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Relaparoskopie bei laparoskopischen Komplikationen

Relaparoscopy as an alternative to laparotomy for laparoscopic complications

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Zusammenfassung

Revisionspflichtige Komplikationen nach laparoskopischen Eingriffen werden in der Viszeralchirurgie heute meist mittels konventioneller Laparotomie operiert. Die Relaparoskopie hat jedoch den theoretischen Vorteil, die durch den Ersteingriff erzielte limitierte Morbidität zu erhalten. Vorraussetzung für eine erfolgreiche Relaparoskopie ist die genaue Kenntnis des spezifischen Komplikationsspektrums. Entschließt sich der Chirurg zur Relaparoskopie, so ist der frühe Revisionszeitpunkt von zentraler Bedeutung. Nach laparoskopischer Cholezystektomie ist es technisch grundsätzlich möglich, mittels erneuter Laparoskopie nicht nur subhepatische Abszesse, sondern auch kleinere Gallenwegsläsionen, beispielsweise aus dem Gallenblasenbett, zu kontrollieren. Laparoskopische Revisionen später Komplikationen nach Fundoplikatio sind von hohem technischen Anspruch und nur sehr erfahrenen Laparoskopikern zu empfehlen. Die Relaparoskopie bei Abszessen nach laparoskopischer Appendektomie hat im Gegensatz zur interventionellen Drainage den theoretischen Vorteil, Ursachen, wie beispielsweise eine Appendixstumpfinsuffizienz, zu erkennen und zu beheben. Sehr früh auftretende postoperative Rezidive nach endoskopischer inguinaler Hernioplastik sind Folge eines technischen Fehlers und können daher meist endoskopisch korrigiert werden. Komplikationen nach laparoskopischer Kolonchirurgie werden bislang aus technischen Gründen und aus Gründen der Patientensicherheit in der Regel offen beherrscht. Bei unsicherer Datenlage in der Literatur ist die Sicherheit des Patienten, insbesondere in der Blutungssituation, grundsätzlich oberstes Gebot bei der Indikation zur Relaparoskopie.

Abstract

In the field of visceral surgery, complications requiring reintervention following laparoscopy are currently most likely to be approached with conventional laparotomy. However, relaparoscopy has the theoretical advantage of maintaining the reduced morbidity allowed by the first procedure. Essential to the success of relaparoscopy is a clear understanding of the various specific complications. Should the surgeon decide on relaparoscopy, then prompt action is of central importance. Following laparoscopic cholecystectomy, it is fundamentally technically possible through renewed laparoscopy to treat not only subhepatic abscesses but also smaller lesions of the bile duct, for example from the gall bladder fossa. Revision of complications following fundoplication is technically very demanding and should be performed only by those most experienced in the techniques of laparoscopy. In contrast to interventional drainage, relaparoscopy of abscesses following laparoscopic appendectomy has the theoretical advantage of allowing recognition and treatment of the causes, for example in the case of appendicular stump insufficiency. Relapses very shortly after endoscopic surgery of inguinal herniae result from erroneous technique and may be corrected endoscopically in most cases. Complications following colon surgery have so far been dealt with using open surgery for technical reasons and also for patient safety. Given the uncertainty in the literature, patient safety must be paramount, when deciding on which technique is best to employ, particularly in cases of haemorrhage.

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  1. Klinik für Allgemeinchirurgie, Georg-August-Universität Göttingen, Robert-Koch-Straße 40, 37075 , Göttingen, Deutschland

    I. Leister & H. Becker

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  1. I. Leister
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Correspondence to I. Leister.

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Leister, I., Becker, H. Relaparoskopie bei laparoskopischen Komplikationen. Chirurg 77, 986–997 (2006). https://doi.org/10.1007/s00104-006-1252-x

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