Dokument

Zusammenfassung:
Vom 01. März 2015 bis zum 29. Februar 2016 wurden an der Ubbo-Emmius- Klinik Aurich 115 Patienten mit einer akuten Appendizitis laparoskopisch operiert. Das Patientenkollektiv wurde charakterisiert und ist vergleichbar: 51 Frauen, 60 Männer und vier Kinder wurden in die Studie eingeschlossen. Das mediane Alter betrug 24 Jahre (4–83). Der Body-Mass-Index betrug median 25 kg/m² (20– 42). Median hatten die Patienten vor Aufnahme eine Schmerzsymptomatik seit 24 Stunden (1–240), ein Drittel der Patienten wurden im Bereitschaftsdienst aufgenommen. Die klinische Untersuchung war das richtungsweisende Diagnostikum, bei einem Drittel der Patienten war die Labordiagnostik negativ. Die Ultraschalldiagnostik wurde zur Ausschlussdiagnostik weiterer Erkrankungen beim akuten Abdomen eingesetzt. Zur diagnostischen Unterstützung neben der Anamnese und der klinischen Untersuchung wurden die Labordiagnostik und die Sonographie herangezogen. Bei der klinischen Untersuchung hatten 87% der Patienten ein akutes Abdomen, 8% einen unklaren Bauchbefund und 5% einen zunächst eher unspezifischen Bauchschmerz. Die Labordiagnostik war bei 39% der operierten Patienten unauffällig. Die sonographische Diagnostik war in ihrer Aussage wenig hilfreich und konnte nur zur Ausschlussdiagnostik herangezogen werden. Bei 87% der Patienten wurde eine akute Appendizitis und bei 8% eine subakute Appendizitis diagnostiziert bzw. bei 5% eher ein unauffälliger Befund erhoben. Alle Patienten wurden laparoskopisch operiert und bei 97% (111 von 115) die Appendix laparoskopisch entfernt. Die Operationen wurden von insgesamt neun verschiedenen Operateuren durchgeführt. Bei 3% der Patienten (vier von 115) musste man aufgrund fehlender Übersicht im OP-Situs auf ein konservatives Vorgehen wechseln. Die Rate an negativen und daher unnötigen Appendektomien lag nach histologischer Begutachtung bei 13%. Nach zwei Stunden postoperativ wurde bei 97% der Patienten mit dem oralen Nahrungsaufbau begonnen und die frühe Mobilisation angestrebt. 96 „Major complications“ traten nicht auf; innerhalb der kurzen Liegezeit konnten keine Wundprobleme identifiziert werden. Median betrug die Krankenhausverweildauer aller Patienten drei Tage (2–21). Die laparoskopische Appendektomie hat sich im Routineeisatz bewährt und kann als Goldstandard der Appendektomie bei akuter Appendizitis bezeichnet werden.

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