Zusammenfassung
Hintergrund
Die Behandlung der „akuten Cholezystitis“ basiert auf der 2018 aktualisierten S3-Leitlinie für „Prophylaxe, Diagnostik und Therapie des Gallensteinleidens“. Wenn eine Operationsfähigkeit des Patienten vorliegt, dann ist die frühzeitige laparoskopische Cholezystektomie die Therapie der Wahl.
Ziel der Arbeit
Aktuelle Metaanalysen und Studien belegen, dass die ersten 24 h nach stationärer Aufnahme für die meisten Patienten der optimale Behandlungszeitraum für eine Operation darstellt. Allerdings besteht eine kontroverse Diskussion darüber, wie strikt diese Regel einzuhalten ist und unter welchen Umständen es sinnvoll sein kann, davon abzuweichen.
Material und Methode
Es erfolgte eine systematische Analyse der aktuellen Literatur und eine klinische Bewertung.
Ergebnisse
Bei der Diagnose einer „akuten Cholezystitis“ ist unabhängig von Alter und Vorerkrankungen der Patienten sowie unabhängig vom Schweregrad der Entzündung die laparoskopische Cholezystektomie innerhalb von 24 h nach Krankenhausaufnahme anzustreben. Besteht keine besondere Notfallsituation, kann der Eingriff unter Umständen auch im nächsten Tagesprogramm erfolgen.
Diskussion
Die Empfehlung zur frühen Operation wurde bislang für Risikopatienten kontrovers diskutiert. Aktuelle Studien belegen jedoch, dass auch für dieses Patientengut die Vorteile einer frühzeitigen, operativen Therapie überwiegen. Das Operationsrisiko sollte dabei individuell bewertet werden und in die Therapieentscheidung mit einfließen.
Abstract
Background
The treatment of acute cholecystitis is based on the German S3 guidelines on “Prophylaxis, diagnosis and treatment of gallstones”, which was updated in 2018. If the patient has no contraindications for surgery, early laparoscopic cholecystectomy is the treatment of choice.
Objective
Current meta-analyses and studies confirm that for most patients the optimal period of time for surgical treatment is the first 24 h after hospitalization; however, there is an ongoing controversial discussion on how strictly the 24 h rule should be adhered to and under which circumstances it may be valid to deviate from it.
Material and method
A systematic analysis of the current literature and a clinical evaluation were carried out.
Results
For the diagnosis of an acute cholecystitis, laparoscopic cholecystectomy should be carried out within the first 24 h after hospitalization regardless of the age and comorbidities of the patient as well as the severity of inflammation. If there is no special emergency situation, under certain circumstances surgery can be performed in the next dayʼs program.
Discussion
This recommendation for early surgery for high-risk patients has so far been controversially discussed; however, current studies confirm that the advantages of early surgery outweigh the disadvantages also for this group of patients. The surgical risk should be individually assessed and be included in the treatment decision.
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C. Gutt und S. Schläfer geben an, dass kein Interessenkonflikt besteht.
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C. T. Germer, Würzburg
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Gutt, C., Schläfer, S. Cholezystektomie bei akuter Cholezystitis – ein chirurgischer Notfall oder elektiv im nächsten Tagesprogramm?. Chirurgie 93, 535–541 (2022). https://doi.org/10.1007/s00104-022-01597-9
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DOI: https://doi.org/10.1007/s00104-022-01597-9