A New Type of Rendezvous: Introduction of Laparo-Endoscopy in Selected Patients

 

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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.

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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