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Evidenz für chirurgische Standardverfahren: Appendizitis, Divertikulitis und Cholezystitis

Evidence for standard surgical procedures: appendicitis, diverticulitis and cholecystitis

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Zusammenfassung

Hintergrund

Die akute Appendizitis, Cholezystitis und Sigmadivertikulitis sind die häufigsten entzündlichen viszeralchirurgischen Notfälle. Der evidenzbasierten Medizin entsprechend sollten chirurgische Indikation und Therapie stetig durch hochwertige Studien hinterfragt bzw. validiert werden.

Ziel der Arbeit

Darstellung und Einordnung der aktuellen Studienlage bzw. des Evidenzniveaus zu den o. g. Indikationen und Therapien.

Material und Methoden

Selektive Literaturrecherche Medline, Cochrane Library und Studienregister (clinicaltrials.gov).

Ergebnisse und Diskussion

Die genannten Indikationen unterliegen durch zunehmend hochwertige klinische Studien einem Wandel; in frühen Stadien scheinen konservative Therapien erfolgreich durchführbar zu sein. Dem gegenüber sind viele chirurgische Teilschritte bisher nicht ausreichend validiert. Weiterhin besteht ein großer Bedarf an hochwertigen, prospektiv-randomisierten klinischen Studien, sodass eine Förderung von Studien und der Studienkultur in der Chirurgie von größtem Interesse sein sollte.

Abstract

Background

Acute appendicitis, cholecystitis and sigmoid diverticulitis are the most common inflammatory visceral surgical emergencies. According to the principles of evidence-based medicine, treatment methods and surgical indications should be constantly questioned and validated by high-quality clinical studies.

Objective

To identify and classify the current evidence on surgical treatment of acute appendicitis, cholecystitis and sigmoid diverticulitis.

Material and methods

Targeted literature search in Medline, the Cochrane Library and study registers (clinicaltrials.gov).

Results and conclusion

The indications for surgery are changing due to increasing numbers of high-quality clinical studies. Conservative treatment seems to be feasible in the early stages. In contrast, many surgical steps have not yet been sufficiently validated. Furthermore, there is a great need for high-quality, prospective randomized clinical trials, so that promotion of studies and the study culture in surgery should continue to be of greatest interest.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    M. Tachezy MBA &  J. R. Izbicki FACS FRCS ed. hon.

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  1. M. Tachezy MBA
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Correspondence to M. Tachezy MBA.

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M. Tachezy und J.R. Izbicki geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Tachezy, M., Izbicki, J.R. Evidenz für chirurgische Standardverfahren: Appendizitis, Divertikulitis und Cholezystitis. Chirurg 90, 351–356 (2019). https://doi.org/10.1007/s00104-018-0779-y

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