Zusammenfassung
Ziel der Untersuchung war es, den Stellenwert der Laparoskopie im Versorgungsablauf
des Bauchverletzten und beim akuten Abdomen zu bestimmen. Für die Beurteilung des
Stellenwertes der Laparoskopie beim Abdominaltrauma wurde das Krankengut der Chirurgischen
Klinik des Carl-Thiem-Klinikums Cottbus aus den Jahren 1998 bis 2002 retrospektiv
analysiert. In diesem Zeitraum wurden 104 Patienten wegen eines Bauchtraumas operativ
versorgt, davon 33 (31,7 %) primär laparoskopiert. In 18 Fällen wurde der abdominelle
Eingriff ohne Konversion laparoskopisch beendet, bei 10 Patienten dabei intraabdominelle
Verletzungen laparoskopisch versorgt. Die Rate der so genannten „negativen” Laparotomien
lag bei 7,7 %. Beim akuten Abdomen besteht die wichtigste Indikation zur diagnostischen
Laparoskopie in der Abklärung unklarer rechtsseitiger Unterbauchbeschwerden. Aber
auch in Einzelindikationen (mesenteriale Durchblutungsstörungen, Perforationen, Meckelsches
Divertikel, gynäkologische Erkrankungen, Peritonitis unklarer Genese, Dünndarmileus)
stellt die diagnostische Laparoskopie ein wichtiges diagnostisches Instrument mit
therapeutischer Option dar. Anhand der Daten einer Multizenterstudie mit 1703 diagnostischen
Laparoskopien bei Verdacht auf Appendizitis wird der Stellenwert der diagnostischen
Laparoskopie im Rahmen der Appendizitisbehandlung dargestellt. Gute Einzelindikationen
werden in Falldarstellungen und Literaturanalysen erörtert. Damit sollte die Laparoskopie
unserer Meinung nach einen festen Platz im diagnostischen und gegebenenfalls therapeutischen
Prozedere beim Bauchtrauma und akuten Abdomen einnehmen.
Abstract
The importance of laparoscopy in the management of acute abdomen and blunt abdominal
trauma should be evaluated. Therefore we retrospectively analysed all patients with
blunt abdominal trauma treated in the Department of Surgery at the Carl-Thiem-Hospital
Cottbus between 1998 and 2002. Within this period a total number of 104 patients with
blunt abdominal trauma underwent operative treatment, 33 (31,7 %) of them had primary
laparoscopy. Of the 18 cases where laparoscopic operation could be completed without
conversion to exploratory laparotomy, 10 patients had intra-abdominal injuries and
underwent sufficient laparoscopic treatment. The percentage of so called „negative”
exploratory laparotomies within this study was 7,7 %. Diagnostic laparoscopy in patients
with unclear right hand side lower abdominal pain is the most important indication
in acute abdomen. In special cases (mesenteric ischemia, perforations, Meckel's diverticulum,
gynecopathies, peritonitis of unknown origin, small bowel obstruction) laparoscopy
is an usefull diagnostic tool with a therapeutic option. The value of diagnostic laparoscopy
is demonstrated by means of the data of a multicenter trial with 1703 diagnostic laparoscopies
under suspicion of acute appendicitis. Special indications are discussed on the basis
of case studies and the literature. Our analysis suggests that laparoscopy should
become firmly established in the diagnostic management and, if indicated, in the treatment
of acute abdomen and blunt abdominal trauma as well.
Schlüsselwörter
Akutes Abdomen - Bauchtrauma - diagnostische Laparoskopie - laparoskopische Therapie
Key words
Acute abdomen - blunt abdominal trauma - diagnostic laparoscopy - laparoscopic treatment
Literatur
- 1
Andersen B R, Kallehave F L, Andersen H K.
Antibiotics versus placebo for prevention of postoperative infection after appendicectomy
(Cochrane Review).
Cochrane Database Syst Rev.
2001;
2
CD001439
- 2
Berci G, Dunkelman D, Michel S L, Sanders G, Wahlstrom E, Morgenstern L.
Emergency minilaparoscopy in abdominal trauma. An update.
Am J Surg.
1983;
146
(2)
261-265
- 3
Berci G.
Elective and emergent laparoscopy.
World J Surg.
1993;
17
(1)
8-15
- 4
Bergamaschi R, Marvik R, Johnsen G, Thoresen J E, Ystgaard B, Myrvold H E.
Open vs laparoscopic repair of perforated peptic ulcer.
Surg Endosc.
1999;
13
679-682
- 5
Block E F, Singh I, Thompson E.
Utility and cost-savings of diagnostic laparoscopy in low-probability gunshot wounds
of the abdomen.
J La State Med Soc.
1998;
150
(5)
232-234
- 6
Bloechle C, Emmermann A, Strate T, Scheurlen U J, Schneider C, Achilles E, Wolf M,
Mack D, Zornig C, Broelsch C E.
Laparoscopic vs open repair of gastric perforation and abdominal lavage of associated
peritonitis in pigs.
Surg Endosc.
1998;
12
218
- 7
Bloechle C, Emmermann A, Treu H, Achilles E, Mack D, Zornig C, Broelsch C E.
Effect of a pneumoperitoneum on the extent and severity of peritonitis induced by
gastric ulcer perforation in the rat.
Surg Endosc.
1995;
9
898-901
- 8
Bloechle C, Emmermann A, Zornig C.
Effect of carbon dioxide pneumoperitoneum on bacteraemia and endotoxaemia in an animal
model of peritonitis.
Br J Surg.
1995;
82
1702-1703
- 9
Brandt C P, Priebe P P, Jacobs D G.
Potential of laparoscopy to reduce non-therapeutic trauma laparotomies.
Am Surg.
1994;
60
(6)
416-420
- 10
Brefort J L, Samama G, Le Roux Y, Damamme A.
Contribution of laparoscopy in the management of abdominal stab wounds.
Ann Chir.
1997;
51
(7)
697-702
- 11
Cuschieri A, Hennessy T P, Stephens R B, Berci G.
Diagnosis of significant abdominal trauma after road traffic accidents: preliminary
results of a multicentre clinical trial comparing minilaparoscopy with peritoneal
lavage.
Ann R Coll Surg Engl.
1988;
70
(3)
153-155
- 12
Decat B, Sussman L, Lewis M P, Secker A, Cohen L, Rogers C, Patel A, Rhodes M.
Randomized clinical trial of early laparoscopy in the management of acute non-specific
abdominal pain.
Br J Surg.
1999;
86
1383-1386
- 13
Ditmars M L, Bongard F.
Laparoscopy for triage of penetrating trauma: the decision to explore.
J Laparoendosc Surg.
1996;
6
(5)
285-291
- 14
Elliott D C, Rodriguez A, Moncure M, Myers R A, Shillinlaw W, Davis F, Goldberg A,
Mitchell K, McRitchie D.
The accuracy of diagnostic laparoscopy in trauma patients: a prospective, controlled
study.
Int Surg.
1998;
83
(4)
294-298
- 15
Franklin M E, Dorman J P, Jacobs M, Plasencia G.
Is laparoscopic surgery applicable to complicated colonic diverticular disease?.
Surg Endosc.
1997;
11
1021-1025
- 16
Gazzaniga A B, Stanton W W, Bartlett R H.
Laparoscopy in the diagnosis of blunt and penetrating injuries to the abdomen.
Am J Surg.
1976;
131
(3)
315-318
- 17
Goh P MY, Kum C-K K, Chia Y-W, Ti T K.
Laparoscopic repair of perforation of the colon during colonoscopy.
Gastrointestinal Endoscopy.
1994;
40
396-397
- 18
Guth A A, Pachter H L.
Laparoscopy for penetrating thoracoabdominal trauma: pitfalls and promises.
J Soc Laparoendosc Surg.
1998;
2
(2)
123-127
- 19
Hallfeldt K K, Trupka A W, Erhard J, Waldner H, Schweiberer L.
Emergency laparoscopy for abdominal stab wounds.
Surg Endosc.
1998;
12
(7)
907-910
- 20
Johnson S R, Luchette F A.
The role of laparoscopy in the acute abdomen and trauma.
Semin Laparosc Surg.
1996;
3
(3)
168-177
- 21
Kim Y S, Kim Y, Cho O K, Koh B H, Rhim H, Park D W, Park C K.
Sonography for right lower quadrant pain.
J Clin Ultrasound.
2001;
29
157-185
- 22
Koch A, Zippel R, Marusch F, Schmidt U, Gastinger I, Lippert H.
Prospective multicenter study of antibiotic prophylaxis in operative treatment
of appendicitis.
Dig Surg (Switzerland).
2000;
17
(4)
370-378
- 23
Korabelnikov A I.
Peace-time penetrating abdominal wounds with injuries of the small intestine.
Khirurgiia (Mosk).
1990;
9
50-53
- 24
Lee F Y, Leung K L, Lai P B, Lau J W.
Selection of patients for laparoscopic repair of perforated peptic ulcer.
Br J Surg.
2001;
88
133-136
- 25
Leppaniemi A K, Elliott D C.
The role of laparoscopy in blunt abdominal trauma.
Ann Med.
1996;
28
(6)
483-489
- 26
Leppaniemi A K, Voutilainen P E, Haapiainen R K.
Indications for early mandatory laparotomy in abdominal stab wounds.
Br J Surg.
1999;
86
(1)
76-80
- 27
Lippert H, Koch A, Marusch F, Wolff S t, Gastinger I.
Offene versus laparoskopische Appendektomie.
Chirurg.
2002;
73
791-798
- 28
Marks J M, Youngelman D F, Berk T.
Cost analysis of diagnostic laparoscopy versus laparotomy in the evaluation of penetrating
abdominal trauma.
Surg Endos.
1997;
11
(3)
272-276
- 29
Marusch F, Allecke K, Gastinger I.
[Value of ultrasound in diagnosis of appendicitis. Results of the East German Multicenter
Study. East German Working Group „Outcome Assessment and Quality Assurance in Surgery”
of the CAQ of the German Society of Surgery].
Zentralbl Chir.
1998;
123
(Suppl 4)
29-31
- 30
Memon M A, Fitzgibbons R J.
The role of minimal access surgery in the acute abdomen.
Surg Clin North Am.
1997;
77
1333-1353
- 31
Nast-Kolb D, Gtrupka A, Buchholtz S.
Abdominaltrauma.
Unfallchirurg.
1998;
101
82-91
- 32
Navez B, Tassetti V, Scohy J J, Mutter D, Guiot P, Evrard S, Marescaux J.
Laparoscopic management of acute peritonitis.
Br J Surg.
1998;
85
32-36
- 33
Niebuhr H, Nahrstedt U, Born O.
[Routine ultrasound in diagnosis of acute appendicitis].
Zentralbl Chir.
1998;
123
(Suppl 4)
6-28
- 34
Ortega A E, Tang E, Froes E T, Asensio J A, Katkhouda N, Demetriades D.
Laparoscopic evaluation of penetrating thoracoabdominal traumatic injuries.
Surg Endosc.
1996;
10
(1)
19-22
- 35
Perri S G, Altilia F, Pietrangeli F, Dalla Torre A, Gabbrielli F, Amendolara M, Nicita A,
Nardi M, Lotti R, Citone G.
Laparoscopy in abdominal emergencies. Indications and limitations.
Chir Ital.
2002;
54
165-178
- 36
Porter J M, Ivatury R R.
The role of laparoscopy in the management of penetrating trauma.
Semin Laparosc Surg.
1996;
3
(3)
156-167
- 37
Richter H A, Thoma E, Lebrecht K, Franke A, Wagner D.
Die laparoskopische Therapie des perforierten peptischen Ulcus ventriculi und duodeni.
Min Invas Chir.
1994;
3
3-6
- 38
Sabra J, Roh M, Paez X, Cronan J.
Use of sonography in diagnosing acute appendicitis: comparison of a teaching hospital
and a community hospital.
Acad Radiol.
1996;
3
438-441
- 39
Schlinkert R T, Rasmussen T E.
Laparoscopic repair of colonoscopic perforations of the colon.
J of Laparoendoscopic Surgery.
1994;
4
51-54
- 40
Simon R J, Rabin J, Kuhls D.
Impact of increased use of laparoscopy on negative laparotomy rates after penetrating
trauma.
J Trauma.
2002;
53
(2)
297-302
- 41
Siu W T, Leong H T, Law B K, Chau C H, Li A C, Fung K H, Tai Y P, Li M K.
Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial.
Ann Surg.
2002;
235
313-319
- 42
Sosa J L, Arrillaga A, Puente I, Sleeman D, Ginzburg E, Martin L.
Laparoscopy in 121 consecutive patients with abdominal gunshot wounds.
J Trauma.
1995;
39
(3)
501-504
- 43
Sosa J L, Baker M, Puente I, Sims D, Sleeman D, Ginzburg E, Martin L.
Negative laparotomy in abdominal gunshot wounds: potential impact of laparoscopy.
J Trauma.
1995;
38
(2)
194-197
- 44
Waclawiczek H W, Sungler P, Boeckl O.
Bedside laparoscopy (BSL) for postoperative follow-up of mesenteric infarct and diffuse
peritonitis.
Langenbecks Arch Chir Suppl Kongressbd (Germany).
1997;
114
708-710
- 45
Weiner R, Wagner D.
Laparoskopische Drainage eines Leberabszesses.
Min Invas Chir.
1995;
4
126-128
- 46
Weiner R, Ziegler B, Wagner D, Görge B.
Intermittierende Bed Side Laparoskopie über ein temporäres Laparoskopie-Stoma nach
Mesenterialinfarkt.
Min Invas Chir.
1996;
5
87-90
- 47
Wustner M, Horst F, Neufang T, Becker H.
[Effect of ultrasonic diagnosis and incidence of appendectomy and laparoscopy].
Langenbecks Arch Chir Suppl Kongressbd.
1998;
115
1117-1119
- 48
Zantut L F, Ivatury R R, Smith R S, Kawahara N T, Porter J M, Fry W R, Poggetti R,
Birolini D, Organ C H.
Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter
experience.
J Trauma.
1997;
42
(5)
825-829
- 49
Zoller W G, Kellner H, Schwerk W B.
[Value of ultrasound in diagnosis of acute appendicitis].
Bildgebung.
1996;
63
78-82
- 50
Zippel R, Meyer L, Koch A, Marusch F, Gastinger I.
Laparoscopic treatment of iatrogenic perforations of the colon.
Zentralbl Chir..
2002;
127
(4)
307-309
Dr. Lutz Meyer
Chirurgische Klinik, Carl-Thiem-Klinikum, Chirurgische Endoskopie
Thiemstraße 111
03048 Cottbus
Phone: 0355/462327
Fax: 0355/462337
Email: L.Meyer@ctk.de
