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Einteilung Und Behandlung Von Gallengangverletzungen Nach Laparoskopischer Cholecystektomie

P. Neuhaus, S. Schmidt, R. Hintze, A. Adler, W. Veltzke, R. Raakow, J. Langrehr, W. Bechstein
Published 2000 · Medicine

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Abstract. Iatrogenic bile duct lesions are serious complications during laparoscopic cholecystectomy and include biliary leakage and major bile duct injury. The incidence of biliary lesions following laparoscopic cholecystectomy is up to threefold higher than that of the open procedure. A total of 108 patients with bile duct lesions after laparoscopic cholecystectomy were treated at our institution. Endoscopic treatment was successful in 68 cases, 6 patients were treated by external drainage, and 34 patients required surgical therapy. Selection criteria for the type of treatment included the etiology, anatomical situation, and diagnostic interval of the biliary lesion. We suggest a classification of bile duct injury and a proposal for diagnosis and treatment of these complications.Zusammenfassung. Die iatrogene Gallengangverletzung stellt eine schwerwiegende Komplikation der laparoskopischen Cholecystektomie dar. Sie umfaßt periphere Galleleckagen und Verletzungen des extrahepatischen Gallengangsystems. Ihre Incidenz ist im Vergleich zur konventionellen Cholecystektomie um das 2–3 fache erhöht. In unserem Zentrum wurden 108 Patienten wegen einer iatrogenen Gallengangläsion nach laparoskopischer Cholecystektomie behandelt. Während 68 Patienten erfolgreich endoskopisch therapiert werden konnten, war bei 34 Patienten eine chirurgische Intervention erforderlich. Bei 6 Patienten mit einem peripheren Galleleck war die alleinige percutane äußere Drainage ausreichend. Für die Gallengangverletzungen wird unter Berücksichtigung der Ätiologie, der Lokalisation und des diagnostischen Intervalls eine neue Klassifikation vorgeschlagen, aus der sich diagnostische und therapeutische Konsequenzen ableiten lassen.
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