Cholecystectomy
A cholecystectomy (also cholecystectomy , abbreviated CHE or CCE ) or gallbladder removal is the surgical removal of the gallbladder . It can be performed as an open or laparoscopic operation . In 2018, around 90% of cholecystectomies were performed as laparoscopic surgery.
Indications
Cholecystectomy is mainly performed in the event of symptoms that can be traced back to gallstones in the gallbladder or to a stone discharge through the bile duct. Symptoms are often complaints in the right upper abdomen after eating, recurring colic , inflammation of the gallbladder, cholecystitis or a drainage disorder of the gallbladder ( gallbladder hydrops ) due to a cysticus obstruction . Other reasons for surgery can be pancreatitis or biliary obstruction, which are repeatedly triggered by small gallbladder stones. Other reasons could be cholesterol polyps or gallbladder cancer ( carcinoma ).
Gallstones are found in up to 10% of the population. If there are no symptoms, removal is not indicated .
Open cholecystectomy
In the open operation, access to the gallbladder is created via a right costal incision approx. 10 cm long. After the cystic duct and the cystic artery at the base of the gallbladder have been exposed, they are closed with suture ligatures or clips and then severed. Then the gallbladder is released from the liver bed . After the bleeding has stopped, the wound is closed again. So-called target drainages are only inserted in justified exceptional cases, for example in the case of an accumulation of pus in the gallbladder, gallbladder empyema or a gallbladder perforation.
Laparoscopic cholecystectomy
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In laparoscopic cholecystectomy, an approx. 2 cm long skin incision is made directly below or above the navel to access the abdominal cavity, through which a special endoscope, the laparoscope , can be inserted. Subsequently, a second access is created under sight, usually directly below the breastbone , through which grasping and cutting instruments can be introduced. In addition, a third and often a fourth similar access is created on the right side at navel level. The process of dissecting the vessels at the base of the gallbladder and releasing them from the liver bed is exactly the same as with open surgery. At the end of the operation, the gallbladder is placed in a retrieval bag in the abdomen and removed either via the access in the area of the navel or below the breastbone. Here, too, drains can be introduced into the wound cavity. A further development of the technique of laparoscopic cholecystectomy is total umbilical cholecystectomy (TULC), in which the smallest accesses are created in the area of the navel so that the number of visible scars is minimized. The actual operation does not differ from the conventional cholecystectomy and observes the same safety standards. Oral and transvaginal assisted cholecystectomy in the hybrid NOTES technique are further access options that are being tested in clinical studies to completely avoid visible scars .
history
The first open cholecystectomy was carried out by Carl Langenbuch in 1882 in the Lazarus Hospital in Berlin, the first laparoscopic cholecystectomy in 1985 by the surgeon Erich Mühe in the Böblingen district hospital and the first endoscopic choledochocele cleavage in 1976 by the internist Siegfried-Ernst Miederer at the University Hospital Bonn . The world's first scarless removal of a gallbladder through the vagina was carried out by Professor Carsten Zornig from the Israelite Hospital in Hamburg in 2007.
literature
- SE Miederer et al .: Endoscopic transpapillary splitting of a choledochocele. In: Dtsch Med Wochenschrift , 1978, Feb. 3: 103 (5), pp. 216-219.
- G. Skibbe: gallbladder and bile ducts. In: Surgery historically: beginning - development - differentiation. Edited by FX Sailer and FW Gierhake, Dustri-Verlag, Deisenhofen near Munich 1973, ISBN 3-87185-021-7 , pp. 72-88
Web links
- S3 guideline gallstones, diagnostics and therapy of the German Society for Digestive and Metabolic Diseases and the German Society for Visceral Surgery. In: AWMF online (as of 2007)
