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Laparoskopische Eingriffe

Möglichkeiten und Grenzen der ambulanten und kurzzeitstationären Chirurgie

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Zusammenfassung

Zahlreiche laparoskopische Eingriffe können prinzipiell ambulant oder zumindest kurzzeitstationär durchgeführt werden, da das postoperative Risikoprofil gut abgeschätzt werden kann und bereits am 1. oder spätestens am 2. postoperativen Tag feststeht, ob ein ungestörter Heilverlauf vorliegt oder ob mit Komplikationen gerechnet werden muss. Voraussetzungen sind die ausreichende spezielle Aufklärung des Patienten und seine Kooperation bzw. die seines sozialen Umfelds. Von medizinischer Seite sind entsprechende organisatorische und infrastrukturelle Bedingungen zu schaffen, die eine effiziente und sichere präoperative Vorbereitung und eine zuverlässige Nachbehandlung des Patienten gewährleisten. Dabei sollte die durch das neue Vergütungssystem erforderliche Umstellung auf kurzstationäre oder ambulante Behandlungsverfahren sicher flexibel und schrittweise vorgenommen werden, da die Reduktion der postoperativen stationären Pflege mit einem Verlust an Komfort für den Patienten und zweifellos mit einer stärkeren Belastung des sozialen Umfelds einhergeht.

Parallel mit der weiteren Reduktion der Liegezeiten ist selbstverständlich eine Optimierung der Zusammenarbeit mit den weiterversorgenden niedergelassenen Ärzten erforderlich, die auch eine verlässliche Abgrenzung der Verantwortlichkeit mit einschließen muss.

Die ambulante bzw. kurzzeitstationäre Laparoskopie kann dessen ungeachtet nur dann erfolgreich betrieben werden, wenn ein hohes Maß an operativer Erfahrung ein Minimum an Komplikationen garantiert.

Abstract

Many laparoscopic operations can usually be performed on an outpatient or at least short-term inpatient basis. Since the postoperative risk is easily estimated and can be determined on the 1st or 2nd postoperative day, it quickly becomes clear whether the healing process will be undisturbed or complications will occur. Prerequisites are comprehensive information to the patient as well as his cooperation and that of his social setting. From a medical standpoint, suitable administrative and infrastructural conditions must be arranged that enable safe, efficient preop preparation and guarantee reliable postoperative care of the patient. The newly begun shift in the German health care delivery system toward outpatient and short-term inpatient treatment must be introduced carefully and step by step, since the resultant reduction in postoperative inpatient care goes hand in hand with reduced patient comfort and without question places a greater burden on the patient’s social setting.

Clearly, optimal collaboration with local doctors is necessary to accompany this nationwide reduction in hospital stay, and the distribution of responsibility among the various physicians must be clarified. However, independently these elements, the success of outpatient and short-term inpatient laparoscopy still can be guaranteed only by surgeons’ high experience and minimal complications.

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  1. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München

    H. Feussner

  2. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 , München

    H. Feussner

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Feussner, H. Laparoskopische Eingriffe. Chirurg 75, 248–256 (2004). https://doi.org/10.1007/s00104-003-0806-4

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