Beschreibung
The first laparoscopic cholecystectomy, performed by Prof. Philippe Mouret in 1987 and described by himself in the first chapter of this book, was an event that revolutionized surgery in the past few decades. Although the majority of surgeons today are unfamiliar with the his- ry of early minimally invasive surgery developments, it is important to realize that the advent of laparoscopy led not only to new surgical te- niques, but also to a change in the doctrine of medical care, by streng- ening the concept of minimal invasiveness. This is particularly the case for biliary lithiasis, for which laparoscopy has provided major benefits in terms of both diagnosis and surgical tre- ment. However, our understanding of the etiology of this disease, as well as the availability of effective medical therapies, have remained subst- tially unchanged over time. The application of the innovative approach has not been, in routine practice, without problems: between 1990 and 2000, the rate of serious complications from laparoscopic cholecystectomy were four times higher than those observed with open surgery. Even initial attempts at lapa- scopic treatment of biliary common bile duct stones resulted in excessive complications and associated medico-legal problems. Nonetheless, today, most indications have been stated, techniques have been standardized, and a new aspect to the treatment of biliary lithiasis has appeared.
Autorenporträt
InhaltsangabeReflections on the birth and on the concept of laparoscopic surgery.- Epidemiology of biliary lithiasis.- Pathophysiology of cholesterol gallstone disease.- Classification, composition and structure of gallstones. Relevance of these parameters for clinical presentation and treatment.- Natural history of biliary lithiasis.- Preoperative noninvasive imaging.- Three-dimensional imaging.- Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound.- Pre- and intra-operative diagnostic fibrocholangioscopy.- Intraoperative cholangiography.- Laparoscopic ultrasound during laparoscopic cholecystectomy.- Diagnostic flow charts for biliary lithiasis.- Medical treatment of gallstone disease.- Surgical treatment of cholelithiasis: exclusion criteria.- Anaesthesia in biliary lithiasis.- Cholecystectomy techniques.- Robot-Assisted cholecystectomy.- Day surgery laparoscopic cholecystectomy.- Diagnosis and treatment of acute cholecystitis.- Incidental carcinoma of the gallbladder.- Complications of laparoscopic cholecystectomy.- Clinical pictures of common bile duct stones.- Synchronous Treatment by laparotomy.-Cholecystocholedocholithiasis: two-stage treatment.- Synchronous laparoscopic treatment.- Rendez-vous technique.- Flow chart for the treatment of common bile duct stones and critical comparison of techniques.- Common bile duct stones in cholecystectomized patients.- Acute biliary pancreatitis.- Mirizzi syndrome.- Biliary lithiasis in children.- Biliary lithiasis in pregnancy.- Biliary lithiasis and obesity.- Biliary lithiasis in patients with gastroesophageal reflux (acid and alkaline).- Hepatic cirrhosis and biliary stones.- Biliary stones and gastrectomy.- Biliary ileus.- Clinical pictures of intrahepatic lithiasis.- Treatment of intrahepatic lithiasis.- Extracorporeal shock wave treatment of gallbladder stones.- Shock wave for main bile duct stones.-Acute gallstone cholangitis: clinical pictures, diagnosis and treatment.- Subject index.
