title: Appendectomy in Germany-an analysis of a nationwide survey 2011/2012.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Abdominal, Vascular and Transplant Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109 Cologne, Germany. buliand@kliniken-koeln.de
authors.forename: Dirk Rolf
authors.initials: DR
authors.lastname: Bulian
authors.forename: Jürgen
authors.initials: J
authors.lastname: Knuth
authors.forename: Axel
authors.initials: A
authors.lastname: Sauerwald
authors.forename: Michael Alfred
authors.initials: MA
authors.lastname: Ströhlein
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Jörg
authors.initials: J
authors.lastname: Ansorg
authors.forename: Markus Maria
authors.initials: MM
authors.lastname: Heiss
mesh_terms: D001062:Appendectomy / Q000379:methods* / Q000706:statistics & numerical data; D001064:Appendicitis / Q000601:surgery*; D005260:Female; D005858:Germany; D019538:Health Care Surveys; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires