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Unlabelled: We studied developments in indication, operation time, conversion rate, morbidity, and mortality from the beginning of laparoscopic cholecystectomy. Between 1990 and 2002 we prospectively evaluated 4498 patients undergoing cholecystectomy (CE), of whom 79% were treated laparoscopically (lap). In 6.6%, the procedure had to be converted from laparoscopic to open cholecystectomy (con), and 14% were performed open from the beginning (open). During the above time period, the rate of open CE decreased steadily (49% in 1990 to 7.2% in 2002). The average operation time of lap CE remained constant with an average of 74 min (range 20-330). The conversion rate decreased in spite of broader indication for lap CE in even more complicated gallstone diseases, from an initial 9.4% to 2.5%. Among intraoperative complications in lap and con, bile duct lesions remained constant with 5/3856 (0.1%), bleeding which led to conversion decreased from 1.9% to 0.3%, and the rate of gall bladder perforation increased from 12% to 20.5%. Thirty-day morbidity was 2% in lap CE, 5% in con, and 11.5% in open. The mortality was 0% in lap, 0.7% in con, and 1% in open., Conclusion: Since the introduction of laparoscopic cholecystectomy the indication for this minimal-invasive operation steadily increased, the conversion-rate decreased and the complication-rate could be held low. Even with fast laparoscopic experience 7% of all cholecystectomies are technically difficult and remain to be carried out primarily in an open technique. The laparoscopic cholecystectomy has become the gold standard in the therapy of gallstone disease.

Haemobilia is defined as bleeding into the hepatobiliary system caused by a pathologic connection between blood vessels and biliary ducts. A rare cause of haemobilia is gallstone disease, with only 52 reported cases in the literature. The haemobilia is characterised by the classical triad: jaundice, colicky pain in the right upper quadrant and signs of gastrointestinal bleeding. Diagnosis can be made with endoscopic procedures and with angiography of the coeliac trunk, which has the highest sensitivity in localisation of bleeding source. The therapy of choice is cholecystectomy. We report the case of a patient with massive gastrointestinal haemorrhage caused by a solitary gallstone and present the diagnostic and therapeutic management of this disease, which is accompanied by a high mortality.

Injuries of the biliary tract remain an important concomitant lesion following liver trauma. Intra- and extrahepatic bile duct injuries differ substantially in etiology and choice of surgical procedure. Intrahepatic bile duct injuries gain clinical relevance postoperatively following primary surgical liver treatment. Characteristic consequences of intrahepatic bile duct injuries are: infected necrosis, abscess, bilious fistula, bilhemia, hemobilia and biliary duct stricture. In contrast, concomitant organ or vessel injury are of primary importance in extrahepatic biliary duct injury. Lesions of the distal biliary duct, always associated with duodenal or pancreatic injury, remains a particular thrill in general surgery. The approach to surgical treatment in case of biliary duct injury and its consequences are outlined and discussed in detail.

Hemobilia is caused by a pathological communication between the biliary tract and the intra- and extrahepatic blood vessels; multifarious pathogenetical mechanisms of this syndrome have to be considered. The trias of colicky upper abdominal pain, jaundice and haemorrhage in the upper gastrointestinal tract determinates the clinical picture. To ensure the diagnosis and to localize the source of bleeding sonography, endoscopic retrograde cholangiography (ERC) and coeliacography are indispensable. Besides the transvasal selective embolization ligature of the hepatic artery resection of the affected part of the liver just as reconstructive vascular operations serve as therapeutical tools in this disease. A patient complaining of intrahepatic hemobilia is described who was successfully treated by highly selective ligature of the respective vessel after intraoperative angiography through the stump of the cystic artery. Using this procedure the resection of the affected part of the liver could be avoided.