CAMIC-Empfehlungen zur chirurgischen Laparoskopie aus nicht geburtshilflicher Indikation während der Schwangerschaft

 

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Zusammenfassung

In der operativ chirurgischen Grundversorgung hat sich die laparoskopische Operationstechnik in den letzten Jahren fest etabliert. Inzwischen werden in der Normalpopulation über 90 % aller Cholezystektomien und über 80 % aller Appendektomien minimalinvasiv durchgeführt. Die nachgewiesenen Vorteile der laparoskopischen Operationstechnik liegen gegenüber konventionell offenen Operationen in einer vergleichsweise schnelleren frühpostoperativen Erholung mit frühzeitiger Wiederaufnahme der allgemeinen körperlichen sowie beruflichen Aktivität. Da diese Vorteile gleichermaßen für notwendige Eingriffe während einer Schwangerschaft nachweisbar sind, wurde in den letzten Jahren auch während der Schwangerschaft zunehmend minimalinvasiv aus nicht geburtshilflicher Indikation operiert. Insgesamt ist davon auszugehen, dass derartige Eingriffe bei ca. 2 % der schwangeren Patientinnen durchgeführt werden müssen. Zahlreiche Studien konnten dabei belegen, dass der Einsatz laparoskopischer Techniken insbesondere für die werdende Mutter sicher und nicht mit einem erhöhten Risiko verbunden ist. Auf der anderen Seite macht die bestehende Schwangerschaft ein adaptiertes Vorgehen bei der Lösung chirurgischer Probleme erforderlich, um den Schutz des ungeborenen Kindes zu gewährleisten. Unter Zugrundelegung der aktuell verfügbaren Datenlage werden Empfehlungen formuliert, die für eine Vielzahl klinischer Situationen als Entscheidungshilfe herangezogen werden können.

Abstract

In the operative surgical primary care, the laparoscopic surgical technique has firmly established itself in recent years. Meanwhile, in the normal population over 90 % of all cholecystectomies and over 80 % of all appendectomies are performed in a minimally invasive manner. The proven benefits of the laparoscopic surgical technique, compared with conventional open surgery, are a comparatively rapid early postoperative recovery with early resumption of the general physical and occupational activity. As these benefits are equally applicable for necessary interventions during pregnancy, in recent years laparoscopy has become the preferred treatment for non-obstetric indications in the gravid patient. Overall, it can be assumed that such interventions have to be performed in approximately 2 % of all pregnant patients. Numerous studies have proven here that the use of laparoscopic techniques, in particular for the expectant mother, is safe and not associated with an increased risk. On the other hand, the current pregnancy makes necessary an adapted approach to the solution of surgical problems to ensure the protection of the unborn child. On the basis of currently available data situation, recommendations are formulated which can be used as a decision-making support for a variety of clinical situations.

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