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Zentralbl Chir 2013; 138(S 02): e75-e80
DOI: 10.1055/s-0032-1327842
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Operationsindikation bei Divertikulitis – Gibt es neue Daten?

Diverticulitis and Indication for Surgery-Are There New Data?
A. Weimann
1   Klinik für Allgemein- und Visceralchirurgie, Klinikum St. Georg gGmbH Leipzig, Deutschland
,
W. D. Hirsch
2   Chirurgie, Muldentalkliniken, Grimma, Deutschland
,
I. Schiefke
3   Klinik für Gastroenterologie und Hepatologie, Klinikum St. Georg gGmbH, Leipzig, Deutschland
› Author Affiliations
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Publication History

Publication Date:
13 December 2012 (online)

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Zusammenfassung

Die Behandlung der akuten Divertikulitis hat in den letzten Jahren einen deutlichen Paradigmenwechsel hin zu einer restriktiveren und individualisierten Operationsindikation erfahren. Die Übersicht der aktuellen Literaturdaten bestätigt dies vor allem im Hinblick auf die Langzeitbeobachtung konservativ behandelter Patienten. So besteht nicht in jedem Fall eines schweren Schubes eine Operationsindikation. Empfohlen wird die Operation für Hochrisikopatienten unter Immunsuppression oder mit chronischer Niereninsuffizienz. Für alle anderen Patientengruppen sollte mit dem Ziel einer laparoskopischen Durchführung die Operationsindikation in Abhängigkeit vom individuellen Verlauf gestellt werden. Anhand der Hansen-Stock-Klassifikation wird ein therapeutischer Algorithmus vorgeschlagen.

Abstract

The treatment in acute diverticulitis has undergone a considerable shift from an offensive to a more restrictive and individual indication for surgery. This review of the very recent literature with special regard to long-term observation of conservatively treated patients clearly shows that surgery is not required in any case of a first episode of severe diverticulitis, but should be recommended in high-risk patients under immunosuppression or chronic renal failure. In all other groups of patients the indication for surgery should be weighed on an individual basis after each episode, again aiming for the laparoscopic procedure. A therapeutic algorithm is proposed according to the Hansen-Stock classification.

Schlüsselwörter

Divertikulitis - Divertikelperforation - Divertikelabszess - Operationsindikation

Key words

diverticulitis - diverticular perforation - diverticular abscess - indication for surgery
 

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