Prospektive Kohortenstudie zum Langzeitbeschwerdebild nach Appendektomie

The diagnosis of acute appendicitis remains difficult. Regarding all attempts to improve the quality of its diagnosis, the question arises witch effect this would have on the treated patients. Nether patients who underwent negative appendicectomy nor conservatively treaded patients with initially suspected appendicitis have been sufficiently observed considering their long- term outcome after surgery/ hospital observation. Therefore, a study was initiated in the University hospital of Marburg/Germany examining the long- term outcome of these patients in comparison to patients after acute ulcerophlegmoneus appendicitis and perforated appendicitis. In preparation, an extensive research of literature was performed in order to register the reported events after appendicectomy and hospital observation for non specific abdominal pain and listed in a questionnaire. This was send to 362 patients representing the groups described above in equal size. Follow- up time was six to eleven years. 49% of the patients answered the questionnaire. In our study, 34% of the patients undergoing negative appendicectomy suffered from early postoperative complications. Patients after appendicectomy for acute non- perforated appendicitis reported early postoperative complications in 15%, which is significantly less. After appendicectomy for perforated appendicitis, 30% reported complications. Regarding further operations following appendicectomy, patients after negative appendicectomy (14%) and perforated appendicitis (18%) were also frequently affected. 3 (7%) of the initially conservatively treated patients underwent appendicectomy within follow-up time. A history of recurrent or persisting abdominal pain was reported by conservatively treated patients in 23%, by patients after negative appendicectomy in 14%, by patients after perforated appendicitis in 11% and by patients after ulcerophlegmoneus appendicitis in 6%. It is concluded that negative appendicectomy is not a harmless procedure for it is frequently followed by complications, even severe ones with recurrent need for surgery. Recurrent pain is also common in these patients. Indication for appendicectomy should therefore be restrictive. Patients with hospital admission for non- specific abdominal pain are likely to suffer from recurrent abdominal pain. Interestingly, we found that 7% of these patients had their appendix removed within follow up time. Postoperative complications have been reported by all observed patients, most often by patients after negative appendicectomy and perforated appendicitis. Those patients were also most likely to suffer from recurrent abdominal pain. Since negative appendicectomy is an avoidable procedure, our study suggests that the number of unnecessary operations should be diminished by restrictive indication for appendicectomy.