Cholecystectomy

A cholecystectomy (also cholecystectomy or gall bladder removal ), abbreviated CHE or CCE, is the surgical removal of the gallbladder. It can be carried out as an open or laparoscopic surgery. Today, about 90% of cholecystectomies are performed as laparoscopic surgery.

Indications

The cholecystectomy is mainly in case of complaints that can be attributed to gallstones in the gallbladder or a stone passage through the bile duct. Symptoms are common complaints in the right upper abdomen after food intake, recurrent colic, inflammation of the gallbladder or a Abflusstörung the gallbladder ( gallbladder ) by a Cysticusverschluss. Other reasons may include surgery, pancreatitis or a Gallengangsaufstau that are triggered by small gallbladder stones again and again. Other reasons may be Cholesterolpolypen or gallbladder cancer ( carcinoma).

Gallstones are found in up to 10% of the population. If no discomfort occurs, a distance is not indicated.

Open cholecystectomy

In open surgery, access to the gallbladder is created via a right rib edge cut of about 10 cm length. After the cystic duct and the cystic artery were dissected free at the base of the gallbladder, they are closed with suture ligatures and then severed. Then the gall-bladder is separated from the liver bed. After hemostasis, the wound is closed again. So-called target drainages will now inserted only in exceptional cases, for example, a collection of pus in the gall bladder gall bladder or a Gallenblasenperforation.

Laparoscopic Cholecystectomy

In laparoscopic cholecystectomy, access to the abdominal cavity is created via a 2 cm skin incision just below or above the navel, through which a special endoscope, the laparoscope can be introduced. A second approach, usually just below the breastbone ( sternum) is then created under direct vision, can be introduced on the gripping and cutting tools. In addition, a third, a fourth and often similar access right is created on the side of navel height. The Freipräparieren the vessels at the base of the gallbladder and the release thereof from the liver bed runs exactly as in case of the open operation. The gallbladder is spent at the end of surgery in the abdomen in an extraction bag and removed either on access in the area of the navel or below the breastbone. Here, too, can be inserted into the wound cavity, final drainage. A further development of the technique of laparoscopic cholecystectomy is the " totally umbilical cholecystectomy " ( TULC ) are created in the smallest additions to the navel, so that the number of visible scarring is minimized. The actual surgery is no different from the conventional cholecystectomy and observe the same safety standards. Additional methods that are being tested in clinical trials to completely avoid visible scars, are oral and transvaginal cholecystectomy assisted in the hybrid NOTES technique.

History

The first open cholecystectomy led 1882 Carl Lange book in the Lazarus Hospital Berlin, the first laparoscopic cholecystectomy in 1985, the surgeon Erich effort in Böblingen District Hospital and the first endoscopic Choledochozelen cleavage 1976 Internist Siegfried Ernst Miederer at Bonn University Clinic by.

Swell

Miederer, S. E.. , et al: Endoscopic transpapillary splitting of a choledochocele, Dtsch Med Wochenschrift, 1978, Feb.3: 103 (5): 216-219