Cholezystolithiasis und Cholezystitis - Indikationsstellung zur Operation

Zusammenfassung

Das Gallensteinleiden gehört mit einer Prävalenz von 10 - 30 % zu den häufigsten Erkrankungen in den industrialisierten Ländern. 60 - 80 % der Patienten mit Gallensteinleiden sind asymptomatisch. Von diesen Patienten erleiden 2 - 4 % im Jahr erste Beschwerden des Gallensteinleidens. Es besteht derzeit ein Konsens, dass nur Patienten mit einem symptomatischen Gallensteinleiden einer chirurgischen Therapie zugeführt werden. Die laparoskopische Cholezystekomie ist das Standardverfahren zur Behandlung des unkomplizierten Gallensteinleidens. Im Stadium der akuten Cholezystitis stellt die laparoskopische Technik eine sichere und effektive Behandlungsform dar. Unter der Berücksichtigung einer frühen, verantwortungsbewussten Konversion ist die Indikation zur laparoskopischen Cholezystektomie auch bei akuter Cholezystitis, bei Patienten mit einer kompensierten Zirrhose und auch bei kardiopulmonalen Risikopatienten zu stellen. Die Operationen bei diesen Befunden sollte nur von einem sehr erfahrenen Operateur durchgeführt werden.

Abstract

10 - 30 % of the population develop gallstones. The cholelithiasis is a common disease in industrialised countries. 60 - 80 % of the patients with gallbladder stones remain asymptomatic during their disease course. Per year about 2 - 4 % of these asymptomatic patients will suffer from episodes of symptoms of gallbladder disease. The surgical treatment is necessary only in the symptomatic stage of gallstone disease. Laparoscopic cholecystectomy is the standard procedure for the treatment of uncomplicated cholecystolithiasis. In stage of acute cholecystitis the laparoscopic procedure is a safe and effective treatment. Considering an early conversion to open cholecystectomy in cases of acute cholecystitis, in patients with cirrhosis or cardiopulmonary high-risk patients the indication for laparoscopic cholecystectomy can be made generously. Great surgical experience is a requirement for the laparoscopic management in these cases.

Schlüsselwörter

Cholezystolithiasis - Cholezystektomie - laparoskopische Technik - akute Cholezystitis

Key words

Cholecystolithiasis - Cholecystectomy - Laparoscopic technique - Acute cholecystitis

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