[Acute XXXX . Are operations more frequent since the introduction of laparoscopy and CT scanning?].

@entity1 @entity4436
INTRODUCTION: Sigmoid resection is now considered as a standard procedure for acute and recurrent @entity4436 ( @entity4436 ). In the last decade significant changes in preoperative diagnosis with computed tomography (CT) scanning and surgical access (laparoscopy) have been implemented. The aim of this study was to examine whether this has led to changes in the indications for surgical therapy. @entity1 AND METHODS: Consecutive admissions of 1,154 @entity1 from January 1995 to December 2009 with acute @entity4436 were prospectively included. In terms of pre-operative and intraoperative findings and postoperative course 3 treatment periods (TP) were distinguished: TP I 1995-1999, TP II 2000-2004 and TP III 2005-2009. RESULTS: CT scanning was used in more than 90% of cases since TP II compared to 51% during TP I (p<0.001). The ratio of emergency versus elective surgery significantly increased in favor of elective surgery (p<0.001). The rate of laparoscopy-assisted sigmoid resections showed a continuous increase from 53% in TP I to 71% in TP III (p<0.001) while the rate of Hartmann's procedures decreased over time (p<0.001). Overall, the rate of surgically treated @entity1 decreased during the time periods studied despite an increase in the total number of @entity1 with @entity4436 (TP III versus TP I +41%.) The rate of conservatively treated @entity1 increased significantly (p<0.001). The morbidity rate decreased (p<0,001) whereas mortality rates remained at a constantly low level (p=0.175). CONCLUSION: The increasing use of CT diagnosis and the laparoscopic approach led to a shift from emergency surgery with a high complication rate to elective surgery with a high rate of primary restoration of continuity and low morbidity. However, the indications for surgery and therefore the overall rate of @entity1 who underwent surgery did not increase due to these changes.
