Skip to main content
Erschienen in: International Journal of Colorectal Disease 4/2019

31.01.2019 | Original Article

Three-dimensional high-resolution anorectal manometry in functional anorectal disorders: results from a large observational cohort study

verfasst von: Charlotte Andrianjafy, Laure Luciano, Camille Bazin, Karine Baumstarck, Michel Bouvier, Véronique Vitton

Erschienen in: International Journal of Colorectal Disease | Ausgabe 4/2019

Einloggen, um Zugang zu erhalten

Abstract

Background

The aim of the study was to describe the results of 3D high-resolution anorectal manometry (3DHRAM) in a large cohort of patients with functional anorectal disorders.

Methods

In this single-center retrospective study, all consecutive patients referred for investigation of fecal incontinence (FI) or dyssynergic defecation (DD) underwent 3DHRAM. The parameters analyzed were usual manometric data, repartition of dyssynergic patterns, and the prevalence of a new “muscular subtype classification” underlying dyssynergia, anal sphincter defects, and pelvic floor disorders.

Results

Final analyses were performed in 1477 patients with a mean age 54 ± 16 years; 825 patients suffered from DD, and 652 patients suffered from FI. Among these patients, 86% met the diagnostic criteria for dyssynergia. Type II dyssynergia was the most frequently observed (56%) in women and men suffering from FI and in women with DD. Type I was the most frequently observed in men with DD (49%). Regarding the muscle type subgroups, combined puborectalis muscle involvement with an external anal sphincter profile was the most frequently observed. The global prevalence of rectal intussusception and excessive perineal descent were 12% and 21%, respectively. Type III dyssynergia was more frequently associated with pelvic floor disorders than were other types of dyssynergia (p < 0.001).

Conclusion

This large cohort study provides reference values for 3DHRAM in patients with functional anorectal disorders. Further studies are necessary to assess the prevalence of pelvic floor disorders in healthy volunteers and to develop new scores and classifications including all of these new parameters.
Literatur
1.
2.
Zurück zum Zitat Diamant NE, Kamm MA, Wald A, Whitehead WE (1999) AGA technical review on anorectal testing techniques. Gastroenterology 116:735–760CrossRefPubMed Diamant NE, Kamm MA, Wald A, Whitehead WE (1999) AGA technical review on anorectal testing techniques. Gastroenterology 116:735–760CrossRefPubMed
3.
Zurück zum Zitat Azpiroz F, Enck P, Whitehead WE (2002) Anorectal functional testing: review of collective experience. Am J Gastroenterol 97:232–240PubMed Azpiroz F, Enck P, Whitehead WE (2002) Anorectal functional testing: review of collective experience. Am J Gastroenterol 97:232–240PubMed
4.
Zurück zum Zitat Rao SSC, Azpiroz F, Diamant N, Enck P, Tougas G, Wald A (2002) Minimum standards of anorectal manometry. Neurogastroenterol Motil 14:553–559CrossRefPubMed Rao SSC, Azpiroz F, Diamant N, Enck P, Tougas G, Wald A (2002) Minimum standards of anorectal manometry. Neurogastroenterol Motil 14:553–559CrossRefPubMed
5.
Zurück zum Zitat Meunier PD, Gallavardin D (1993) Anorectal manometry: the state of the art. Dig Dis 11:252–264CrossRefPubMed Meunier PD, Gallavardin D (1993) Anorectal manometry: the state of the art. Dig Dis 11:252–264CrossRefPubMed
6.
Zurück zum Zitat Savoye G, Leroi AM, Bertot-Sassigneux P, Touchais JY, Devroede G, Denis P (2002) Does water-perfused catheter overdiagnose anismus compared to balloon probe? Scand J Gastroenterol 37:1411–1416CrossRefPubMed Savoye G, Leroi AM, Bertot-Sassigneux P, Touchais JY, Devroede G, Denis P (2002) Does water-perfused catheter overdiagnose anismus compared to balloon probe? Scand J Gastroenterol 37:1411–1416CrossRefPubMed
7.
Zurück zum Zitat Cheeney G, Nguyen M, Valestin J, Rao SSC (2012) Topographic and Manometric characterization of the recto-anal inhibitory reflex (RAIR). Neurogastroenterol Motil 24:e147–e154CrossRefPubMedPubMedCentral Cheeney G, Nguyen M, Valestin J, Rao SSC (2012) Topographic and Manometric characterization of the recto-anal inhibitory reflex (RAIR). Neurogastroenterol Motil 24:e147–e154CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Lee TH, Lee JS (2012) High-resolution anorectal manometry and anal Endosonographic findings in the evaluation of fecal incontinence. J Neurogastroenterol Motil 18:450–451CrossRefPubMedPubMedCentral Lee TH, Lee JS (2012) High-resolution anorectal manometry and anal Endosonographic findings in the evaluation of fecal incontinence. J Neurogastroenterol Motil 18:450–451CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Jones MP, Post J, Crowell MD (2007) High-resolution manometry in the evaluation of anorectal disorders: a simultaneous comparison with water-perfused manometry. Am J Gastroenterol 102:850–855CrossRefPubMed Jones MP, Post J, Crowell MD (2007) High-resolution manometry in the evaluation of anorectal disorders: a simultaneous comparison with water-perfused manometry. Am J Gastroenterol 102:850–855CrossRefPubMed
10.
Zurück zum Zitat Lee HJ, Jung KW, Han S, Kim JW, Park SK, Yoon IJ, Koo HS, Seo SY, Yang DH, Kim KJ, Ye BD, Byeon JS, Yang SK, Kim JH, Myung SJ (2014) Normal values for high-resolution anorectal manometry/topography in a healthy Korean population and the effects of gender and body mass index. Neurogastroenterol Motil 26:529–537CrossRefPubMed Lee HJ, Jung KW, Han S, Kim JW, Park SK, Yoon IJ, Koo HS, Seo SY, Yang DH, Kim KJ, Ye BD, Byeon JS, Yang SK, Kim JH, Myung SJ (2014) Normal values for high-resolution anorectal manometry/topography in a healthy Korean population and the effects of gender and body mass index. Neurogastroenterol Motil 26:529–537CrossRefPubMed
11.
Zurück zum Zitat Noelting J, Ratuapli SK, Bharucha AE, Harvey DM, Ravi K, Zinsmeister AR (2012) Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient. Am J Gastroenterol 107:1530–1536CrossRefPubMedPubMedCentral Noelting J, Ratuapli SK, Bharucha AE, Harvey DM, Ravi K, Zinsmeister AR (2012) Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient. Am J Gastroenterol 107:1530–1536CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Li Y, Yang X, Xu C, Zhang Y, Zhang X (2013) Normal values and pressure morphology for three-dimensional high-resolution anorectal manometry of asymptomatic adults: a study in 110 subjects. Int J Color Dis 28:1161–1168CrossRef Li Y, Yang X, Xu C, Zhang Y, Zhang X (2013) Normal values and pressure morphology for three-dimensional high-resolution anorectal manometry of asymptomatic adults: a study in 110 subjects. Int J Color Dis 28:1161–1168CrossRef
13.
Zurück zum Zitat Carrington EV, Grossi U, Knowles CH, Scott SM (2014) Normal values for high-resolution anorectal manometry: a time for consensus and collaboration. Neurogastroenterol Motil 26:1356–1357CrossRefPubMed Carrington EV, Grossi U, Knowles CH, Scott SM (2014) Normal values for high-resolution anorectal manometry: a time for consensus and collaboration. Neurogastroenterol Motil 26:1356–1357CrossRefPubMed
14.
Zurück zum Zitat Lazarescu A, Sadowski DC (2011) High resolution anorectal manometry: establishment of normal values in healthy volunteers. Gastroenterology 140:S–796CrossRef Lazarescu A, Sadowski DC (2011) High resolution anorectal manometry: establishment of normal values in healthy volunteers. Gastroenterology 140:S–796CrossRef
15.
Zurück zum Zitat Coss-Adame E, Rao SS, Valestin J et al (2015) Accuracy and reproducibility of high-definition anorectal manometry and pressure topography analyses in healthy subjects. Clin Gastroenterol Hepatol 13:1143–1150.e1CrossRefPubMedPubMedCentral Coss-Adame E, Rao SS, Valestin J et al (2015) Accuracy and reproducibility of high-definition anorectal manometry and pressure topography analyses in healthy subjects. Clin Gastroenterol Hepatol 13:1143–1150.e1CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Xu C, Zhao R, Conklin JL et al (2014) Three-dimensional high-resolution anorectal manometry in the diagnosis of paradoxical puborectalis syndrome compared with healthy adults: a retrospective study in 79 cases. Eur J Gastroenterol Hepatol 26:621–629PubMed Xu C, Zhao R, Conklin JL et al (2014) Three-dimensional high-resolution anorectal manometry in the diagnosis of paradoxical puborectalis syndrome compared with healthy adults: a retrospective study in 79 cases. Eur J Gastroenterol Hepatol 26:621–629PubMed
17.
Zurück zum Zitat Mion F, Garros A, Brochard C, Vitton V, Ropert A, Bouvier M, Damon H, Siproudhis L, Roman S (2017) 3D high-definition anorectal manometry: values obtained in asymptomatic volunteers, fecal incontinence and chronic constipation. Results of a prospective multicenter study (NOMAD). Neurogastroenterol Motil 29(8). https://doi.org/10.1111/nmo.13049 Mion F, Garros A, Brochard C, Vitton V, Ropert A, Bouvier M, Damon H, Siproudhis L, Roman S (2017) 3D high-definition anorectal manometry: values obtained in asymptomatic volunteers, fecal incontinence and chronic constipation. Results of a prospective multicenter study (NOMAD). Neurogastroenterol Motil 29(8). https://​doi.​org/​10.​1111/​nmo.​13049
18.
Zurück zum Zitat Pilipenko VI, Tepliuk DA, Shakhovskaia AK, Isakov VA (2014) Normal values for high-resolution anorectal manometry in a healthy women: effects of age and maternity. Eksp Klin Gastroenterol (7):55–58 Pilipenko VI, Tepliuk DA, Shakhovskaia AK, Isakov VA (2014) Normal values for high-resolution anorectal manometry in a healthy women: effects of age and maternity. Eksp Klin Gastroenterol (7):55–58
19.
Zurück zum Zitat James-Stevenson T, Xu H, Heit M, Shin A (2018) Age and dyssynergia subtypes associated with normal sphincter pressures in women with fecal incontinence. Female Pelvic Med Reconstr Surg 24(3):247–251 James-Stevenson T, Xu H, Heit M, Shin A (2018) Age and dyssynergia subtypes associated with normal sphincter pressures in women with fecal incontinence. Female Pelvic Med Reconstr Surg 24(3):247–251
20.
Zurück zum Zitat Vitton V, Ben Hadj Amor W, Baumstarck K et al (2013) Comparison of three-dimensional high-resolution manometry and endoanal ultrasound in the diagnosis of anal sphincter defects. Colorectal Dis 15:e607–e611CrossRefPubMed Vitton V, Ben Hadj Amor W, Baumstarck K et al (2013) Comparison of three-dimensional high-resolution manometry and endoanal ultrasound in the diagnosis of anal sphincter defects. Colorectal Dis 15:e607–e611CrossRefPubMed
21.
Zurück zum Zitat Benezech A, Cappiello M, Baumstarck K, Grimaud JC, Bouvier M, Vitton V (2017) Rectal intussusception: can high resolution three-dimensional ano-rectal manometry compete with conventional defecography? Neurogastroenterol Motil 29(4). https://doi.org/10.1111/nmo.12978 Benezech A, Cappiello M, Baumstarck K, Grimaud JC, Bouvier M, Vitton V (2017) Rectal intussusception: can high resolution three-dimensional ano-rectal manometry compete with conventional defecography? Neurogastroenterol Motil 29(4). https://​doi.​org/​10.​1111/​nmo.​12978
22.
Zurück zum Zitat Benezech A, Bouvier M, Grimaud J-C et al (2014) Three-dimensional high-resolution anorectal manometry and diagnosis of excessive perineal descent: a comparative pilot study with defaecography. Colorectal Dis 16:O170–O175CrossRefPubMed Benezech A, Bouvier M, Grimaud J-C et al (2014) Three-dimensional high-resolution anorectal manometry and diagnosis of excessive perineal descent: a comparative pilot study with defaecography. Colorectal Dis 16:O170–O175CrossRefPubMed
23.
Zurück zum Zitat Ratuapli SK, Bharucha AE, Noelting J, Harvey DM, Zinsmeister AR (2013) Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry. Gastroenterology 144:314–322.e2CrossRefPubMed Ratuapli SK, Bharucha AE, Noelting J, Harvey DM, Zinsmeister AR (2013) Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry. Gastroenterology 144:314–322.e2CrossRefPubMed
24.
Zurück zum Zitat Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97CrossRefPubMed Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97CrossRefPubMed
25.
Zurück zum Zitat Knowles CH, Scott SM, Legg PE, Allison ME, Lunniss PJ (2002) Level of classification performance of KESS (symptom scoring system for constipation) validated in a prospective series of 105 patients. Dis Colon Rectum 45:842–843CrossRefPubMed Knowles CH, Scott SM, Legg PE, Allison ME, Lunniss PJ (2002) Level of classification performance of KESS (symptom scoring system for constipation) validated in a prospective series of 105 patients. Dis Colon Rectum 45:842–843CrossRefPubMed
26.
Zurück zum Zitat Rao SS, Welcher KD, Leistikow JS (1998) Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol 93:1042–1050CrossRefPubMed Rao SS, Welcher KD, Leistikow JS (1998) Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol 93:1042–1050CrossRefPubMed
27.
28.
Zurück zum Zitat Grossi U, Carrington EV, Bharucha AE, Horrocks EJ, Scott SM, Knowles CH (2016) Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defaecation. Gut 65:447–455CrossRefPubMed Grossi U, Carrington EV, Bharucha AE, Horrocks EJ, Scott SM, Knowles CH (2016) Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defaecation. Gut 65:447–455CrossRefPubMed
30.
Zurück zum Zitat Raja S, Okeke FC, Stein EM, Dhalla S, Nandwani M, Lynch KL, Gyawali CP, Clarke JO (2017) Three-dimensional anorectal manometry enhances diagnostic gain by detecting sphincter defects and puborectalis pressure. Dig Dis Sci 62:3536–3541CrossRefPubMed Raja S, Okeke FC, Stein EM, Dhalla S, Nandwani M, Lynch KL, Gyawali CP, Clarke JO (2017) Three-dimensional anorectal manometry enhances diagnostic gain by detecting sphincter defects and puborectalis pressure. Dig Dis Sci 62:3536–3541CrossRefPubMed
31.
Zurück zum Zitat Vitton V, Grimaud J-C, Bouvier M (2013) Three-dimension high-resolution anorectal manometry can precisely measure perineal descent. J Neurogastroenterol Motil 19:257–258CrossRefPubMedPubMedCentral Vitton V, Grimaud J-C, Bouvier M (2013) Three-dimension high-resolution anorectal manometry can precisely measure perineal descent. J Neurogastroenterol Motil 19:257–258CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Heinrich H, Fruehauf H, Sauter M, Steingötter A, Fried M, Schwizer W, Fox M (2013) The effect of standard compared to enhanced instruction and verbal feedback on anorectal manometry measurements. Neurogastroenterol Motil 25:230–237, e163CrossRefPubMed Heinrich H, Fruehauf H, Sauter M, Steingötter A, Fried M, Schwizer W, Fox M (2013) The effect of standard compared to enhanced instruction and verbal feedback on anorectal manometry measurements. Neurogastroenterol Motil 25:230–237, e163CrossRefPubMed
33.
Zurück zum Zitat Bharucha AE, Dunivan G, Goode PS, Lukacz ES, Markland AD, Matthews CA, Mott L, Rogers RG, Zinsmeister AR, Whitehead WE, Rao SSC, Hamilton FA (2015) Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. Am J Gastroenterol 110:127–136CrossRefPubMed Bharucha AE, Dunivan G, Goode PS, Lukacz ES, Markland AD, Matthews CA, Mott L, Rogers RG, Zinsmeister AR, Whitehead WE, Rao SSC, Hamilton FA (2015) Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. Am J Gastroenterol 110:127–136CrossRefPubMed
34.
Zurück zum Zitat Abramov Y, Sand PK, Botros SM, Gandhi S, Miller JJR, Nickolov A, Goldberg RP (2005) Risk factors for female anal incontinence: new insight through the Evanston-Northwestern twin sisters study. Obstet Gynecol 106:726–732CrossRefPubMed Abramov Y, Sand PK, Botros SM, Gandhi S, Miller JJR, Nickolov A, Goldberg RP (2005) Risk factors for female anal incontinence: new insight through the Evanston-Northwestern twin sisters study. Obstet Gynecol 106:726–732CrossRefPubMed
35.
Zurück zum Zitat Rao SSC, Ozturk R, Laine L (2005) Clinical utility of diagnostic tests for constipation in adults: a systematic review. Am J Gastroenterol 100:1605–1615CrossRefPubMed Rao SSC, Ozturk R, Laine L (2005) Clinical utility of diagnostic tests for constipation in adults: a systematic review. Am J Gastroenterol 100:1605–1615CrossRefPubMed
36.
Zurück zum Zitat Staller K (2015) Role of anorectal manometry in clinical practice. Curr Treat Options Gastroenterol 13:418–431CrossRefPubMed Staller K (2015) Role of anorectal manometry in clinical practice. Curr Treat Options Gastroenterol 13:418–431CrossRefPubMed
37.
Zurück zum Zitat Rao SSC, Mudipalli RS, Stessman M, Zimmerman B (2004) Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). Neurogastroenterol Motil 16:589–596CrossRefPubMed Rao SSC, Mudipalli RS, Stessman M, Zimmerman B (2004) Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). Neurogastroenterol Motil 16:589–596CrossRefPubMed
38.
Zurück zum Zitat Patcharatrakul T, Valestin J, Schmeltz A, Schulze K, Rao SSC (2018) Factors associated with response to biofeedback therapy for dyssynergic defecation. Clin Gastroenterol Hepatol 16(5):715–721 Patcharatrakul T, Valestin J, Schmeltz A, Schulze K, Rao SSC (2018) Factors associated with response to biofeedback therapy for dyssynergic defecation. Clin Gastroenterol Hepatol 16(5):715–721
39.
Zurück zum Zitat Rezaie A, Iriana S, Pimentel M et al (2017) Can three-dimensional high-resolution anorectal manometry detect anal sphincter defects in patients with faecal incontinence? Colorectal Dis 19:468–475CrossRefPubMed Rezaie A, Iriana S, Pimentel M et al (2017) Can three-dimensional high-resolution anorectal manometry detect anal sphincter defects in patients with faecal incontinence? Colorectal Dis 19:468–475CrossRefPubMed
40.
Zurück zum Zitat Mellgren A, Bremmer S, Johansson C, Dolk A, Udén R, Ahlbäck SO, Holmström B (1994) Defecography. Results of investigations in 2,816 patients. Dis Colon Rectum 37:1133–1141CrossRefPubMed Mellgren A, Bremmer S, Johansson C, Dolk A, Udén R, Ahlbäck SO, Holmström B (1994) Defecography. Results of investigations in 2,816 patients. Dis Colon Rectum 37:1133–1141CrossRefPubMed
42.
Zurück zum Zitat Ramage L, Simillis C, Yen C, Lutterodt C, Qiu S, Tan E, Kontovounisios C, Tekkis P (2017) Magnetic resonance defecography versus clinical examination and fluoroscopy: a systematic review and meta-analysis. Tech Coloproctol 21:915–927CrossRefPubMed Ramage L, Simillis C, Yen C, Lutterodt C, Qiu S, Tan E, Kontovounisios C, Tekkis P (2017) Magnetic resonance defecography versus clinical examination and fluoroscopy: a systematic review and meta-analysis. Tech Coloproctol 21:915–927CrossRefPubMed
43.
Zurück zum Zitat Benezech A, Bouvier M, Lesavre N, Gonzalez JM, Baumstarck K, Grimaud JC, Vitton V (2016) Does patient position influence the results of three-dimension high resolution ano-rectal manometry? Br J Med Med Res 13:1–7CrossRef Benezech A, Bouvier M, Lesavre N, Gonzalez JM, Baumstarck K, Grimaud JC, Vitton V (2016) Does patient position influence the results of three-dimension high resolution ano-rectal manometry? Br J Med Med Res 13:1–7CrossRef
44.
Zurück zum Zitat Altomare DF, Rinaldi M, Veglia A, Guglielmi A, Sallustio PL, Tripoli G (2001) Contribution of posture to the maintenance of anal continence. Int J Color Dis 16:51–54CrossRef Altomare DF, Rinaldi M, Veglia A, Guglielmi A, Sallustio PL, Tripoli G (2001) Contribution of posture to the maintenance of anal continence. Int J Color Dis 16:51–54CrossRef
Metadaten
Titel
Three-dimensional high-resolution anorectal manometry in functional anorectal disorders: results from a large observational cohort study
verfasst von
Charlotte Andrianjafy
Laure Luciano
Camille Bazin
Karine Baumstarck
Michel Bouvier
Véronique Vitton
Publikationsdatum
31.01.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 4/2019
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-019-03235-z

Weitere Artikel der Ausgabe 4/2019

International Journal of Colorectal Disease 4/2019 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.