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Laparoskopische Cholezystektomie Und Choledochusrevision

A. Shamiyeh, W. Wayand
Published 2008 · Medicine

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ZusammenfassungGrundlagen: Die Arbeitsgruppe für Minimal Invasive Chirurgie in Österreich (AMIC) beschloß während der 40. Jahrestagung für Chirurgie im Juni 1999 in Linz, Leitlinien für minimalinvasive chirurgische Eingriffe zu verfassen. Im folgenden Artikel wird die Laparoskopische Cholezystektomie (LCHE) abgehandelt, der wohl häufigste minimal invasive Eingriff. Methodik: Die Arbeitsgruppenleiter der einzelnen Teilbereiche der AMIC diskutierten im Rahmen eines Meetings im Juni 1999 Zielsetzung. Inhalt und Aufbau. Anhand der vorhandenen Literatur wurden die Empfehlungen zum Thema Cholezystektomie verfaßt, welche schließlich von nationalen Experten vidiert wurden. Ergebnisse: Die Sonographie stellt die Basis der Diagnostik dar. Die akute Cholezystitis ist keine Kontraindikation zur LCHE. Die Behandlung der Choledocholithiasis wird derzeit kontrovers beurteilt. Neben dem etablierten therapeutischen Splitting zeigt die laparoskopische Choledochussanierung exzellente Ergebnisse. Die Umstiegsrate in Österreich (4,7 %) ist so wie die Morbidität mit internationalen Zahlen vergleichbar. Schlußfolgerungen: Die laparoskopische Cholezystektomie hat sich als Therapie der Wahl zur Behandlung des Gallensteinleidens etabliert. Bei entsprechender Sorgfalt ist es ein sicheres Verfahren mit niedriger Morbidität und Mortalität. Die LCHE eignet sich als Ausbildungsoperation.SummaryBackground: The panel of the Austrian society for minimal invasive surgery (AMIC) decided to publish guidelines for endoscopic minimal access surgical procedures. This paper concentrates on cholecystolithiasis and the laparoscopic cholecystectomy (LC). Methods: In June 1999 a national panel of Austrian surgeons discussed the set-up for these guidelines under the auspices of the AMIC. The following recommendations concerning cholecystolithiasis and laparoscopic cholecystectomy are composed with reference to the literature and have been reviewed by national experts. Results: Abdominal ultrasound is still the method of choice for the diagnosis of cholelithiasis. Acute cholecystitis is not a contraindication for the laparoscopic approach. The treatment of choledocholithiasis is controversially discussed. Besides the established therapeutic splitting recent papers prove excellent results for the laparoscopic treatment of common bile duct stones. The conversion rate to open cholecystectomy is 4.7 %. The Austrian results are comparable to the literature. Conclusions: LC has become the treatment of choice for cholecystolithiasis. Taking appropriate care it can be performed safely with low morbidity and mortality. LC is suitable as an operation for beginners in laparoscopic surgery assisted by an experienced surgeon.
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