RIGHT UPPER PAIN
Pain in the right upper or central abdomen.
ZURÜCK ZU DEN LEISTUNGENSAFE LAPAROSCOPIC CHOLECYSTECTOMY
GALLENBLASENCHIRURGIE
From symptomatic gallstones to acute inflammation, with systematic anatomical identification and safety strategies.
CRITICAL VIEW OF SAFETYICG / NIRBAIL-OUT STRATEGY
EINGRIFFE ANSEHENHinweis: Die Seitennavigation ist auf Deutsch verfügbar. Die ausführlichen medizinischen Inhalte dieser Fachseite werden derzeit auf Englisch angezeigt.
ELIXIS · ADVANCED CARE
The goal is not simply removal — it is safe identification
Biliary anatomy is confirmed before division. When inflammation obscures planes, the strategy changes early.
SYMPTOME
Symptoms that merit assessment
Many gallstones cause no symptoms. Temporary blockage of bile flow may cause biliary colic, while prolonged obstruction can lead to inflammation or other complications.
AFTER MEALS
Pain often follows a meal and may last from minutes to several hours.
TO BACK OR SHOULDER
Discomfort may travel to the back or right shoulder.
NAUSEA OR VOMITING
A pain episode may be accompanied by nausea or vomiting.
FEVER OR CHILLS
Fever or chills may indicate that inflammation has developed.
JAUNDICE
Yellow skin or eyes, dark urine and pale stools may indicate bile-duct obstruction.
Indigestion or bloating alone do not prove gallstone disease. Assessment combines history, examination, blood tests and usually ultrasound.
EINGRIFFE
Procedures and safety techniques
These are different clinical scenarios; not every option is used in every patient.
01GALLSTONES
SYMPTOMATIC GALLSTONE DISEASE
Before surgery is recommended, the symptoms are assessed to confirm that gallstones are the likely cause.
- WANN ES ERWOGEN WIRD
- Biliary colic, gallstone complications or another established indication.
- WAS DER EINGRIFF UMFASST
- Ultrasound, blood tests and common-duct assessment guide the appropriate plan.
02LAP CHOLE
LAPAROSCOPIC CHOLECYSTECTOMY
Removal of the gallbladder through small incisions for symptomatic stones.
- WANN ES ERWOGEN WIRD
- Symptomatic gallstones or a prior complication with a clear surgical indication.
- WAS DER EINGRIFF UMFASST
- Safe dissection, control of the cystic duct and artery, and protected specimen extraction.
03CVS
CRITICAL VIEW OF SAFETY
Three defined anatomical criteria before dividing the cystic duct and artery.
- WANN ES ERWOGEN WIRD
- A core safety goal in standard laparoscopic cholecystectomy.
- WAS DER EINGRIFF UMFASST
- All three criteria are required: the hepatocystic triangle is cleared of fat and fibrous tissue, the lower one third of the gallbladder is separated from the liver to expose the cystic plate, and two —and only two— structures are seen entering the gallbladder.
04ICG · NIR
ICG FLUORESCENCE CHOLANGIOGRAPHY
Intravenous ICG displays biliary anatomy with near-infrared imaging and no ionising radiation.
- WANN ES ERWOGEN WIRD
- Adjunctive mapping in selected laparoscopic procedures.
- WAS DER EINGRIFF UMFASST
- The fluorescence view is alternated with white light; it supports but does not replace safe dissection and surgical judgement.
05ACUTE
ACUTE CHOLECYSTITIS SURGERY
Early laparoscopic treatment of an inflamed gallbladder when clinically appropriate.
- WANN ES ERWOGEN WIRD
- Acute inflammation confirmed by clinical, laboratory and imaging findings.
- WAS DER EINGRIFF UMFASST
- Decompression when needed, careful dissection and early use of a safer bail-out strategy or conventional cholangiography when indicated.
06BAIL-OUT
SUBTOTAL CHOLECYSTECTOMY
A bail-out strategy when safe anatomical identification is not possible.
- WANN ES ERWOGEN WIRD
- Severe inflammation, fibrosis or hazardous anatomy in the hepatocystic triangle.
- WAS DER EINGRIFF UMFASST
- The safely accessible gallbladder and reachable stones are removed; the remnant and cystic duct are managed according to the anatomy. Bile leak and retained-stone risks remain.
Originale realistische Anatomiedarstellung zu Lehrzwecken — kein Patientenfoto.
PLANUNG & SICHERHEIT
Anatomy is confirmed before division
ICG and conventional cholangiography are distinct adjuncts. ICG uses no X-rays and does not reliably exclude common-duct stones; neither tool replaces the Critical View of Safety or surgical judgement.
TIME-OUT
A pause before division to confirm anatomy.
TWO STRUCTURES
Clear identification of cystic duct and artery.
IMAGING
ICG for adjunct anatomical mapping; conventional cholangiography when common-bile-duct imaging is needed.
BAIL-OUT
Early change of plan in hazardous anatomy.
FRAGEN
HÄUFIGE FRAGEN
Kurze Antworten vor der individuellen chirurgischen Beurteilung.
01Is a minimally invasive approach always possible?
No. It is chosen when safe and meaningfully beneficial. Anatomy, previous surgery and complexity may require another approach or conversion.
02How long does recovery take?
Recovery varies with the procedure, disease severity and general health. The individual plan covers mobilisation, diet, work and exercise.
03Is ICG fluoroscopy?
No. It uses near-infrared fluorescence rather than ionising radiation. Contraindications and the possibility of a rare reaction must still be checked.
KLINISCHE EVIDENZ
KLINISCHE EVIDENZ
Die endgültige Wahl richtet sich nach Befund, Anatomie und aktuellen Leitlinien.
01SAGES · Safe Cholecystectomy GuidelineCritical View of Safety and injury-prevention strategiesOFFIZIELLE QUELLE02SAGES · Fluorescence-Guided SurgeryClinical guidance for ICG fluorescenceOFFIZIELLE QUELLE03SAGES · Intraoperative CBD ImagingICG fluorescence and conventional X-ray cholangiographyOFFIZIELLE QUELLE04NIDDK · GallstonesSymptoms of gallstones and complicationsOFFIZIELLE QUELLE
Diese Informationen ersetzen keine ärztliche Untersuchung. Nutzen, Risiken und Alternativen werden individuell besprochen.
INDIVIDUELLE CHIRURGISCHE BEURTEILUNG
Der richtige Eingriff beginnt mit der richtigen Indikation.
Beschwerden, Untersuchungen und Alternativen werden gemeinsam geprüft.
Praxis REA MED & Anfahrt