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Akute Sigmadivertikulitis

Wird seit Einführung der Laparoskopie und CT-Diagnostik häufiger operiert?

Acute sigmoid diverticulitis

Are operations more frequent since the introduction of laparoscopy and CT scanning?

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Zusammenfassung

Hintergrund

Die Sigmaresektion gilt heute als Standardverfahren bei der komplizierten und rezidivierenden Sigmadivertikulitis (SD). Im letzten Jahrzehnt hat sich ein deutlicher Wandel in der präoperativen Diagnostik (CT) und im operativen Zugangsweg (Laparoskopie) vollzogen. Ziel dieser Studie war es, zu prüfen, ob sich hierdurch eine Veränderung der Indikationsstellung zur chirurgischen Therapie ergeben hat.

Patienten und Methoden

In die Studie wurden 1154 Patienten mit der chirurgischen Therapie einer akuten SD über einen Zeitraum von 15 Jahren (1995 bis 2009) prospektiv eingeschlossen. In Hinblick auf die prä- und intraoperativen Befunde sowie den postoperativen Verlauf wurden 3 Therapiezeiträume (ZR) unterschieden: ZR I 1995–1999, ZR II 2000–2004, ZR III 2005–2009.

Ergebnisse

Die CT-Untersuchung kam ab dem ZR II in über 90% der Fälle zur Anwendung im Vergleich zu 51% im ZR I (p<0,001). Das Verhältnis Notfall- zu Elektivoperation nahm zugunsten der Elektiveingriffe signifikant zu (p<0,001). Der Anteil an laparoskopisch-assistierten Sigmaresektionen stieg von 53% im ZR I auf 71% im ZR III (p<0,001) bei abnehmender Rate an Diskontinuitätsresektionen (p<0,001). Insgesamt nahm der Anteil an operierten Patienten trotz Zunahme der SD-Patienten (ZR III vs. I + 41%) über die Jahre ab (p<0,001). Dagegen nahm der Anteil an konservativ therapierten Patienten signifikant zu. Die Morbiditätsrate sank (p<0,001) bei auf niedrigem Niveau konstanter Mortalitätsrate (p=0,175).

Schlussfolgerung

Durch den Einsatz der CT-Diagnostik sowie der laparoskopischen Resektionstechnik kam es zu einer Verschiebung von der notfallmäßigen Operation mit hoher Komplikationsrate zur elektiven Operation mit hoher Rate an primären Rekonstruktionen und geringer Morbidität. Die Operationsquote nahm hierbei jedoch nicht zu. Insgesamt nahm der Anteil an operativ therapierten Patienten zugunsten von konservativ therapierten Patienten sogar signifikant ab.

Abstract

Introduction

Sigmoid resection is now considered as a standard procedure for acute and recurrent sigmoid diverticulitis (SD). In the last decade significant changes in preoperative diagnosis with computed tomography (CT) scanning and surgical access (laparoscopy) have been implemented. The aim of this study was to examine whether this has led to changes in the indications for surgical therapy.

Patients und Methods

Consecutive admissions of 1,154 Patients from January 1995 to December 2009 with acute SD were prospectively included. In terms of pre-operative and intraoperative findings and postoperative course 3 treatment periods (TP) were distinguished: TP I 1995–1999, TP II 2000–2004 and TP III 2005–2009.

Results

CT scanning was used in more than 90% of cases since TP II compared to 51% during TP I (p<0.001). The ratio of emergency versus elective surgery significantly increased in favor of elective surgery (p<0.001). The rate of laparoscopy-assisted sigmoid resections showed a continuous increase from 53% in TP I to 71% in TP III (p<0.001) while the rate of Hartmann’s procedures decreased over time (p<0.001). Overall, the rate of surgically treated Patients decreased during the time periods studied despite an increase in the total number of Patients with SD (TP III versus TP I +41%.) The rate of conservatively treated Patients increased significantly (p<0.001). The morbidity rate decreased (p<0,001) whereas mortality rates remained at a constantly low level (p=0.175).

Conclusion

The increasing use of CT diagnosis and the laparoscopic approach led to a shift from emergency surgery with a high complication rate to elective surgery with a high rate of primary restoration of continuity and low morbidity. However, the indications for surgery and therefore the overall rate of Patients who underwent surgery did not increase due to these changes.

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Authors and Affiliations

  1. Chirurgische Klinik I, Klinik für Allgemein-, Gefäß- und Thoraxchirurgie, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    J.-P. Ritz, K.S. Lehmann, H.J. Buhr &  C. Holmer

  2. Krankenhaus Porz am Rhein, Abteilung für Allgemein-, Viszeral- und Unfallchirurgie, Köln, Deutschland

    A.J. Kroesen

Authors
  1. J.-P. Ritz
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  2. K.S. Lehmann
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  3. A.J. Kroesen
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  4. H.J. Buhr
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  5. C. Holmer
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Correspondence to C. Holmer.

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Ritz, JP., Lehmann, K., Kroesen, A. et al. Akute Sigmadivertikulitis. Chirurg 82, 701–706 (2011). https://doi.org/10.1007/s00104-011-2074-z

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