Abstract:
BACKGROUND:Although in hospitals focussing on minimal invasive surgery laparoscopic appendectomy (LA) is widely practiced as method of choice in patients with acute appendicitis, the decision for the laparoscopic or the conventional technique (OA) is usually ensued by individual viewpoints. Aim of this prospective observation study was to analyse the decision algorithm for both procedures in patients with the presumptive diagnosis "appendicitis". PATIENTS AND METHODS:Between January 1996 and July 2001 512 patients with the presumptive diagnosis "acute appendicitis" underwent surgery and, assigned by intention-to-treat, were subdivided in a laparoscopic (I) and a conventional group (II). The choice of surgical procedure was analysed with regard to patient characteristics (age, gender, comorbidity), severity of appendicitis (clinical manifestation, preoperative inflammation signs), surgeon (clinical experience) and daytime (during the day, in the evening, at night). Furthermore, the outcome of either method was related to postoperative diagnosis, perioperative morbidity, analgesia, length of hospital stay and cosmetic results. RESULTS:In group I 265 patients and in group II 247 patients underwent surgery. Conversion from LA to OA was necessary in 6.4 %. Group I consisted of significantly more female (67.9 % vs. 45.7 %) and younger patients (21 yrs. vs. 30 yrs.) with less medical history as well as minor severity of tissue inflammation and significantly lower preoperative serum inflammation parameters (leukocytes (1000/ml): 10.6 +/- 4.3 vs. 13.5 +/- 4.9; CRP (mg/l): 2.3 +/- 3.3 vs. 5.6 +/- 7.5, I vs. II: p < 0.001). In group I more patients underwent surgery during day-time as well as by more laparoscopic-experienced surgeons. In the postoperative histopathologic evaluation there were significantly fewer cases with complicated appendicitis (33.2 % vs. 52.2 %, p < 0.001). Additionally, patients after LA revealed a lower postoperative complication rate (9.3 % vs. 18.3 %), length of hospital stay (median 3 vs. 4 days) and duration of analgesia (2.1 +/- 1.8 vs. 4.1 +/- 7.1 days). CONCLUSIONS:Important factors for decision algorithm between a laparoscopic or an open appendectomy include severity of appendicitis, gender, day-time as well as the surgeon's individual laparoscopic experience. With appropriate indication for each technique, both procedures are of equal value in the treatment of acute appendicitis. Furthermore the positive patient selection for laparoscopic appendectomy contributed to a better postoperative outcome in this study.
journal_name
Zentralbl Chirjournal_title
Zentralblatt fur Chirurgieauthors
Horstmann R,Tiwisina C,Classen C,Palmes D,Gillessen Adoi
10.1055/s-2004-836240subject
Has Abstractpub_date
2005-02-01 00:00:00pages
48-54issue
1eissn
0044-409Xissn
1438-9592journal_volume
130pub_type
临床试验,杂志文章abstract::134 patients with necrotizing pancreatitis were operated. Preoperative organ insufficiency (pulmonary or renal), the presence of shock or sepsis and the intraoperative morbidity factors: parenchymal necroses greater than 30%, extrapancreatic necroses, ascites and in particular bacterial contamination were directly cor...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1989-01-01 00:00:00
abstract::Truth and truthfulness are traditional subjects of philosophy. The paper discusses different concepts of truth (epistemological, ontological, normative) and different theories about the acquisition of truth (truth as correspondence, coherence or consensus, pragmatic theories of truth, and truth as immediate subjective...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-2000-10062
更新日期:2000-01-01 00:00:00
abstract::Accidental ingestion of foreign bodies is a common problem in infants and childhood, but ingestion of magnetic construction toys is very rare. In the case of ingestion of multiple parts of these magnetic construction toys, they may attract each other through the intestinal walls, causing pressure necrosis, perforation...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-0028-1098941
更新日期:2010-06-01 00:00:00
abstract::Idiopathic varicocele is quite common even among children and adolescents. Irreversible testicular damage may occur before adult age. Diagnosis and therapy for the purpose of preventing infertility constitute a challenge to youth health organisations and paediatric surgeons. Surgery according to Bernardt or Ivanissevi...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
abstract::Only in 2/3 out of a total of 33 patients suffering from renal artery stenosis surgery was indicated. Thrombendarterectomy and saphenous patch are the method of choice for reconstructive procedures. In 87% of successful reconstructions the functional result was satisfactory. The follow-up gave evidence of change to th...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1979-01-01 00:00:00
abstract::Aorto-iliacal or aortofemoral bifurcation grafts were implanted to 351 patients for stenotic or occlusive diseases of pelvic and femoral arteries, between 1974 and 1986. The average age of patients was 62.7 years, and perioperative lethality amounted to 7.4 per cent. The average age of patients who died was 68.2 years...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1988-01-01 00:00:00
abstract::This article describes problems some surgeons of Dresden were confronted with in the time between 1750 and 1850. These surgeons present the transition of the 'Age of Enlightment' and the period of sciences. Special achievements are mentioned: Hedenus as the founder of the modern surgery in Dresden and as a pioneer in ...
journal_title:Zentralblatt fur Chirurgie
pub_type: 历史文章,杂志文章
doi:
更新日期:1996-01-01 00:00:00
abstract::From January 1990 to December 1995 79 patients with mediastinal lesions were seen for parasternal mediastinoscopy at the Ruhrlandklinik Essen. Diagnosis was achieved in 91.1%. In 7 cases (8.9%) the diagnosis was not established. Six intraoperative complications occurred following mediastinoscopy: minor bleeding in fiv...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1997-01-01 00:00:00
abstract::The role of total mesorectal excision for rectal cancer treatment is one of the most exciting findings in surgical oncology of the recent years. The patient's prognosis largely depends on the surgical quality of rectal resection. The excision of the cancer bearing rectum has to follow very precisely along the mesorect...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:
更新日期:1999-01-01 00:00:00
abstract::The emergency room functions as a junction between preclinical and early clinical treatment of patients with multiple trauma and should have defined technical and room possibilities. The personal staff should continue resuscitation measures and perform clinical and technical diagnostic procedures according to trained ...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1996-01-01 00:00:00
abstract::Laparoscopic colorectal surgery has become increasingly more common since first being described in a publication in 1990. Despite a multitude of studies about the learning curve in laparoscopic colon surgery, there are almost no such studies with regard to laparoscopic rectum surgery. This paper aims to describe a sur...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-0030-1262684
更新日期:2011-06-01 00:00:00
abstract:BACKGROUND:In Germany, more than one million people use benzodiazepines on a regular basis. The majority of them is older than 60 years and take low-dose benzodiazepines for sleep disorders. This does not necessarily induce tolerance, but may result in problems such as falling, seizures or delirium if benzodiazepines a...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0041-107198
更新日期:2016-02-01 00:00:00
abstract::Report on 40 patients suffering from a therapy resistant gastroesophageal reflux disease. Conventional ligamentum-teres-plastic was performed on 18 patients, while 22 patients were treated laparoscopically as minimal invasive procedure. Both techniques are described and the advantages of the laparoscopy versus the con...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1995-01-01 00:00:00
abstract::Excellent results were found to be achievable from conservative functional treatment of upper arm fractures. A critical appraisal is made in this paper of the authors' own cases and of literature published over the past 25 years for comparison of the above results with surgical therapy. The conservative functional app...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1987-01-01 00:00:00
abstract::The Peutz-Jeghers syndrome is an autosomal dominant inherited disease, characterized by the presence of hamartomatous polyposis of the gastrointestinal tract and perioral mucocutaneous pigmentation. The incidence of surgical complications in these patients is relatively rare, and correlates with the size and location ...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-2002-22026
更新日期:2002-02-01 00:00:00
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journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-2001-18259
更新日期:2001-10-01 00:00:00
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journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1991-01-01 00:00:00
abstract::Blunt abdominal injuries are associated with a high mortality rate. Particularly in children, the most important cause of deaths is delay in diagnosis and treatment. In recent years, peritoneal lavage has been gaining importance as a diagnostic method in such injuries.--Between 1977 to 1980, 315 patients (under the ag...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1982-01-01 00:00:00
abstract::In newborns, acute appendicitis is a very rare condition associated with significant lethality. Due to mostly non-specific symptoms, it is difficult to find the correct diagnosis preoperatively. Interestingly, rectal bleeding as a clinical sign in neonatal appendicitis is very uncommon. Here, we report on a 4-day-old ...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-0028-1098922
更新日期:2009-12-01 00:00:00
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journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1977-01-01 00:00:00
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journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1978-01-01 00:00:00
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journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1987-01-01 00:00:00
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journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:
更新日期:1999-01-01 00:00:00
abstract::The transplantation of marginal organs or those meeting the so-called extended donor criteria (EDC) is today a significant option to alleviate the low availability or organs and to increase the number of transplantation which in turn is -accompanied by a lower mortality among wait-ing-list patients. However such an ex...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0028-1098880
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:Neuroendocrine tumours of the gastroenteropancreatic system (GEP-NETs) are rare, in particular those of the gallbladder. Due to the limited therapeutic options, surgical resection is favoured. CASE REPORT AND METHODS:Described below is the case of a 69-year-old male with a lymphogenically metastasising, poo...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:10.1055/s-0030-1262764
更新日期:2012-02-01 00:00:00
abstract::From 1973 to June 1982, 218 patients older than 70 years (148 women, 70 men) suffering from acute bowel obstruction were seen at our Dept. The mortality rate came up to 33%. Main causes of the ileus were incarcerated hernias and colonic obstruction (25% each). In case of an incarcerated hernia the authors emphasize ea...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1984-01-01 00:00:00
abstract::The study described in this paper helped to establish the present position in locally delimited treatment of children for thermic injuries. 25 hospitals or other medical institutions were involved in the inquiry programme, including 16 departments of paediatric surgery and nine departments of general surgery. Studies ...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
abstract::Since the beginning of the decade we can remark an increasing of publications about laparoscopic approach in splenic surgery. We report about 17 unselected own cases (8 males, 9 females). Main indications were 12 hematologic diseases: 9 idiopathic thrombopenic purpuras, 1 hemolytic anemia, 1 Hodgkin's disease and 1 re...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:
更新日期:1997-01-01 00:00:00
abstract::Regional chemotherapy offers a means to enhance the local efficacy of an otherwise ineffective systemic chemotherapy. The regional concentration advantage of a drug is proportional to its total body clearance and inversely proportional to the blood flow through the organ. Regional infusion of adriamycin, cisplatin, me...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:
更新日期:1995-01-01 00:00:00
abstract::The synthesis of radioiodinated meta-iodobenzylguanidine (MIBG), a physiologic norepinephrine analog, was first accomplished by a group from the University of Michigan. Since the first report of the detection of pheochromocytoma with MIBG in humans, there have been several studies about the role of this agent in the d...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:
更新日期:1997-01-01 00:00:00