Zusammenfassung
Das therapeutische Splitting gilt im Moment noch bei der überwiegenden Mehrzahl der Chirurgen als das Verfahren der Wahl bei Vorliegen von Gallengangssteinen. Die endoskopische Steinextraktion ist sicher für den Patienten wesentlich weniger belastend als eine offene Choledochusrevision. Dies gilt allerdings nicht mehr beim Vergleich mit einer laparoskopischen Sanierung der Gallenwege. Beide Verfahren sind hinsichtlich des Erreichens einer Steinfreiheit gleich effektiv, die laparoskopische Choledochusrevision bewahrt den Patienten aber vor den durch die endoskopische Papillotomie ausgelösten Langzeitfolgen. Dies dürfte vor allem für jüngere Patienten von Bedeutung sein. Die laparoskopische Gallengangssanierung ist ein kostengünstiges und risikoarmes Verfahren. Sie erfordert allerdings spezielle Expertise im laparoskopischen Operieren. Ziel muss es daher sein, durch spezielles Training den Techniken der laparoskopischen Gallengangsrevision eine weitere Verbreitung und Akzeptanz unter den Chirurgen zu verschaffen.
Abstract
At the moment, therapeutic splitting is still regarded by the vast majority of surgeons as the gold standard for stones in the common bile duct. Endoscopic clearance of the duct certainly is much less invasive than open exploration. However, this does not apply when compared with laparoscopic stone removal. Both are equivalent in respect to stone clearance rates, but the laparoscopic techniques protect patients from the long-term sequelae of endoscopic papillotomy. This can be important particularly for younger patients. Laparoscopic bile duct exploration is cost-effective and safe. Special experience in laparoscopic surgical techniques, however, is mandatory. Thus, surgeons should intensify their training in laparoscopic bile duct exploration in order to increase the acceptance of these techniques.
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Hopt, U., Adam, U. Cholelithiasis: Therapeutisches Splitting als Standard?. Chirurg 77, 307–314 (2006). https://doi.org/10.1007/s00104-006-1178-3
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DOI: https://doi.org/10.1007/s00104-006-1178-3