Zusammenfassung
Die Appendizitis ist die häufigste Ursache für ein akutes Abdomen. Jährlich werden
ca. 135 000 Patienten in Deutschland appendektomiert. Die akute Appendizitis zeigt
Veränderungen in der Epidemiologie, der Diagnostik und der Therapie. Die Epidemiologie
weist eine weiter anhaltende rückläufige Inzidenz für die akute nicht perforierte
Appendizitis auf. Die Inzidenz der perforierten Appendizitis ist trotz Laparoskopie
und bildgebender Diagnostik konstant geblieben. In der Diagnostik nimmt der Stellenwert
der Sonografie und Computertomografie weiter zu. Es zeigen sich jedoch Differenzen
zwischen der Sensitivität und Spezifität der Untersuchungen in Studien und der klinischen
Routine. Die Zunahme der bildgebenden Diagnostik korreliert nicht mit einer Abnahme
der perforierten Appendizitis. Die laparoskopische Appendektomie entwickelt sich zum
dominierenden Verfahren in der operativen Therapie. Die höhere Rate intraabdomineller
Abzesse nach laparoskopischer Appendektomie bei perforierter Appendizitis ist nicht
mehr nachzuweisen. Der Stapler wird zur Appendixstumpfversorgung am häufigsten genutzt.
Abstract
Appendicitis is the most common cause of an acute abdomen. Around 135 000 patients
undergo appendectomy in Germany every year. Acute appendicitis shows changes in epidemiology,
diagnosis and therapy. Epidemiological data indicate a continuing decrease in the
incidence of acute non-perforated appendicitis. The incidence of perforated appendicitis
has remained constant despite laparoscopy and imaging diagnostics. The status of sonography
and CT scanning is increasing in the diagnosis of appendicitis. But there are differences
between the sensitivity and specifity of study results and the clinical routine. The
increase of imaging diagnostics does not correlate with a decrease in the incidence
of perforated appendicitis. Laparoscopic appendectomy has developed as a dominant
method for operative therapy. There is no proof of a higher rate of postoperative
intraabdominal abscesses any more. The use of a stapler is mostly required for appendical
stump closure.
Schlüsselwörter
akute Appendizitis - Epidemiologie - Appendektomie - Diagnostik
Key words
acute appendicitis - epidemiology - appendectomy - diagnosis
Literatur
- 1
Reissfelder C, McCafferty B, von Frankenberg M.
Offene Appendektomie. Wann wird sie noch gebraucht.
Chirurg.
2009;
80
602-607
- 2
Wolff H.
Medizinhistorische Aspekte der Appendizitisbehandlung.
Zentralbl Chir.
1998;
4
2-5
- 3
Ring A, Gelis V, Klupsch C et al.
De Garengeot Appendizitis – seltene Variante eines alltäglichen Kranheitsbildes.
Zentralbl Chir.
2009;
134
564-566
- 4
Morgenstern L.
Charles McBurney (1845–1913). Afield from the appendix.
Surg Endosc.
1996;
10
385-386
- 5
Semm K.
Endoscopic appendectomy.
Endoscopy.
1983;
15
59-64
- 6
Koch A, Marusch F, Schmidt U et al.
Die Appendizitisbehandlung in der letzten Dekade des 20. Jahrhunderts.
Zentralbl Chir.
2002;
127
290-296
- 7
Kang J Y, Hoare J, Majeed A et al.
Decline in admission rates for acute appendicitis in England.
Br J Surg.
2003;
90
1586-1592
- 8
Andreu-Ballester J C, Gonzalez-Sanchez A, Ballester F et al.
Epidemiology of appendectomy and appendicitis in the Valencian community (Spain),
1998–2007.
Dig Surg.
2009;
26
406-412
- 9
Ohmann C, Franke C, Kraemer M et al.
Neues zur Epidemiologie der akuten Appendizitis.
Chirurg.
2002;
73
769-776
- 10
Addiss D G, Shaffer N, Fowler B S et al.
The epidemiology of appendicitis and appendectomy in the United States.
Am J Epidemiol.
1990;
132
910-925
- 11
Andersson R, Hugander A, Thulin A et al.
Indications for operation in suspected appendicitis and incidence of perforation.
BMJ.
1994;
308
107-110
- 12
McCahy P.
Continuing fall in the incidence of acute appendicitis.
Ann R Coll Surg Engl.
1994;
76
282-283
- 13
Papadopoulos A A, Polymeros D, Kateri M et al.
Dramatic decline of acute appendicitis in Greece over 30 years: index of improvement
of socioeconomic conditions or diagnostic aids?.
Dig Dis.
2008;
26
80-84
- 14
Lee J H, Park Y S, Choi J S.
The epidemiology of appendicitis and appendectomy in South Korea: National registry
data.
J Epidemiol.
2010;
20
97-105
- 15
Andersen S B, Paerregaard A, Larsen K.
Changes in the epidemiology of acute appendicitis and appendectomy in Danish children
1996–2004.
Eur J Pediatr Surg.
2009;
19
286-289
- 16
Korner H, Soreide J A, Pedersen E J et al.
Stability in incidence of acute appendicitis. A population-based longitudinal study.
Dig Surg.
2001;
18
61-66
- 17
Livingston E H, Woodward W A, Sarosi G A et al.
Disconnect between incidence of nonperforated and perforated appendicitis: implications
for pathophysiology and management.
Ann Surg.
2007;
245
886-892
- 18
Cuschieri J, Florence M, Flum D R et al.
Negative appendectomy and imaging accuracy in the Washington State Surgical Care
and Outcomes Assessment Program.
Ann Surg.
2008;
248
557-563
- 19
Simpson J, Samaraweera A P, Sara R K et al.
Acute appendicitis – a benign disease?.
Ann R Coll Surg Engl.
2008;
90
313-316
- 20
Wagner P L, Eachempati S R, Soe K et al.
Defining the current negative appendectomy rate: for whom is preoperative computed
tomography making an impact?.
Surgery.
2008;
144
276-282
- 21
Ohmann C, Franke C, Yang Q et al.
Diagnosescore für akute Appendizitis.
Chirurg.
1995;
66
135-141
- 22
Alvarado A.
A practical score for the early diagnosis of acute appendicitis.
Ann Emerg Med.
1986;
15
557-564
- 23
Binnebosel M, Otto J, Stumpf M et al.
Akute Appendizitis. Moderne Diagnostik – der chirurgische Ultraschall.
Chirurg.
2009;
80
579-587
- 24
Shetty M K, Garrett N M, Carpenter W S et al.
Abdominal computed tomography during pregnancy for suspected appendicitis: A 5-year
experience at a maternity hospital.
Semin Ultrasound CT MR.
2010;
31
8-13
- 25
Gracey D, McClure M J.
The impact of ultrasound in suspected acute appendicitis.
Clin Radiol.
2007;
62
573-578
- 26
Kaiser S, Frenckner B, Jorulf H K.
Suspected appendicitis in children: US and CT – a prospective randomized study.
Radiology.
2002;
223
633-638
- 27
Kessler N, Cyteval C, Gallix B et al.
Appendicitis: evaluation of sensitivity, specificity, and predictive values of US,
Doppler US, and laboratory findings.
Radiology.
2004;
230
472-478
- 28
Khanal B R, Ansari M A, Pradhan S.
Accuracy of ultrasonography in the diagnosis of acute appendicitis.
Kathmandu Univ Med J (KUMJ).
2008;
6
70-74
- 29
Manner M, Stickel W.
Diagnostik bei Verdacht auf Appendizitis – Lässt sich eine akute Appendizitis sonographisch
ausschließen?.
Chirurg.
2001;
72
1036-1042
- 30
Sivit C J, Applegate K E, Stallion A et al.
Imaging evaluation of suspected appendicitis in a pediatric population: effectiveness
of sonography versus CT.
AJR Am J Roentgenol.
2000;
175
977-980
- 31
Doria A S, Moineddin R, Kellenberger C J et al.
US or CT for diagnosis of appendicitis in children and adults? A meta-analysis.
Radiology.
2006;
241
83-94
- 32
Obermaier R, Benz S, Asgharnia M et al.
Value of ultrasound in the diagnosis of acute appendicitis: interesting aspects.
Eur J Med Res.
2003;
8
451-456
- 33
van Randen A, Bipat S, Zwinderman A H et al.
Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression
US related to prevalence of disease.
Radiology.
2008;
249
97-106
- 34
Cobben L, Groot I, Kingma L et al.
A simple MRI protocol in patients with clinically suspected appendicitis: results
in 138 patients and effect on outcome of appendectomy.
Eur Radiol.
2009;
19
1175-1183
- 35
Hermanek P.
Jahresauswertung 2007, Modul 12 / 2. Bayerische Arbeitsgemeinschaft für Qualitätssicherung
in der stationären Versorgung.
Appendektomie.
2007;
- 36
Faiz O, Clark J, Brown T et al.
Traditional and laparoscopic appendectomy in adults: outcomes in English NHS hospitals
between 1996 and 2006.
Ann Surg.
2008;
248
800-806
- 37
Guller U, Hervey S, Purves H et al.
Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative
database.
Ann Surg.
2004;
239
43-52
- 38
Guller U, Jain N, Curtis L H et al.
Insurance status and race represent independent predictors of undergoing laparoscopic
surgery for appendicitis: secondary data analysis of 145 546 patients.
J Am Coll Surg.
2004;
199
567-575
- 39
Sporn E, Petroski G F, Mancini G J et al.
Laparoscopic appendectomy – is it worth the cost? Trend analysis in the US from 2000
to 2005.
J Am Coll Surg.
2009;
208
179-185
- 40
Sadr-Azodi O, Andren-Sandberg A.
The quality of randomized clinical trials in the field of surgery: studies on laparoscopic
versus open appendectomy as an example.
Dig Surg.
2009;
26
351-357
- 41 Sauerland S, Lefering R, Neugebauer E A. Laparoscopic versus open surgery for suspected
appendicitis. Cochrane Database Syst Rev 2004; CD001546
- 42
Aziz O, Athanasiou T, Tekkis P P et al.
Laparoscopic versus open appendectomy in children: a meta-analysis.
Ann Surg.
2006;
243
17-27
- 43
Kazemier G, in’t Hof K H, Saad S et al.
Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine
stapling?.
Surg Endosc.
2006;
20
1473-1476
- 44
Beldi G, Vorburger S A, Bruegger L E et al.
Analysis of stapling versus endoloops in appendiceal stump closure.
Br J Surg.
2006;
93
1390-1393
- 45
Koch A, Zippel R, Marusch F et al.
Prospective multicenter study of antibiotic prophylaxis in operative treatment of
appendicitis.
Dig Surg.
2000;
17
370-378
- 46
Malik A A, Bari S U.
Conservative management of acute appendicitis.
J Gastrointest Surg.
2009;
13
966-970
Dr. M. Sahm
DRK Kliniken Berlin|Köpenick · Klinik für Chirurgie
Salvador-Allende-Str. 2–8
12559 Berlin
Deutschland
Phone: 0 30 / 30 35 33 17
Fax: 0 30 / 30 35 33 28
Email: m.sahm@drk-kliniken-berlin.de
