ABSTRACT
Background At more than 50%, appendicitis is the leading cause of acute intra-abdominal disease requiring surgery. In the course of various other operations, prophylactic appendectomy (PA) is frequently performed. Objectives This study examines to what extent PA is justified. Patients and Methods A prospective study was performed in all patients (n = 173) undergoing prophylactic appendectomy in Katharinen Hospital Unna between January 2010 and October 2013. The following variables were analysed: age, gender, type of primary surgery, emergency or elective surgery, complications, lethality, intraoperative and histopathological evaluation of the appendix. In addition, patients were contacted postoperatively with the request to complete a questionnaire. Results Prophylactic appendectomy was carried out without any specific complications. 117 patients (68%) participated in the survey. 15% of these patients had suffered symptoms that could be attributable to irritation of the appendix. With only one exception, all appendectomy specimens revealed pathological findings in the histopathological examination. PA allowed the early diagnosis of 4 adenomas, one neuroendocrine tumour and 6 metastases or manifestations of peritoneal carcinomatosis. Conclusion PA is ethically justifiable, as there are few complications. Moreover, it can help to avoid future appendicitis and allows early detection of malignancies.
Subject(s)
Appendectomy/ethics , Appendicitis/prevention & control , Ethics, Medical , Prophylactic Surgical Procedures/ethics , Adult , Aged , Aged, 80 and over , Female , Germany , Humans , Male , Middle Aged , Postoperative Complications/etiology , Prospective Studies , Risk Factors , Treatment Outcome , Young AdultABSTRACT
Patients with familial adenomatous polyposis require surgical intervention at some point in their lives. The diagnosis is often apparent from their phenotype and family history, however, this is not always the case. Many factors can influence the surgical strategy although the polyposis burden and distribution remain the main consideration. While prophylactic removal of the rectum and colon is often required, sparing the rectum at the index surgery is safe in select patients. This article aims to dispel misconceptions in the diagnosis and treatment of patients with familial adenomatous polyposis.
Subject(s)
Abdominal Neoplasms/complications , Adenomatous Polyposis Coli/diagnosis , Colorectal Neoplasms/diagnosis , Fibromatosis, Aggressive/complications , Proctocolectomy, Restorative/methods , Therapeutic Misconception/ethics , Abdominal Neoplasms/diagnosis , Adenomatous Polyposis Coli/complications , Adenomatous Polyposis Coli/mortality , Adenomatous Polyposis Coli/surgery , Adult , Anastomosis, Surgical/standards , Clinical Decision-Making , Colorectal Neoplasms/surgery , Cost of Illness , Female , Fibromatosis, Aggressive/diagnosis , Genotype , Humans , Laparoscopy/methods , Male , Proctocolectomy, Restorative/adverse effects , Prophylactic Surgical Procedures/ethics , Quality of Life , Rectum/surgery , Risk FactorsABSTRACT
There is considerable evidence that pre-emptive transplants have several clinical advantages. However, pre-emptive transplants raise a number of ethical issues. Pre-emptive transplants from living donors offer distinctly greater benefits than those from deceased donors and some pre-emptive transplantation programmes actively encourage living organ donations. Moreover, the offer of a pre-emptive transplant to a patient who is not yet on dialysis unquestionably penalises patients already on dialysis who may have been on the waiting list for a long time. Therefore preemptive transplants give rise to conflicts between justice and utility. Several factors should be considered: health conditions, clinical urgency, probability of imminent worsening of a patient's clinical condition, the future chances of finding a matching organ, and others. From the various values at stake, ethical issues are analysed in search of an acceptable synthesis.