Zusammenfassung
Objekt: Bericht über die Einführung einer neuen Methode sowie über die damit verbundenen
Erfahrungen innerhalb eines Jahres. Patienten und Methode: Ein Teil der Patienten mit Gallenblasensteinen verfügt gleichzeitig über Steine in
den Gallengängen. Sollte die wegen Verdacht auf einen Choledochus-Stein präoperativ
absolvierte Cholangiopankreatografie keine eindeutige Diagnose erbringen, kann eine
Rendezvous-ERCP (Laparoendoskopie) zur Lösung führen. Die Verfasser berichten über
10 eigene Fälle, an denen sie nach Studium der internationalen Literatur zum Thema
den o. g. Eingriff erfolgreich vornahmen. Ergebnisse: Hervorgehoben werden dabei die Vorteile dieses neuen Verfahrens bei bestimmten Patientengruppen
gegenüber der üblichen, sequenziellen Methode (präoperative ERCP, dann laparoskopische
Cholezystektomie), sie gehen dabei auch auf die verschiedenen Kunstgriffe ein, die
während der Operationen verwendet wurden. Schlussfolgerung: Letztendlich weisen sie auf die Bedeutung der Team-Arbeit hin, da bei der Erstellung
der Indikation, der Organisation und Durchführung des Eingriffs die Zusammenarbeit
von Gastroenterologen, Chirurgen und Anästhesisten unentbehrlich ist.
Abstract
Objective: The aim of this work is to demonstrate the introduction of laparo-endoscopy and to
investigate the year-long experience with its use. Patients and Methods: In a subgroup of patients with cholecystolithiasis, concomitant lithiasis of the
common bile duct may also be present. When the preoperative endoscopic cholangiopancreatography,
performed as a result of a suspected choledocholithiasis, was unsuccessful, a “rendezvous”
ERCP, laparo-endoscopy, is performed. After a survey of the international literature
on the method, and a description of its technique, the authors give a review of the
cases of their own 10 patients, which were all successful. Results: These findings emphasise the advantages of the new method in a certain subgroup of
patients over the conventional, sequential approach (preoperative ERCP followed by
laparoscopic cholecystectomy), and also give technical hints obtained during their
performance of the operations up to now. Conclusions: These results underline the importance of team work that involves the cooperation
of a gastroenterologist, a surgeon and an anaesthesiologist in the indication, organisation
and implementation of the intervention.
Key words
laparoscopic cholecystectomy - endoscopic retrograde cholangiopancreatography - laparo-endoscopy
- choledocholithiasis
Schlüsselwörter
laparoskopische Cholezystektomie - endoskopisch retrograde Cholangiopankreatikografie
- Laparoendoskopie - Choledocholithiasis
References
- 1
Sarli L, Iusco D R, Roncoroni L.
Preoperative endoscopic sphincterotomy and laparoscopic cholecystectomy for the management
of cholecystocholedocholithiasis: 10-year experience.
World J Surg.
2003;
27
180-186
- 2
Miller R E, Kimmelstiel F M, Winkler W P.
Management of common bile stones in the era of laparoscopic cholecystectomy.
Am J Surg.
1995;
169
272-276
- 3
Sarli L, Costi R, Gobbi S et al.
Asymptomatic bile duct stones: selection criteria for intravenous cholangiography
and/or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy.
Eur J Gastroenterol Hepatol.
2000;
12
1175-1180
- 4
Yang M H, Chen T H, Wang S E et al.
Biochemical predictors for absence of common bile duct stones in patients undergoing
laparoscopic cholecystectomy.
Surg Endosc.
2008;
22
1620-1624
- 5
Barkun A N, Barkun J S, Fried G M et al.
Useful predictors of bile duct stones in patients undergoing laparoscopic cholecystectomy.
Ann Surg.
1994;
220
32-39
- 6
Onken J E, Brazer S R, Eisen G M et al.
Predicting the presence of choledocholithiasis in patients with symptomatic cholelithiasis.
Am J Gastroenterol.
1996;
91
762-767
- 7
Peng W K, Sheikh Z, Paterson-Brown S et al.
Role of liver function tests in predicting common bile duct stones in patients with
acute calculous cholecystitis.
Br J Surg.
2005;
92
1241-1247
- 8
O’Connor H J, Hamilton I, Watters J et al.
Ultrasound detection of choledocholithiasis: prospective comparison with ERCP in the
postcholecystectomy patient.
Gastrointest Radiol.
1986;
11
161-164
- 9
Varon R L, Stanley R J, Lee J K et al.
A prospective comparison of the evaluation of biliary obstruction using computed tomography
and ultrasonography.
Radiology.
1982;
145
91-98
- 10
Costi R, Sarli L, Caruso G et al.
Preoperative ultrasonographic assessment of the number and size of gallbladder stones:
is it a useful predictor of asymptomatic choledocholithiasis.
J Ultrasound Med.
2002;
21
971-976
- 11
Lakatos L, Mester G, Reti G Y et al.
Selection criteria for preoperative endoscopic retrograde cholangiopancreatography
before laparoscopic cholecystectomy and endoscopic treatment of bile duct stones:
Results of a retrospective, single center study between 1996 – 2002.
World J Gastroenterol.
2004;
10
3495-3499
- 12
ASGE Guidline. The role of endoscopy in the evaluation of suspected choledocholithiasis.
Gastrointest Endosc.
2010;
71
1-7
- 13
Romagnoulo J, Bardou M, Rahme E et al.
Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in
suspected biliary disease.
Ann Intern Med.
2003;
139
547-557
- 14
Verma D, Kapadia A, Eisen G M et al.
EUS vs MRCP for detection of choledocholithiasis.
Gastrointest Endosc.
2006;
64
248-254
- 15
Soto J A.
Bile duct stones: diagnosis with MR cholangiography and helical CT.
Semin Ultrasound CT MRI.
1999;
20
304-316
- 16
Liu T H, Consorti E T, Kawashima A et al.
The efficacy of magnetic resonance cholangiography for the evaluation of patients
with suspected choledocholithiasis before laparoscopic cholecystectomy.
Am J Surg.
1999;
178
480-484
- 17
Kohut M, Nowakowska-Dulawa E, Marek T.
Accuracy of linear ultrasonography in the evaluation of patients with suspected common
bile duct stones.
Endoscopy.
2002;
34
299-303
- 18
Lachter J, Rubin A, Shiller M et al.
Linear EUS for bile duct stones.
Gastrointest Endosc.
2000;
51
51-54
- 19
Wu J CY, Chan F KL, Wong S KH et al.
Comparison of EUS and ERCP in the investigation with suspected biliary obstruction
caused by choledocholithiasis: a randomized study.
Gastrointest Endosc.
2008;
67
660-668
- 20
Liu C L, Fan S T, Lo C M et al.
Comparison of early endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography
in the management of acute biliary pancreatitis: a prospective randomized study.
Clin Gastroenterol Hepatol.
2005;
3
1238-1244
- 21
Karakan T, Cindoruk M, Alagozlu H et al.
EUS versus endoscopic retrograde cholangiography for patients with intermediate probability
of bile duct stones: a prospective randomized trial.
Gastrointest Endosc.
2009;
69
244-252
- 22
Tüske G Y, Vattay P, Csermely L et al.
Alteration of the treatment in choledocholithiasis (Hung.).
Magy Seb.
2000;
53
56-60
- 23
Neuhaus H, Feussner H, Ungeheuer A et al.
Prospective evaluation of the use of endoscopic retrograde cholangiography prior to
laparoscopic cholecystectomy.
Endoscopy.
1992;
24
745-749
- 24
Huang S M, Wu C W, Chan G Y et al.
An alternative approach of choledochotomy via laparoscopic choledochotomy.
Arch Surg.
1996;
131
407-411
- 25
Keeling N J, Menzies D, Motson R W.
Laparoscopic exploration of the common bile duct: beyond the learning curve.
Surg Endosc.
1999;
13
109-112
- 26
Völgyi Z, Fischer T, Szenes M et al.
Újfajta randevú, azaz a laparo-endoscopia bevezetése válogatott betegenyagban (Hung.).
Orv Hetil.
2010;
25
1026-1032
- 27
Cavina E, Franceschi M, Sidoti F et al.
Laparo-endoscopic “rendezvous”: a new technique in the choledocholithiasis treatment.
Hepatogastroenterology.
1998;
45
1430-1435
- 28
La Greca G, Barbagallo F, Di Blasi M et al.
Laparo-endoscopic “rendezvous” to treat cholecysto-choledocolithiasis: efective, safe
and simplifies the endoscopist’s work.
World J Gastroenterol.
2004;
10
3495-3499
- 29
Enochsson L, Lindberg B, Swahn F.
Intraoperative endoscopic retrograde cholangiopancreatography (ERCP) to remove common
bile duct stones during routine laparoscopic cholecystectomy does not prolong hospitalization:
a 2-year experience.
Surg Endosc.
2004;
18
367-371
- 30
Lella F, Bagnolo F, Rebuffat C et al.
Use of the laparoscopic–endoscopic approach, the so-called “rendezvous” technique,
in cholecystocholedocholithiasis. A valid method in cases with patient-related risk
factors for post-ERCP pancreatitis.
Surg Endosc.
2006;
20
419-423
- 31
Morino M, Baracchi F, Miglietta C et al.
Preoperative endoscopic sphincterotomy versus laparoendoscopic rendezvous in patients
with gallbladder and bile duct stones.
Ann Surgery.
2006;
6
244, 889-893
- 32
Basso N, Pizzuto G, Surgo D.
Laparoscopic cholecystectomy and intraoperative endoscopic sphincterotomy in the treatment
of cholecysto-choledocholithiasis.
Gastrointest Endosc.
1999;
4
532-535
- 33
NIH State-of-the Science Statement on endoscopic retrograde cholangiopancreatography
(ERCP) for diagnosis and therapy.
NIH Consens State Sci Statements.
2002;
19
1-26
- 34
Nakajima H, Okubo H, Masuko Y et al.
Intraoperative endoscopic sphincterotomy during laparoscopic cholecystectomy.
Endoscopy.
1996;
28
264
- 35
Tricarico A, Cione G, Sozio M et al.
Endolaparoscopic rendezvous treatment: a satisfying therapeutic choice for cholecystocholedocholithiasis.
Surg Endosc.
2002;
16
711-713
Zoltán Völgyi, MD
Department of Internal Medicine, Zala County Hospital
Zrínyi str. 1
H-8900 Zalaegerszeg
Hungary
Phone: ++ 36/92/50 75 00
Fax: ++ 36/92/59 69 82
Email: Mistral9@freemail.hu
