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Reinterventionen an den Gallenwegen

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Praxis der Viszeralchirurgie

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Zusammenfassung

Auch heute noch sind Gallenwegsläsionen für den Patienten oft schicksalsbestimmend und führen nicht selten nach langen schweren Krankheitsverläufen zum Tode. Am häufigsten werden sie bei der offenen und der laparoskopischen Cholezystektomie verursacht (Clavien 1992; Hannan et al. 1999; MacFadyen et al. 1998; Orlando et al. 1993; Roslyn et al. 1993). Von geringerer Bedeutung sind instrumentelle Verletzungen im Rahmen von Endoskopien, Anastomosenkomplikationen nach Lebertransplantationen (Abt et al. 2003) oder unfallbedingten Schädigungen.

Jede Schädigung der Gallenwege erfordert stets eine sachkundige Versorgung durch entsprechend erfahrene und geübte Zentren, um die kritische Prognose möglichst günstig zu beeinflussen. Selbst dann sind dennoch Reinterventionen häufig erforderlich.

Per definitionem werden darunter alle invasiven Maßnahmen im Anschluss an einen bereits abgeschlossenen Eingriff am Gallenwegssystem verstanden. Reparative Maßnahmen von Läsionen im Rahmen des Primäreingriffes gehören streng genommen nicht zu den Reinterventionen.

Reinterventionen an den Gallenwegen sind heute längst nicht mehr allein die Domäne der Chirurgie. Endoluminale interventionelle Maßnahmen (endoskopisch-retrograd oder transhepatisch) können bei bestimmten Indikationen ausreichend sein.

Es hat sich gezeigt, dass ein wohlabgewogener Einsatz verschiedener therapeutischer Ansätze je nach Schädigungsmuster die Effizienz der Behandlung insgesamt verbessern kann (Doctor et al. 1998; Nordin et al. 2002; Nuzzo et al. 2005).

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  1. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München

    J. R. Siewert (Prof. Dr.) & H. Feussner (Prof. Dr.)

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  1. J. R. Siewert
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  2. H. Feussner
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  1. Medizinische Fakultät der RWTH, Universitätsklinik und Poliklinik, Pauwelsstr. 30, 52057, Aachen

    Volker Schumpelick

  2. Chirurgische Klinik und Poliklinik, Technische Universität München Klinikum rechts der Isar, Ismaninger Str. 22, 81657, München

    Jörg Rüdiger Siewert

  3. Zentrum für Operative Medizin I, Klinikum der Philipps-Universität, Baldinger Straße, 35043, Marburg

    Matthias Rothmund

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Siewert, J.R., Feussner, H. (2006). Reinterventionen an den Gallenwegen. In: Schumpelick, V., Siewert, J.R., Rothmund, M. (eds) Praxis der Viszeralchirurgie. Springer, Berlin, Heidelberg . https://doi.org/10.1007/978-3-540-29042-1_77

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  • DOI: https://doi.org/10.1007/978-3-540-29042-1_77

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