY State Med J 50:676–687
Semm K (1983) Endoscopic appendectomy. Endoscopy 15:59–64
Litynski GS (1998) Erich Muhe and the rejection of laparoscopic cholecystectomy (1985): A surgeon ahead of his time. JSLS 2:341–346
Cuschieri A (1996) Laparoscopic Pancreatic Resections. Semin Laparosc Surg 3:15–20
Henle KP, Beller S, Rechner J et al (1996) Laparoscopic versus conventional appendectomy: A prospective randomized study. Chirurg 67:526–530
Ortega AE, Hunter JG, Peters JH et al (1995) A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. Laparoscopic Appendectomy Study Group. Am J Surg 169:208–212
Krähenbühl L, Frei E, Klaiber C, Buchler MW (Hrsg) (1997) Acute appendicitis: Standard treatment or laparoscopic surgery? Karger
Di Sebastiano P, Fink T, di Mola FF et al (1999) Neuroimmune appendicitis. Lancet 354:461–466
Attwood SE, Hill AD, Murphy PG et al (1992) A prospective randomized trial of laparoscopic versus open appendectomy. Surgery 112:497–501
Garbutt JM, Soper NJ, Shannon WD et al (1999) Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy. Surg Laparosc Endosc 9:17–26
Jonas J, Bahr R (2007) Economic observations on the operative treatment of acute appendicitis. Zentralbl Chir 132:106–111
Long KH, Bannon MP, Zietlow SP et al (2001) A prospective randomized comparison of laparoscopic appendectomy with open appendectomy: Clinical and economic analyses. Surgery 129:390–400
Chung RS, Rowland DY, Li P, Diaz J (1999) A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy. Am J Surg 177:250–256
Katkhouda N, Mason RJ, Towfigh S (2006) Laparoscopic versus open appendectomy: A prospective, randomized, double-blind study. Adv Surg 40:1–19 1–19
Tzovaras G, Liakou P, Baloyiannis I et al (2007) Laparoscopic appendectomy: Differences between male and female patients with suspected acute appendicitis. World J Surg 31:409–413
Ignacio RC, Burke R, Spencer D et al (2004) Laparoscopic versus open appendectomy: What is the real difference? Results of a prospective randomized double-blinded trial. Surg Endosc 18:334–337
Oka T, Kurkchubasche AG, Bussey JG et al (2004) Open and laparoscopic appendectomy are equally safe and acceptable in children. Surg Endosc 18:242–245
Aziz O, Athanasiou T, Tekkis PP et al (2006) Laparoscopic versus open appendectomy in children: A meta-analysis. Ann Surg 243:17–27
Walsh CA, Tang T, Walsh SR (2008) Laparoscopic versus open appendicectomy in pregnancy: A systematic review. Int J Surg Pathol 6:339–344
McGory ML, Zingmond DS, Tillou A et al (2007) Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 205:534–540
Moore DE, Speroff T, Grogan E et al (2005) Cost perspectives of laparoscopic and open appendectomy. Surg Endosc 19:374–378
Sporn E, Petroski GF, Mancini GJ et al (2009) Laparoscopic appendectomy – is it worth the cost? Trend analysis in the US from 2000 to 2005. J Am Coll Surg 208:179–185
Horstmann R, Tiwisina C, Classen C et al (2005) Laparoscopic versus open appendectomy: Which factors influence the decision between the surgical techniques? Zentralbl Chir 130:48–54
Cervini P, Smith LC, Urbach DR (2002) The surgeon on call is a strong factor determining the use of a laparoscopic approach for appendectomy. Surg Endosc 16:1774–1777
Botha AJ, Elton C, Moore EE, Sauven P (1995) Laparoscopic appendicectomy: A trainee’s perspective. Ann R Coll Surg Engl 77:259–262
Owais AE, Wilson TR, Sethi N, Aldoori MI (2008) Whose appendicectomy? Do laparoscopic appendicectomies impair SHO training? Ann R Coll Surg Engl 90:577–580
Schick KS, Huttl TP, Fertmann JM et al (2008) A critical analysis of laparoscopic appendectomy: How experience with 1,400 appendectomies allowed innovative treatment to become standard in a university hospital. World J Surg 32:1406–1413
Wu JM, Lin HF, Chen KH et al (2007) Impact of previous abdominal surgery on laparoscopic appendectomy for acute appendicitis. Surg Endosc 21:570–573
Ben Haim M, Rosenthal RJ (1999) Causes of arterial hypertension and splachnic ischemia during acute elevations in intra-abdominal pressure with CO2 pneumoperitoneum: A complex central nervous system mediated response. Int J Colorectal Dis 14:227–236
Reissfelder C, Buhr HJ, Ritz JP (2006) Can laparoscopically assisted sigmoid resection provide uncomplicated management even in cases of complicated diverticulitis? Surg Endosc 20:1055–1059
Ball CG, Kortbeek JB, Kirkpatrick AW, Mitchell P (2004) Laparoscopic appendectomy for complicated appendicitis: An evaluation of postoperative factors. Surg Endosc 18:969–973
Pokala N, Sadhasivam S, Kiran RP, Parithivel V (2007) Complicated appendicitis – is the laparoscopic approach appropriate? A comparative study with the open approach: outcome in a community hospital setting. Am Surg 73:737–741
Interessenkonflikt
Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Reißfelder, C., Mc Cafferty, B. & von Frankenberg, M. Offene Appendektomie. Chirurg 80, 602–607 (2009). https://doi.org/10.1007/s00104-009-1683-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00104-009-1683-2
Schüsselwörter
- Konventionelle Appendektomie
- Laparoskopische Appendektomie
- Alter
- Geschlecht
- Schwangerschaft
- Kosten
- Infrastruktur
- Komplizierte Appendizitis