Laparoskopische „Fast-track”-Sigmaresektion bei Divertikulitis in Deutschland

Zusammenfassung

Hintergrund und Fragestellung: Die Risiken des Spontanverlaufs bei konservativer Therapie einer Sigmadivertikulitis werden gegenüber dem Risiko elektiver Resektionen von Internisten und Chirurgen verschieden bewertet. Die „Fast-track”-Rehabilitation nach kolorektalen Resektionen beschleunigt die Rekonvaleszenz und reduziert die Rate allgemeiner Komplikationen. Die Ergebnisse der laparoskopischen Fast-track-Sigmaresektion sollten in einer Qualitätssicherungsstudie untersucht werden, um das Risiko der elektiven Operation der Sigmadivertikulitis besser bewerten zu können.

Patienten und Methodik: Es erfolgte in der freiwilligen Qualitätssicherungsstudie „Fast-track- Kolon II” eine prospektive Datenerhebung aller Patienten mit multimodaler, evidenzbasierter, perioperative Therapie bei elektiven Sigmaresektionen wegen Divertikulitis.

Ergebnisse: Die Daten von 846 Patienten mit laparoskopischen Fast-track-Sigmaresektionen aus 23 Kliniken wurden ausgewertet. Das mittlere Alter der Patienten war 63 Jahre (23 – 91). 203 Patienten (24,0 %) hatten schwere Begleiterkrankungen (ASA-Klasse III – IV). 51 Patienten (6,0 %) der Patienten wurden zur offenen Operationstechnik konvertiert. Komplikationen traten bei 93 Patienten (11,0 %) auf, davon bei 76 Patienten chirurgische (8,9 %) und bei 32 Patienten allgemeine Komplikationen (3,8 %). Zwei Patienten starben durch Multiorganversagen nach Anastomoseninsuffizienz. Die Patienten hatten Stuhlgang am 2. (0 – 22) Tag und nahmen feste Kost zu sich am 1. (0 – 5) Tag. Die Patienten waren nach 4 (1 – 58) Tagen entlassungsfähig (schmerzarm, normale Kost, Stuhlgang, vollständig mobilisiert) und wurden am 7. (3 – 72) Tag nach der Operation entlassen. Die 30-Tage-Wiederaufnahmequote war 3,9 %.

Schlussfolgerung: Patienten mit laparoskopischer Fast-track-Sigmaresektion hatten in einer deutschlandweiten Qualitätssicherungsmaßnahme eine niedrige allgemeine Komplikationsrate, eine rasche Rekonvaleszenz und eine kurze postoperative Krankenhausverweildauer.

Abstract

Background and objective: The natural course of sigmoid colon diverticulitis during conservative therapy and the assessment of the perioperative morbidity after sigmoid colon resection are differently evaluated by surgeons and gastroenterologists. The „fast-track” rehabilitation accelerates the reconvalescence and reduces the rate of postoperative general complications after colorectal surgery. The results of the laparoscopic „Fast-track” sigmoidectomy should be examined within a quality assurance program to better evaluate the perioperative risks following surgical management of diverticulitis.

Patients and methods: A prospective data collection within the voluntary quality assurance program „fast-track” Kolon II was performed. All participating clinics agreed on a multimodal, evidence-based standard perioperative treatment in terms of a „fast-track” rehabilitation for elective operations for sigmoid diverticulitis.

Results: Data from 846 patients undergoing laparoscopic „fast-track” sigmoid colon resection in 23 surgical departments in Germany were collected and evaluated. The mean age of the patients was 63 years (range 23 – 91). 203 patients (24 %) had severe co-morbidities (ASA classification III – IV). A conversion to conventional open surgery was necessary in 51 cases (6 %). Complications occurred in 93 patients (11 %). 76 patients suffered a surgical complication (8.9 %) and 32 patients (3.8 %) a

general complication. Two patients died postoperatively due to multi-organ failure following anastomotic leaks. The patients took solid food in median on day 1 after surgery (range, 0 – 5) and passed stool on day 2 (range, 0 – 22). Predefined discharge criteria (free of pain on oral medication, normal oral feeding, stool) were met on day 4 (range, 1 – 58) and the patients were discharged on day 7 (range, 3 – 72). The 30-day re-admission rate was 3.9 %.

Conclusion: Patients undergoing laparoscopic „fast-track” sigmoidectomy had a low rate of general complications and had a rapid reconvalescence with a short postoperative in-patient treatment as documented in a german quality assurance program.

Schlüsselwörter

Sigmaresektion - laparoskopisch - Fast-track - Divertikulitis

Keywords

sigmoidectomy - laparoscopic - fast-track - diverticulitis

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