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Maßnahmen zur Vermeidung von Gallengangsläsionen bei schwieriger Cholezystektomie – Bail-out-Prozeduren

Measures for preventing bile duct injuries during difficult cholecystectomies–Bail-out procedures

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Zusammenfassung

Hintergrund

Cholezystektomien können mitunter sehr komplexe Operationen sein, die höchste Anforderungen an die Operierenden stellen.

Fragestellung

Welche prä- und intraoperativen Vorgehensweisen können helfen, das Risiko einer intraoperativen Gallenwegsverletzung bei schwieriger Cholezystektomie zu senken?

Ergebnisse

Bereits präoperativ sollte der mögliche Schwierigkeitsgrad der Operation abgeschätzt werden. Erweiterte Diagnostik, präoperative Gallengangsschienung und die Durchführung des Eingriffs durch erfahrene Operierende können zur Risikominimierung beitragen. Im Einzelfall kann auch das Verschieben der Operation sinnvoll sein. Von entscheidender Bedeutung ist es, intraoperativ rechtzeitig zu erkennen, wann eine reguläre Cholezystektomie nicht möglich ist. Dann bieten sog. Bail-out-Prozeduren, wie Fundus-down oder subtotale Cholezystektomie, einen Ausweg. Ein Umstieg auf eine offene Operation ist hingegen nicht zwingend erforderlich.

Schlussfolgerungen

Bail-out-Prozeduren dienen der Vermeidung von Gallenwegsläsionen bei schwierigen Cholezystektomien und können eine sichere Beendigung der Operation ermöglichen.

Abstract

Background

Cholecystectomies can sometimes be very complex operations, which place high demands on the surgeon.

Objective

Are there preoperative and intraoperative procedures available for reducing the risk of intraoperative bile duct injuries during a complex cholecystectomy?

Results

The complexity of the operation should be estimated preoperatively. Extended diagnostic examinations, preoperative biliary stenting and the performance of the operation by an experienced surgeon may help to reduce the operative risk. In high-risk patients, postponing the cholecystectomy may be indicated. The timely intraoperative recognition of the impossibility to perform a regular cholecystectomy is of decisive importance. In this situation, so-called bail-out procedures, such as fundus-down cholecystectomy or subtotal cholecystectomy are warranted. Conversion from laparoscopic to open surgery is not always necessary.

Conclusion

Bail-out procedures are useful to reduce the risk of bile duct injuries during complex cholecystectomy and can enable a safe completion of the operation.

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Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, München Klinik Neuperlach, München, Deutschland

    Tanja Morant, Thomas Klier &  Natascha C. Nüssler

  2. München Klinik Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, München, Deutschland

    Natascha C. Nüssler

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  1. Tanja Morant
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  2. Thomas Klier
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Correspondence to Natascha C. Nüssler.

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Interessenkonflikt

T. Morant, T. Klier und N.C. Nüssler geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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C. T. Germer, Würzburg

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Morant, T., Klier, T. & Nüssler, N.C. Maßnahmen zur Vermeidung von Gallengangsläsionen bei schwieriger Cholezystektomie – Bail-out-Prozeduren. Chirurgie 93, 548–553 (2022). https://doi.org/10.1007/s00104-022-01582-2

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