Die laparoskopische Appendektomie als Standardverfahren in der Behandlung der akuten Appendizitis. Eine klinische Beobachtungsstudie

Beginning the 1st of March 2013 until the 29th of February 2016, 115 patients underwent laparoscopic surgery because of an acute inflammation of the appendix in the Ubbo-Emmius-Clinic in Aurich, Germany. The patient collective has been characterized and is comparable: 51 women, 60 men and four children have been enrolled in this study. The median age was 24 years (4-83) and the median Body-Mass-Index was 25 kg/m2 (20-42). The median appearance of symptoms of pain before emergency admission was 24 hours (1-240), of which one third of the patients had been hospitalized by the emergency stand-by duty. The clinical examination was the main guiding diagnostic criteria. One third of the enrolled patients had a negative outcome in the laboratoric diagnostic. The ultrasonic diagnostic was used as a rule-out criteria for other possible reasons of the acute abdomen. The clinical examination and anamnesis was diagnostically supported by the laboratory investigation and ultrasonic sonography. Within the clinical examination, 87% of the patients had an acute abdomen, 8% uncertain abdominal findings and 5% more or less simply a stomach ache. The laboratory diagnostic was inconspicuous in 39% of the patients. The sonographic diagnostic showed itself to be diagnostically less conclusive and was instead used as an exclusion criterion. 87% of the patients were diagnosed as having acute appendicitis, 8% with a subacute appendicitis, and 5% had rather inconspicuous findings. Every patient underwent laparoscopic surgery and 97% had a laparoscopic removal of the appendix. The surgeries were performed by nine different surgeons. In 3% of the cases (four out of 115) the surgery method had to be changed to the conservative surgical approach because of the lack of operation situs oversight. After histological control of the appendices the rate of unnecessary appendectomies was measured at 13%. After two hours postoperative, 97% of the patients were able to start with a stepwise progression of oral nutrition with the aim of early mobilization. 98 There were no major complications within the patient collective and no lesion complications could be identified. The median length of stay in the hospital of all admitted patients was three days (2-21). The laparoscopic appendectomy has proven itself in everyday routine utilization and can be declared as the new gold standard of appendectomy in acute appendicitis