Abstract
Introduction
Although appendectomies are frequently performed and new procedural techniques have emerged, no nationwide analysis exists after the cessation of the German quality control in 2004.
Methods
One thousand eight hundred seventy surgical hospitals in Germany were asked to answer questions anonymously concerning the size of the department, applied procedural techniques, various technical details, as well as the approach to the intraoperative finding of an inconspicuous appendix.
Results
We received 643 questionnaires (34.4 %) for evaluation. Almost all hospitals (95.5 %) offer laparoscopic appendectomy (LA), 15.4 % offer single-port (SPA), and 2.2 % (hybrid-) NOTES technique (NA). LA is the standard procedure in 85.2 % of male and in 89.1 % for female patients. In an open procedure (OA), the appendix and mesoappendix are mostly ligated (93.8 and 91.5 %). A Veress needle and open access are employed equally for LA. In 66.6 % of LA, the appendix is divided using an Endo-GIA, the mesoappendix in 45.5 % with bipolar coagulation. Almost half of the hospitals routinely flush the site in OA and LA. In open surgery with an inconspicuous appendix but a pathological finding elsewhere in the abdomen, it is resected “en principe” in 64.7 % and in the absence of any pathological finding in 91.2 %. For laparoscopic procedures, the numbers are 54.8 and 88.4 %.
Conclusions
Most German hospitals perform appendectomies laparoscopically regardless of patients’ gender. Usage of an Endo-GIA is widely established. SPA has not gained much acceptance, nor is NA widely used yet. In the absence of any pathological findings in particular, the macroscopically inconspicuous appendix results in an appendectomy “en principe” in most German hospitals.
Similar content being viewed by others
References
Wilms IM, de Hoog DE, de Visser DC, Janzing HM (2011) Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev 11:CD008359. doi:10.1002/14651858.CD008359.pub2
Statistisches_Bundesamt (2011) Operationen und Prozeduren der vollstationären Patientinnen und Patienten der Krankenhäuser. https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Krankenhaeuser/OperationenProzeduren5231401107014.pdf?__blob=publicationFile. Accessed 22 Mar 2012
Semm K (1983) Endoscopic appendectomy. Endoscopy 15(2):59–64. doi:10.1055/s-2007-1021466
BQS BfQtg (2004) Bundesauswertung 6.0 2003 Modul 12/2: Appendektomie. http://www.bqs-outcome.de/2003/ergebnisse/leistungsbereiche/appendektomie/buaw60/Download%206.0. Accessed 22 Mar 2012
Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev (10):CD001546. doi:10.1002/14651858.CD001546.pub3
Chu T, Chandhoke RA, Smith PC, Schwaitzberg SD (2011) The impact of surgeon choice on the cost of performing laparoscopic appendectomy. Surg Endosc 25(4):1187–1191. doi:10.1007/s00464-010-1342-1
Gaitan HG, Reveiz L, Farquhar C (2011) Laparoscopy for the management of acute lower abdominal pain in women of childbearing age. Cochrane Database Syst Rev (1):CD007683. doi:10.1002/14651858.CD007683.pub2
Garbarino S, Shimi SM (2009) Routine diagnostic laparoscopy reduces the rate of unnecessary appendicectomies in young women. Surg Endosc 23(3):527–533. doi:10.1007/s00464-008-9855-6
Partecke LI, von Bernstorff W, Karrasch A, Cziupka K, Glitsch A, Stier A, Heidecke CD, Tepel J (2010) Unexpected findings on laparoscopy for suspected acute appendicitis: a pro for laparoscopic appendectomy as the standard procedure for acute appendicitis. Langenbecks Arch Surg 395(8):1069–1076. doi:10.1007/s00423-009-0567-8
Corneille MG, Gallup TM, Bening T, Wolf SE, Brougher C, Myers JG, Dent DL, Medrano G, Xenakis E, Stewart RM (2010) The use of laparoscopic surgery in pregnancy: evaluation of safety and efficacy. Am J Surg 200(3):363–367. doi:10.1016/j.amjsurg.2009.09.022
Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, Wei HB (2011) Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc 25(4):1199–1208. doi:10.1007/s00464-010-1344-z
Clarke T, Katkhouda N, Mason RJ, Cheng BC, Olasky J, Sohn HJ, Moazzez A, Algra J, Chaghouri E, Berne TV (2011) Laparoscopic versus open appendectomy for the obese patient: a subset analysis from a prospective, randomized, double-blind study. Surg Endosc 25(4):1276–1280. doi:10.1007/s00464-010-1359-5
Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P, Navez B, Saad S, Neugebauer EA (2006) Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 20(1):14–29. doi:10.1007/s00464-005-0564-0
Korndorffer JR Jr, Fellinger E, Reed W (2010) SAGES guideline for laparoscopic appendectomy. Surg Endosc 24(4):757–761. doi:10.1007/s00464-009-0632-y
Sahm M, Koch A, Schmidt U, Wolff S, Pross M, Gastinger I, Lippert H (2012) Acute appendicitis—Clinical Health-Service Research on the Current Surgical Therapy. Zentralbl Chir. doi:10.1055/s-0031-1283947
Ingraham AM, Cohen ME, Bilimoria KY, Pritts TA, Ko CY, Esposito TJ (2010) Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery 148(4):625–635. doi:10.1016/j.surg.2010.07.025, discussion 635-627
Brugger L, Rosella L, Candinas D, Guller U (2011) Improving outcomes after laparoscopic appendectomy: a population-based, 12-year trend analysis of 7446 patients. Ann Surg 253(2):309–313. doi:10.1097/SLA.0b013e3181fc9d53
Sporn E, Petroski GF, Mancini GJ, Astudillo JA, Miedema BW, Thaler K (2009) Laparoscopic appendectomy—is it worth the cost? Trend analysis in the US from 2000 to 2005. J Am Coll Surg 208(2):179–185 e172. doi:10.1016/j.jamcollsurg.2008.10.026
Faiz O, Clark J, Brown T, Bottle A, Antoniou A, Farrands P, Darzi A, Aylin P (2008) Traditional and laparoscopic appendectomy in adults: outcomes in English NHS hospitals between 1996 and 2006. Ann Surg 248(5):800–806. doi:10.1097/SLA.0b013e31818b770c
Tiwari MM, Reynoso JF, Tsang AW, Oleynikov D (2011) Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg 254(6):927–932. doi:10.1097/SLA.0b013e31822aa8ea
Katsuno G, Nagakari K, Yoshikawa S, Sugiyama K, Fukunaga M (2009) Laparoscopic appendectomy for complicated appendicitis: a comparison with open appendectomy. World J Surg 33(2):208–214. doi:10.1007/s00268-008-9843-y
Lehmann KS, Ritz JP, Wibmer A, Gellert K, Zornig C, Burghardt J, Busing M, Runkel N, Kohlhaw K, Albrecht R, Kirchner TG, Arlt G, Mall JW, Butters M, Bulian DR, Bretschneider J, Holmer C, Buhr HJ (2010) The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients. Ann Surg 252(2):263–270. doi:10.1097/SLA.0b013e3181e6240f
Begin GF (1993) Appendectomy in children by simple port laparoscopy. Chir Endosc 2:6–9
D’Alessio A, Piro E, Tadini B, Beretta F (2002) One-trocar transumbilical laparoscopic-assisted appendectomy in children: our experience. Eur J Pediatr Surg 12(1):24–27. doi:10.1055/s-2002-25096
Meyer A, Preuss M, Roesler S, Lainka M, Omlor G (2004) Transumbilical laparoscopic-assisted “one-trocar” appendectomy—TULAA—as an alternative operation method in the treatment of appendicitis. Zentralbl Chir 129(5):391–395. doi:10.1055/s-2004-820388
Rehman H, Rao AM, Ahmed I (2011) Single incision versus conventional multi-incision appendicectomy for suspected appendicitis. Cochrane Database Syst Rev (7):CD009022. doi:10.1002/14651858.CD009022.pub2
Cho MS, Min BS, Hong YK, Lee WJ (2011) Single-site versus conventional laparoscopic appendectomy: comparison of short-term operative outcomes. Surg Endosc 25(1):36–40. doi:10.1007/s00464-010-1124-9
Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, Prasad M (2008) Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES—world’s first report. Surg Endosc 22(5):1343–1347. doi:10.1007/s00464-008-9811-5
Bernhardt J, Gerber B, Schober HC, Kahler G, Ludwig K (2008) NOTES—case report of a unidirectional flexible appendectomy. Int J Colorectal Dis 23(5):547–550. doi:10.1007/s00384-007-0427-3
Pelosi MA 3rd, Pelosi MA (1996) Vaginal appendectomy at laparoscopic-assisted vaginal hysterectomy: a surgical option. J Laparoendosc Surg 6(6):399–403
Ghezzi F, Raio L, Mueller MD, Franchi M (2003) Laparoscopic appendectomy: a gynecological approach. Surg Laparosc Endosc Percutan Tech 13(4):257–260
Park PO, Bergstrom M (2010) Transgastric peritoneoscopy and appendectomy: thoughts on our first experience in humans. Endoscopy 42(1):81–84. doi:10.1055/s-0029-1243795
Huang MT, Wei PL, Wu CC, Lai IR, Chen RJ, Lee WJ (2001) Needlescopic, laparoscopic, and open appendectomy: a comparative study. Surg Laparosc Endosc Percutan Tech 11(5):306–312
Lau DH, Yau KK, Chung CC, Leung FC, Tai YP, Li MK (2005) Comparison of needlescopic appendectomy versus conventional laparoscopic appendectomy: a randomized controlled trial. Surg Laparosc Endosc Percutan Tech 15(2):75–79
Andersen BR, Kallehave FL, Andersen HK (2005) Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev (3):CD001439. doi:10.1002/14651858.CD001439.pub2
Gorecki WJ, Grochowski JA (2001) Are antibiotics necessary in nonperforated appendicitis in children? A double blind randomized controlled trial. Med Sci Monit 7(2):289–292
Ahmad G, O’Flynn H, Duffy JM, Phillips K, Watson A (2012) Laparoscopic entry techniques. Cochrane Database Syst Rev 2:CD006583. doi:10.1002/14651858.CD006583.pub3
Kazemier G, In't Hof KH, Saad S, Bonjer HJ, Sauerland S (2006) Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling? Surg Endosc 20(9):1473–1476. doi:10.1007/s00464-005-0525-7
Beldi G, Vorburger SA, Bruegger LE, Kocher T, Inderbitzin D, Candinas D (2006) Analysis of stapling versus endoloops in appendiceal stump closure. Br J Surg 93(11):1390–1393. doi:10.1002/bjs.5474
Sahm M, Kube R, Schmidt S, Ritter C, Pross M, Lippert H (2011) Current analysis of endoloops in appendiceal stump closure. Surg Endosc 25(1):124–129. doi:10.1007/s00464-010-1144-5
Delibegovic S, Matovic E (2009) Hem-o-lok plastic clips in securing of the base of the appendix during laparoscopic appendectomy. Surg Endosc 23(12):2851–2854. doi:10.1007/s00464-009-0493-4
Alis H, Gonenc M, Deniztas C, Kapan S, Turhan AN (2012) Metal endoclips for the closure of the appendiceal stump in laparoscopic appendectomy. Tech Coloproctol 16(2):139–141. doi:10.1007/s10151-011-0764-7
Rickert A, Bonninghoff R, Post S, Walz M, Runkel N, Kienle P (2012) Appendix stump closure with titanium clips in laparoscopic appendectomy. Langenbecks Arch Surg 397(2):327–331. doi:10.1007/s00423-011-0869-5
Vettoretto N, Agresta F (2011) A brief review of laparoscopic appendectomy: the issues and the evidence. Tech Coloproctol 15(1):1–6. doi:10.1007/s10151-010-0656-2
Petrowsky H, Demartines N, Rousson V, Clavien PA (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 240(6):1074–1084, discussion 1084-1075
Pauniaho SL, Lahdes-Vasama T, Helminen MT, Iber T, Makela E, Pajulo O (2010) Non-absorbable interrupted versus absorbable continuous skin closure in pediatric appendectomies. Scand J Surg 99(3):142–146
Grunewald B, Keating J (1993) Should the ‘normal’ appendix be removed at operation for appendicitis? J R Coll Surg Edinb 38(3):158–160
Chiarugi M, Buccianti P, Decanini L, Balestri R, Lorenzetti L, Franceschi M, Cavina E (2001) “What you see is not what you get”. A plea to remove a ‘normal’ appendix during diagnostic laparoscopy. Acta Chir Belg 101(5):243–245
Phillips AW, Jones AE, Sargen K (2009) Should the macroscopically normal appendix be removed during laparoscopy for acute right iliac fossa pain when no other explanatory pathology is found? Surg Laparosc Endosc Percutan Tech 19(5):392–394. doi:10.1097/SLE.0b013e3181b71957
van den Broek WT, Bijnen AB, de Ruiter P, Gouma DJ (2001) A normal appendix found during diagnostic laparoscopy should not be removed. Br J Surg 88(2):251–254. doi:10.1046/j.1365-2168.2001.01668.x
Acknowledgment
The authors thank Mrs. Christina Wagner of the Institute for Communication, University of Witten/Herdecke for proofreading of the manuscript.
Disclosures
Drs. Dirk Rolf Bulian, Jürgen Knuth, Axel Sauerwald, Michael Ströhlein, Jörg Ansorg, and Markus Maria Heiss have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bulian, D.R., Knuth, J., Sauerwald, A. et al. Appendectomy in Germany—an analysis of a nationwide survey 2011/2012. Int J Colorectal Dis 28, 127–138 (2013). https://doi.org/10.1007/s00384-012-1573-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-012-1573-9