Zentralblatt für Chirurgie
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Comparative Study Clinical Trial
[Laparoscopic versus open appendectomy: which factors influence the decision between the surgical techniques?].
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". ⋯ 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.
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Improved healthcare and longer life expectancy have led to more and overall, healthier older patients. As a consequence, we now see more surgical complications attributable to an ever-increasing spectrum of the physiologic changes of aging. These include functional decline, psychiatric as well as medical co-morbidities, medication effects and peri-operative environmental changes. ⋯ This will require competency in the realm of geriatrics, on behalf of the treating surgeon who, as a result, will become increasingly more specialized in the future. This article addresses current epidemiology and symptomatology of particular diseases, and as well, offers treatment suggestions with explanations of geriatric pathophysiology and functional decline from a clinically relevant perspective. This review highlights the increased difficulty in treatment of multiple disease processes in the elderly as a result of natural decline in function of all organ systems.
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The requirements of the anaesthetist regarding ambulatory surgery correspond to those in surgical procedures in hospital. This applies especially to the examination of the patients prior to anaesthesia. Anamnesis and physical examination are more important than radiological or laboratory examinations. ⋯ In observance to the recommendations of anaesthesiological associations and institutions both personnel and technical equipment should meet hospital standards. In day case surgery especially postoperative care must be well planned. This contains the prevention of postoperative nausea or vomiting and a sufficient postoperative analgesia.