[Laparoscopic cholecystectomy in antegrade (prograde) technique].
In the case of acute cholecystitis and chronic cholecystitis of lang standing, the inflammatory changes in Calot's triangle make the risk of damaging the bile duct during laparoscopic cholecystectomy particularly high. In view of the difficult anatomical situation in Calot's triangle, such patho-anatomical conditions when encountered during open surgery best dealt with by anterograde (prograde) dissection of the gallbladder beginning from the fundus and proceeding towards the neck of the gallbladder. Since this approach is considered to be safer and less risky, it should also be adopted during laparoscopic surgery. The advantage is to be seen in the initial dissection far removed from the bile ducts. Despite pronounced inflammatory changes and initial preservation of the cystic artery, the use of modern technologies permit a virtually bloodless procedure. Nevertheless, the difficult anatomical situation makes a high level of readiness to conver mandatory. Should there be any doubt, the open surgical approach is the safer modality.
Köckerling
F
F
Chirurgische Klinik mit Poliklinik, Universität Erlangen-Nürnberg.
Schneider
C
C
Reymond
M A
MA
Hohenberger
W
W
D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D002764:Cholecystitis / Q000473:pathology / Q000601:surgery*; D002769:Cholelithiasis / Q000473:pathology / Q000601:surgery*; D003549:Cystic Duct / Q000473:pathology / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D013525:Surgical Instruments