Skip to main content
SpringerLink
Log in

Strategien zur Vermeidung negativer Appendektomien

Strategy for avoidance of negative appendectomies

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Bei der Appendektomie handelt es sich um die am häufigsten durchgeführte nichtelektive Operation. Auch in der Ära der laparoskopischen Chirurgie und der modernen Computertomographie gibt es noch immer eine nicht unerhebliche Rate an negativen Appendektomien (10–15%), also der Entfernung eines in der histopathologischen Aufarbeitung nicht akut entzündlich veränderten Wurmfortsatzes. Sowohl die Problemstellung und Inzidenz als auch der Einfluss moderner diagnostischer Modalitäten auf die Rate der negativen Appendektomie sind von klinischer Relevanz. Verschiedene klinische Scoring-Systeme, die zur Diagnosestellung der akuten Appendizitis entwickelt wurden, haben keinen Einzug in den klinischen Alltag gefunden. Ein diagnostischer Algorithmus kann Hilfestellung zur Verminderung der Rate negativer Appendektomien geben; die Gefahr der Überanspruchung der negativen Appendektomierate liegt möglicherweise in der Inkaufnahme einer höheren Perforationsrate.

Abstract

Appendectomy is the most commonly performed emergency surgical procedure. Even in the era of laparoscopic surgery and modern computed tomography, the rate of negative appendectomies, defined as the removal of a non-inflamed appendix, remains high (10–15%). The general problem and incidence, as well as the influence of modern diagnostic modalities on the rate of negative appendectomies are of particular clinical relevance. Several clinical scoring systems have been developed, but they did not find their way into the daily clinical routine. A proposed diagnostic algorithm could support further efforts to reduce the rate of negative appendectomies. The risk of overtreatment in the reduction of the negative appendectomy rate might potentially lead to acceptance of a higher perforation rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Simpson J, Samaraweera AP, Sara RK, Lobo DN (2008) Acute appendicitis–a benign disease? Ann R Coll Surg Engl 90:313–316

    Article  PubMed  CAS  Google Scholar 

  2. de Dombal FT (1979) Diagnose und Operationsindikation bei der akuten Appendizitis: Wieviele „Irrtümer“ sind unvermeidlich? Chirurg 50:291–296

    Google Scholar 

  3. Beasley SW (2000) Can we improve diagnosis of acute appendicitis? BMJ 321:907–908

    Article  Google Scholar 

  4. Australian Council of Healthcare Standards Care Evaluation Program (1999) Surgical indicators: clinical indicators in pediatric surgery. Sydney

  5. Kern E, Kujath P (1989) Die Appendektomie im Erwachsenenalter. Chirurg 60:508–512

    PubMed  CAS  Google Scholar 

  6. Ziegler HK (1972) Zur Ätiologie und Pathogenese der Appendicitis. Langenbecks Arch Chir 330:209–219

    Article  PubMed  CAS  Google Scholar 

  7. Käufer C, Franz I, Löblich HJ (1989) Appendizitis – Wandel des Krankheitsbildes? Chirurg 60:501–507

    PubMed  Google Scholar 

  8. Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557–564

    Article  PubMed  CAS  Google Scholar 

  9. Colson M, Skinner KA, Dunnington G (1997) High negative appendectomy rates are no longer acceptable. Am J Surg 174:723–726

    Article  PubMed  CAS  Google Scholar 

  10. Korner H, Sondenaa K, Soreide JA et al (1997) Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg 21:313–317

    Article  PubMed  CAS  Google Scholar 

  11. Zielke A, Sitter H, Rampp TA et al (1999) Überprüfung eines diagnostischen Scoresystems (Ohmann-Score) für die akute Appendizitis. Chirurg 70:777–783

    Article  PubMed  CAS  Google Scholar 

  12. Flum DR, Morris A, Koepsell T, Dellinger EP (2001) Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 286:1748–1753

    Article  PubMed  CAS  Google Scholar 

  13. Bijnen CL, Van Den Broek WT, Bijnen AB et al (2003) Implications of removing a normal appendix. Dig Surg 20:115–121

    Article  PubMed  CAS  Google Scholar 

  14. Jones K, Pena AA, Dunn EL et al (2004) Are negative appendectomies still acceptable? Am J Surg 188:748–754

    Article  PubMed  Google Scholar 

  15. Kim K, Lee CC, Song KJ et al (2008) The impact of helical computed tomography on the negative appendectomy rate: a multi-center comparison. J Emerg Med 34:3–6

    Article  PubMed  Google Scholar 

  16. Cuschieri J, Florence M, Flum DR et al (2008) Negative appendectomy and imaging accuracy in the Washington State Surgical Care and Outcomes Assessment Program. Ann Surg 248:557–563

    PubMed  Google Scholar 

  17. Wagner PL, Eachempati SR, Soe K et al (2008) Defining the current negative appendectomy rate: for whom is preoperative computed tomography making an impact? Surgery 144:276–282

    Article  PubMed  Google Scholar 

  18. Kraemer M, Ohmann C, Leppert R, Yang Q (2000) Macroscopic assessment of the appendix at diagnostic laparoscopy is reliable. Surg Endosc 14:625–633

    Article  PubMed  CAS  Google Scholar 

  19. Richards W, Watson D, Lynch G et al (1993) A review of the results of laparoscopic versus open appendectomy. Surg Gynecol Obstet 177:473–480

    PubMed  CAS  Google Scholar 

  20. Attwood SE, Hill AD, Murphy PG et al (1992) A prospective randomized trial of laparoscopic versus open appendectomy. Surgery 112:497–501

    PubMed  CAS  Google Scholar 

  21. Heikkinen TJ, Haukipuro K, Hulkko A (1998) Cost-effective appendectomy. Open or laparoscopic? A prospective randomized study. Surg Endosc 12:1204–1208

    Article  PubMed  CAS  Google Scholar 

  22. Macarulla E, Vallet J, Abad JM et al (1997) Laparoscopic versus open appendectomy: a prospective randomized trial. Surg Laparosc Endosc 7:335–339

    Article  PubMed  CAS  Google Scholar 

  23. Larsson PG, Henriksson G, Olsson M et al (2001) Laparoscopy reduces unnecessary appendicectomies and improves diagnosis in fertile women. A randomized study. Surg Endosc 15:200–202

    Article  PubMed  CAS  Google Scholar 

  24. Pedersen AG, Petersen OB, Wara P et al (2001) Randomized clinical trial of laparoscopic versus open appendicectomy. Br J Surg 88:200–205

    Article  PubMed  CAS  Google Scholar 

  25. Harland LC (2006) Computergestützte Entscheidungsfindung bei Akuter Appendizitis: Berechnung und Vergleich diagnostischer Richtigkeiten zweier Computerprogramme. Dissertation. Fachbereich Medizin der Philipps-Universität, Marburg

  26. Flum DR, Koepsell T (2002) The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 137:799–804

    Article  PubMed  Google Scholar 

  27. Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925

    PubMed  CAS  Google Scholar 

  28. Frieling T (2009) Das akute Abdomen aus internistischer Sicht. Dtsch Med Wochenschr 134:246–250

    Article  PubMed  CAS  Google Scholar 

  29. Jancelewicz T, Kim G, Miniati D (2008) Neonatal appendicitis: a new look at an old zebra. J Pediatr Surg 43:e1–e5

    Article  PubMed  Google Scholar 

  30. Velanovich V, Satava R (1992) Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance. Am Surg 58:264–269

    PubMed  CAS  Google Scholar 

  31. Flum DR, Cuschieri J, Florence M et al (2009) Letter regarding negative appendectomy and imaging accuracy in the washington state surgical care and outcomes assessment program. Ann Surg

  32. de Dombal FT, Leaper DJ, Staniland JR et al (1972) Computer-aided diagnosis of acute abdominal pain. Br Med J 2:9–13

    Google Scholar 

  33. Owen TD, Williams H, Stiff G et al (1992) Evaluation of the Alvarado score in acute appendicitis. J R Soc Med 85:87–88

    PubMed  CAS  Google Scholar 

  34. Kalan M, Talbot D, Cunliffe WJ, Rich AJ (1994) Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl 76:418–419

    PubMed  CAS  Google Scholar 

  35. Ohmann C, Franke C, Yang Q et al (1995) Diagnosescore für akute Appendizitis. Chirurg 66:135–141

    PubMed  CAS  Google Scholar 

  36. Ohmann C, Franke C, Yang Q (1999) Clinical benefit of a diagnostic score for appendicitis: results of a prospective interventional study. German Study Group of Acute Abdominal Pain. Arch Surg 134:993–996

    Article  PubMed  CAS  Google Scholar 

  37. Tepel J, Sommerfeld A, Klomp HJ et al (2004) Prospective evaluation of diagnostic modalities in suspected acute appendicitis. Langenbecks Arch Surg 389:219–224

    Article  PubMed  Google Scholar 

  38. Wong KK, Cheung TW, Tam PK (2008) Diagnosing acute appendicitis: are we overusing radiologic investigations? J Pediatr Surg 43:2239–2241

    Article  PubMed  Google Scholar 

  39. Van Den Broek WT, Bijnen AB, De RP, Gouma DJ (2001) A normal appendix found during diagnostic laparoscopy should not be removed. Br J Surg 88:251–254

    Article  Google Scholar 

  40. Grunewald B, Keating J (1993) Should the ‚normal‘ appendix be removed at operation for appendicitis? J R Coll Surg Edinb 38:158–160

    PubMed  CAS  Google Scholar 

  41. Di Sebastiano P, Fink T, di Mola FF et al (1999) Neuroimmune appendicitis. Lancet 354:461–466

    Article  Google Scholar 

  42. Abes M, Petik B, Kazil S (2007) Nonoperative treatment of acute appendicitis in children. J Pediatr Surg 42:1439–1442

    Article  PubMed  Google Scholar 

  43. Styrud J, Eriksson S, Nilsson I et al (2006) Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial. World J Surg 30:1033–1037

    Article  PubMed  Google Scholar 

  44. Malik AA, Bari SU (2009) Conservative management of acute appendicitis. J Gastrointest Surg 13:966–970

    Article  PubMed  Google Scholar 

  45. Hansson J, Korner U, Khorram-Manesh A et al (2009) Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg 96:473–481

    Article  PubMed  CAS  Google Scholar 

  46. White JJ, Santillana M, Haller JA Jr (1975) Intensive in-hospital observation: a safe way to decrease unnecessary appendectomy. Am Surg 41:793–798

    PubMed  CAS  Google Scholar 

  47. Thomson HJ, Jones PF (1986) Active observation in acute abdominal pain. Am J Surg 152:522–525

    Article  PubMed  CAS  Google Scholar 

  48. Dolgin SE, Beck AR, Tartter PI (1992) The risk of perforation when children with possible appendicitis are observed in the hospital. Surg Gynecol Obstet 175:320–324

    PubMed  CAS  Google Scholar 

  49. Kirby CP, Sparnon AL (2001) Active observation of children with possible appendicitis does not increase morbidity. ANZ J Surg 71:412–413

    Article  PubMed  CAS  Google Scholar 

  50. Cavusoglu YH, Erdogan D, Karaman A et al (2009) Do not rush into operating and just observe actively if you are not sure about the diagnosis of appendicitis. Pediatr Surg Int 25:277–282

    Article  PubMed  Google Scholar 

  51. Antevil JL, Rivera L, Langenberg BJ et al (2006) Computed tomography-based clinical diagnostic pathway for acute appendicitis: prospective validation. J Am Coll Surg 203:849–856

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    M.N. Wente

  2. Chirurgische Abteilung, Evangelisches Krankenhaus Hattingen, Hattingen, Deutschland

    H. Waleczek

Authors
  1. M.N. Wente
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Waleczek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M.N. Wente.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wente, M., Waleczek, H. Strategien zur Vermeidung negativer Appendektomien. Chirurg 80, 588–593 (2009). https://doi.org/10.1007/s00104-009-1686-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-009-1686-z

Schlüsselwörter

Keywords

Search

Navigation