Polyp of the gallbladder. Causes, symptoms, diagnosis, treatment and prevention. Removal of polyps in the gallbladder without removal of the gallbladder Is it possible to remove a polyp from the gallbladder

The gallbladder is a tumor-like formation of various etiologies ( the reasons), which is localized on the inner wall of the gallbladder and grows into its lumen.

According to the summary data of various authors, 6 percent of the total population suffers from gallbladder polyps. Among patients with this pathology, 80 percent are women whose age exceeds 35 years. The sex of a person affects not only the prevalence of polyps, but also the nature of polyposis formations. So, in men, cholesterol polyps are most often diagnosed, while hyperplastic formations of the gallbladder predominate in the female.

Interesting Facts

The first to discover pathological deposits in the gallbladder mucosa was the German pathologist Rudolf Virchow in 1857. In the same year, this phenomenon was studied in detail by a microscopic method and described by another scientist. An important point in the study of gallbladder polyps was the assumption that there was a link between gallbladder polyposis and impaired fat metabolism. In 1937, the first medical work on this topic was published.

The author of the article identified the pathology of lipid metabolism as the main factor provoking the formation of one of the types of polyps. 19 years later, at the World Gastroenterological Congress, impaired fat metabolism was identified as the underlying cause of one of the categories of gallbladder polyps.
All the works of that period on the study of this pathology were more descriptive. The basis for the study of polyposis proliferation of the mucosa was mainly accidental findings during operations or autopsies. X-rays were also used to identify gallbladder polyps.

The introduction of ultrasound scanning into medical practice has expanded the possibilities of diagnosing gallbladder polyps.

Anatomy of the gallbladder

The gallbladder is located in the fossa or bed) of the gallbladder, which is located between the right and left lobes of the liver. The fibrous membrane covering the liver in this place fuses directly with the gallbladder. Thus, the bladder turns out to be, as it were, completely covered by the liver, leaving only a small extrahepatic segment. This segment is projected onto the anterior abdominal wall at the point of intersection of the 10th rib and the outer edge of the rectus abdominis muscle.

The gallbladder is pear-shaped and dark green in color. The length of this organ varies from 9 to 15 centimeters, and the volume is from 40 to 60 cubic centimeters. In the structure of the gallbladder, several departments are distinguished.

The divisions of the gallbladder are:

• bottom- the widest part, which is projected onto the anterior abdominal wall;
• body of the gallbladder, which narrows to the neck of the gallbladder;
• gallbladder neck, which gradually narrows, passes into the cystic duct, subsequently connecting with the common hepatic duct.

The structure of the walls of the gallbladder

Outer serosa
The serous membrane of the gallbladder is formed by loose connective tissue.

muscle layer
The muscular coat is formed by smooth muscle tissue, which, unlike skeletal muscles, does not contract voluntarily. The bundles of muscle fibers are located in a circular, oblique and longitudinal layer. This layer is developed differently in different parts of the gallbladder. So, in the region of the bottom of the gallbladder, muscle fibers are poorly developed, and in the region of its neck, the muscle layer is developed most intensively. The muscular layer of the cystic duct is similarly well developed. Thanks to this developed layer of the gallbladder wall, the bile duct itself is able to contract, thereby ensuring the promotion of bile.

mucous membrane
The mucous layer of the gallbladder forms numerous folds. It is lined with a single-layered epithelium, in the thickness of which there are glands.

Blood supply and innervation of the gallbladder

Innervation is carried out by nerve fibers extending from the celiac plexus. These fibers are located along the hepatic artery. Also, the gallbladder receives innervation from the vagus nerve. It controls the contractility of the gallbladder.

Physiology of the gallbladder

So, the intake of food and its digestion in the duodenum leads to the secretion of the hormone cholecystokinin. Receptors for this hormone are located in the thickness of the walls of the gallbladder. When cholecystokinin is released, it stimulates the receptors, causing the gallbladder to contract. Contracting, the gallbladder causes the passage of bile through the cystic duct into the common bile duct, and from there into the duodenum. The flow of bile is regulated by contraction or relaxation of the sphincter of Oddi. When the sphincter relaxes, bile flows into the duodenum. When it is reduced under the influence of cholecystokinin and other humoral factors, the flow of bile stops.

The composition of bile and its functions

Other functions of bile are:

• fat absorption;
• activation of pancreatic juice enzymes;
• absorption of fat-soluble vitamins ( A, E, D, K) and calcium salts;
• stimulation of intestinal motility.

Causes of a polyp

• genetic abnormalities and hereditary factor;
• inflammatory diseases of the gallbladder;
• violations of metabolic processes;
• biliary dyskinesia and other diseases of the hepatobiliary system.

Genetic anomalies and hereditary factor

The hereditary factor also plays a large role in diseases against which polyps can develop. Thus, a genetic predisposition to the development of biliary dyskinesia was noted.

However, today polyps are considered a polyetiological disease, which means that several factors are simultaneously involved in their formation. So, against the background of a burdened family history in terms of polyps under the influence of other incoming factors ( e.g. bile stasis) polyps may form.

Inflammatory diseases of the gallbladder

In the period between pains, patients are worried about belching with bitter contents, morning sickness on an empty stomach due to stagnation of bile. During the inflammatory process in the gallbladder, its wall thickens and deforms. As a result of this, stagnation of bile occurs, which is the cause of the above symptoms.
As a reaction to the inflammatory process, granulation tissue grows on the walls of the gallbladder. Thus, inflammatory pseudopolyps are formed.

Metabolic disorders

This type of polyp is the most common. For a long time, they do not bother the patient in any way, which is the reason for the long-term failure to see a doctor. This, in turn, leads to extensive cholesterol deposits.

Biliary dyskinesia and other diseases of the hepatobiliary system

Excessive contractions of the gallbladder are observed with its increased tone. The pains are sharper and more cramping and are caused by strong contractions. The outflow of bile is also impaired, which provokes symptoms such as belching with bitter contents, heaviness after eating.
Most often, gallbladder polyps are the result of several causes. This is the interaction of both hereditary factors and all kinds of metabolic disorders.

Symptoms of a gallbladder polyp

Symptoms of a gallbladder polyp are:

• pain syndrome;
• jaundice;
• hepatic colic;
• dyspeptic manifestations - bitter taste in the mouth, nausea, periodic vomiting.

Pain syndrome

The pains are located on the right in the hypochondrium and are dull in nature. They are rarely constant and are more often cramping in nature. Pain is provoked by fatty and plentiful food, alcoholic beverages, sometimes stressful situations.

Jaundice

Also, jaundice is accompanied by symptoms such as itching, nausea and vomiting. Skin itching appears as a result of the release of bile acids into the blood. Since the outflow of bile from the gallbladder is blocked, the bile begins to build up in it. Accumulating up to a certain time ( based on the initial size of the gallbladder), bile begins to look for a way out. It is soaked through the walls of the gallbladder and enters directly into the blood ( where normally it shouldn't be). Circulating in the vessels of the skin, bile acids irritate the nerve endings, thus causing itching. Often, scratching from severe itching is visible on the skin of patients. The skin is very dry and tight. Skin itching with jaundice is generalized and does not have a clear localization. Nausea and vomiting with jaundice is a consequence of stagnation of bile.
Also, with jaundice, urine becomes dark in color, pain in the joints and muscles appears. An unfavorable symptom is fever.

hepatic colic

A pedunculated polyp is a type of polyp that is shaped like a mushroom. In its structure, a leg and the hat itself are distinguished. The leg of the polyp can be very long and thin. Therefore, it can easily twist and pinch if the polyp is located in the neck of the bladder. When the bubble contracts, it can pinch either the entire poly or its movable leg. This moment provokes sharp, sharp and cramping pains like hepatic colic.
Very intense pains appear sharply and suddenly. The patient at the same time can not sit in one place and is constantly rushing about. An increase in heart rate ( pulse), and blood pressure may also rise. The skin becomes pale and covered with sweat.

A distinctive feature of hepatic colic from a pain syndrome of another etiology is that the patient in this condition cannot find a suitable position. As a rule, with pain of a different etiology, the patient finds himself a position in which the pain subsides a little. For example, with pleurisy, a person lies on the affected side in order to weaken the excursion of the chest and, thereby, reduce pain. With hepatic colic, this is not observed.

Dyspeptic manifestations

Manifestations of dyspeptic syndrome with a gallbladder polyp are:

• bitter taste in the mouth;
• nausea, especially in the morning;
• occasional vomiting, especially after eating large meals.

Classification of polyps in the gallbladder

Diagnosis of a polyp of the gallbladder

Ultrasound diagnosis of a polyp

On ultrasound, the gallbladder looks like a dark oval formation surrounded by a light thin wall. The wall is normally thin and even. The bladder cavity is normally uniform in color. With a polyp on a dark background, a light formation is diagnosed, growing from the wall into the cavity. The shape of this light formation is determined by the shape of the polyp - if it is a polyp on a stalk, then a stalk and a cap stand out in it. If there are many polyps, then several light formations growing from the wall into the dark cavity are determined at once. The color of polyps on ultrasound is heterogeneous. If it is a cholesterol or inflammatory polyp, then on ultrasound the formation is completely white. If it is an adenomatous polyp, then there are blackouts on a light background.

Carrying out ultrasound diagnostics
Preliminary preparation before the ultrasound is not required. However, if the patient suffers from severe gas formation ( swelling), then it is recommended to exclude gas-forming products 2-3 days before the diagnosis. Directly on the day of the study, a light breakfast or lunch is recommended so as not to overload the digestive system.

The place to which the sensor will be attached is treated with gel. This prevents air from penetrating between the sensor and the skin. For better visualization, the doctor may ask the patient to lie on the right side. The difference between a gallbladder polyp and its other formations is that the polyp does not give an acoustic track, for example, as with a gallbladder stone. Another feature is that it does not move when changing the position of the body.

Endoscopic ultrasonography method

For this diagnostic method, miniature ultrasound probes are used, which are first inserted into the stomach, and from there into the duodenum.

Performing endoscopic ultrasonography
The procedure is performed on an empty stomach. The night before, dinner should also be light so as not to overload the stomach. On the day of the procedure, the patient if he is very nervous) intramuscular injection of diazepam. The cavity of the oropharynx is treated with a solution of lidocaine, which is injected as a spray.
The patient is asked to open his mouth, and when the endoscope is inserted into the oropharynx, he makes a swallowing movement. At the moment of swallowing, the endoscope tube is pushed into the esophagus, and from there into the stomach cavity. From the cavity of the stomach, the endoscope, at the end of which an ultrasonic sensor is attached, enters the cavity of the duodenum, from where the surrounding tissues are scanned. Due to the high frequency of the ultrasound wave, the picture of the gallbladder is obtained with high resolution. This makes it possible to diagnose even very small polyps.

CT scan

In addition to instrumental diagnostic methods that allow you to identify the polyp itself, standard laboratory tests are carried out.

Laboratory diagnostic methods that are used for gallbladder polyps

Treatment of a polyp of the gallbladder

Drugs prescribed to eliminate the symptoms of a gallbladder polyp

Surgery
It is the main treatment for gallbladder polyps. As a rule, a polyp in the gallbladder is removed endoscopically. In this case, the entire gallbladder is removed, and this version of the operation is called cholecystectomy.

Indications for surgical treatment of gallbladder polyps are:

• the size of the polyp exceeds one centimeter;
• if the polyp develops against the background of another chronic pathology, for example, against the background of cholecystitis;
• if the polyp is constantly growing and increasing;
• if there are multiple polyps of the gallbladder;
• if there are additional gallbladder stones;
• if there is a burdened family history in terms of oncology.

Is surgery necessary for a gallbladder polyp?

Another indication for surgery is the presence in the gallbladder, in addition to polyps, stones and other neoplasms. Those polyps that cause discomfort and adversely affect the patient's health are also removed. A timely operation allows you to avoid serious complications. The method of surgical treatment is established by the physician, based on data on the general condition of the patient and the nature of the polyps.

The reasons why it is necessary to remove a gallbladder polyp are:

• transformation of a polyp into cancer;
• attacks of hepatic colic;
• inflammation of the walls of the gallbladder;
• purulent cholecystitis;
• deterioration of the outflow of bile;
• increased levels of bilirubin.

Transformation of a polyp into cancer

Attacks of hepatic colic

Other manifestations of a gallbladder polyp are:

• severe nausea;
• frequent vomiting, not leading to relief;
• pallor and moisture of the skin;
• yellowness of the skin and mucous membranes of the eyes;
• soreness and bloating;
• increase in temperature;
• dark urine.

Inflammation of the gallbladder

Purulent cholecystitis

The consequences of untimely removal of the gallbladder polyp are:

• Gangrenous cholecystitis- represents the next stage of purulent cholecystitis and is accompanied by necrosis ( deadness) walls of the gallbladder. The consequence of this condition may be the rupture of this organ.
• liver abscess- the formation of a cavity in the tissues of the liver, which is filled with purulent contents. An abscess can break into the abdominal cavity and cause a general infection of the body.
• Peritonitis- an inflammatory process in the peritoneal cavity, which develops as a result of a breakthrough of purulent contents into the peritoneum. This complication is characterized by a high mortality rate.
• Cholangitis- inflammation of the bile ducts, which can lead to sepsis ( blood poisoning).

Decreased flow of bile

Complications of gallbladder polyps are:

• cirrhosis of the liver ( pathological changes in the structure of the liver tissue);
• jaundice ( staining of the eye sclera and skin in a yellow tint);
• osteoporosis ( decrease in bone density);
• liver failure ( decrease in the functions of these organs).

Increasing bilirubin levels

Types of surgery for a polyp of the gallbladder

Laparoscopic cholecystectomy

Before the operation, the patient undergoes all the necessary clinical examinations. A repeated ultrasound examination, a complete blood count and a coagulogram ( includes testing for platelets, prothrombin, fibrinogen).

Anesthesia
Laparoscopic cholecystectomy is performed under general anesthesia with the use of muscle relaxants.

• four small incisions are made through which trocars are inserted;
• surgical instruments are inserted through the trocars into the abdominal cavity;
• being audited ( inspection) abdominal organs;
• there is a hepatoduodenal ligament, from which the cystic artery and cystic duct stand out;
• artery and duct are ligated and divided ( clipping occurs in medical language);
• from the liver bed is released and the gallbladder is separated. Most often, an electrocoagulator is used, which cuts and coagulates tissues;
• the gallbladder is removed from the abdominal cavity through the punctures made.

• short and moderate pain intensity in the postoperative period;
• minimal hospital stay in the postoperative period ( up to 5 days);
• a low percentage of complications such as adhesions, postoperative hernia, infection of postoperative wounds;
• immediately after the operation, the patient can serve himself.

Open cholecystectomy

The operation consists of the following steps:

• the field of the preliminary incision is treated with antiseptics;
• then an incision of 10 - 15 centimeters is made with a scalpel;
• tissue incision is carried out layer by layer;
• next is the hepatoduodenal ligament, after which the artery and duct are clipped;
• the gallbladder is removed from the bed, bandaged and removed;
• regional lymph nodes are removed;
• the incision is also sutured in layers, but in reverse order.

With open cholecystectomy, general anesthesia is performed with tracheal intubation and the use of muscle relaxants. The sutures are removed on the 6th - 7th day. On the first day after the operation, the patient can drink water, on the second - to eat. Getting up after an open laparotomy is allowed from 3 to 4 days. The duration of the rehabilitation period lasts about two weeks.

Rehabilitation after surgery for a gallbladder polyp

The first stage of rehabilitation ( early stationary stage)

Nutrition for the first stage of rehabilitation
During the first 4-6 hours, the operated person is forbidden to eat or drink. Further, within 10 - 15 hours, you need to drink only still water in small portions. After a day, you can begin to introduce liquid and semi-liquid food into the patient's diet.

Allowed dishes in the first stage of rehabilitation are:

• kefir, yogurt;
• oatmeal and buckwheat porridge;
• potato, squash, pumpkin puree;
• vegetable soups;
• banana puree;
• baked apples;
• lean meat soufflé.

Physical exercises of the first stage of rehabilitation
The first 5-6 hours after recovery from anesthesia, the patient should be in a horizontal position. Attempts to get out of bed can only be made with the permission of a doctor and in the presence of medical personnel. This is necessary in order to avoid fainting, which can develop due to prolonged lying and the action of medications.

An important stage of this rehabilitation stage is the implementation of a series of exercises. The task of physical activity is to activate breathing to remove the anesthetic from the respiratory tract. Also, exercises are necessary to normalize the circulation of blood and lymph. In the absence of complications, the exercises should be started immediately after the effect of anesthesia ends. You should start with breathing exercises, which consists of a slow deep breath and a sharp exhalation. It is necessary to repeat the alternation of inhalation and exhalation for 2-3 minutes, while holding the postoperative wound with your hand.

Then, within 2-3 minutes, flexion and extension of the limbs should be carried out, as well as their dilution to the sides and bringing them to their original position. After the patient is allowed to get up, gymnastics should be supplemented with a number of exercises.

Physical exercises of the first stage of rehabilitation are:

• breeding legs bent at the knees in a prone position;
• torso to the side, sitting on a chair;
• walking in place with alternately raising the right and left knee;
• rolling from heels to toes and back.

The second stage of rehabilitation after removal of the gallbladder polyp

The directions of rehabilitation of the second stage are:

• compliance with the regime of physical activity;
• diet therapy;
• hygiene of postoperative wounds;
• tracking complications.

diet therapy
Compliance with certain principles in the selection and preparation of dishes is an important stage in the rehabilitation of surgical treatment of gallbladder polyps.

The rules for the preparation and use of products are:

• the diet should be fractional and meals should be carried out every 3 hours;
• after eating, there should not be a feeling of overeating;
• during the cooking process, the products must be crushed or wiped;
• as a heat treatment, it is recommended to use boiling, steaming or baking in the oven;
• ready-made dishes are seasoned with butter and vegetable oil;
• the temperature of the food consumed should be medium;
• within 1.5 - 2 hours after eating, it is necessary to abandon physical activity;
• the introduction of new products should be carried out gradually, controlling the reaction of the body.

Complication tracking
Any type of surgery for gallbladder polyps can be accompanied by complications. To take timely measures to eliminate negative consequences, the patient must monitor the state of the body. If you notice any changes in your health, you should consult a doctor.

Symptoms of complications after gallbladder polyp surgery are:

• redness, suppuration of postoperative wounds;
• the appearance of painful seals in the wound area;
• rash, redness of the skin;
• bloating, abdominal pain;
• nausea, vomiting;
• muscle, joint pain.

The third stage of rehabilitation after removal of the gallbladder polyp

Prevention of gallbladder polyps

Directions for the prevention of polyposis overgrowth of the gallbladder mucosa are:

• dynamic observation by a doctor with hereditary predisposition;
• prevention of bile stasis cholestasis);
• timely treatment of inflammation of the gallbladder;
• normalization of fat metabolism.

Dynamic observation by a doctor with hereditary predisposition

Timely treatment of inflammation of the gallbladder

Signs of the development of the inflammatory process in the gallbladder are:

• dull pain under right row of ribs;
• swollen belly;
• dysfunction of the digestive system;
• nausea, vomiting;
• staining of the skin and eye sclera in a yellow tint.

Prevention of bile stasis ( cholestasis)

Measures that will help prevent gallbladder polyps are:

• compliance with the regimen when eating;
• inclusion in the diet of plant products with fiber;
• control of consumption of animal fats;
• maintaining an active lifestyle;
• timely treatment of gastritis, ulcers, pancreatitis;
• adequate therapy of infectious diseases of the intestine;
• timely access to a doctor with dysfunctions of the nervous system.

Normalization of fat metabolism

Measures to normalize fat metabolism are:

• quality control and quantity of consumed fats;
• increase in the rate of dietary fiber consumed;
• control of the balance of carbohydrates in the diet;
• fight against hypodynamia;
• timely detection and treatment of diseases.

Controlling the quality and quantity of fats consumed
Excess intake of fats in the body leads to the fact that the liver ceases to cope with their processing, which leads to a deterioration in lipid metabolism. The likelihood of developing this disorder is affected by both the amount and quality of fat consumed. All fats consumed by a person can be divided into two groups - good and bad. Healthy fats include unsaturated fats, which are found mainly in plant foods. Saturated and modified fats are harmful. The main difference between one category and another is the fact that at room temperature, unhealthy fats retain a solid consistency. In order to prevent gallbladder polyps, people over 40 should consume no more than 70 ( women) – 100 (men) grams of fat per day. In this case, the proportion of harmful fats should not exceed 10 percent.

Good and bad fats and the foods they contain

Foods that are rich in dietary fiber are:

• fruit- raspberries, blackberries, bananas, pears, apples, kiwi;
• vegetables- green peas, beets, broccoli, cabbage, carrots;
• cereals- pearl barley, buckwheat, bulgur ( whole wheat cereal), oatmeal;
• legumes- lentils, beans, chickpeas, soybeans, peas;
• nuts- walnuts, forest, almonds, cashews, peanuts.

The fight against hypodynamia
A sedentary lifestyle has a negative effect on metabolism, increasing the risk of the formation of gallbladder polypous formations. In addition, physical inactivity contributes to a decrease in immunity, which also contributes to the occurrence of polyps. In order to prevent this pathology, it is necessary to increase physical activity. It can be morning exercises, sports dancing, walking, active sports. Regardless of the type of lesson chosen, a number of rules must be observed when performing them.

The rules for dealing with hypodynamia are:

• gradual increase in load;
• control of one's own state;
• the regularity of the exercises.

Timely detection and treatment of diseases
Violation of fat metabolism can be triggered by some diseases. Prevention of gallbladder polyps implies timely treatment of these disorders.

Diseases that cause lipid metabolism disorders are:

• pancreatitis ( inflammatory disease of the pancreas);
• enteritis ( inflammation in the small intestine);
• hypothyroidism ( decreased thyroid function);
• hypovitaminosis ( vitamin deficiency).

What are the consequences of polyps in the gallbladder?

The consequences of polyps in the gallbladder are:

• transition to gallbladder cancer;
• infringement of the legs of the polyp;
• complete obstruction ( overlap) gallbladder polyp.

The greatest risk of malignancy is in sessile adenomatous polyps. Percentage of malignancy ( transition of a polyp to a malignant tumor) according to various data varies from 10 to 35 percent. An increased risk of malignancy is also observed in the case of large polyps - more than 10 millimeters in diameter.
The symptoms of gallbladder cancer are similar to those of gallbladder polyps. Pain, nausea, vomiting are also observed. However, with cancer, they are the most pronounced - vomiting is observed much more often, pain is constantly disturbing. A common symptom is jaundice and icteric staining of the sclera. Sometimes there may be a fever that appears on the background of jaundice.

Infringement of the polyp leg
Infringement of the polyp's leg provokes a sharp, burning pain in the right hypochondrium, which is similar in intensity to hepatic colic. This complication is observed when a pedunculated polyp is detected in the gallbladder, and it is localized in the neck of the gallbladder. This type of polyp resembles a mushroom in shape, in the structure of which a leg and a hat are distinguished. The stem can be short, wide or very long. When the stalk is long, it can twist, bend, and be pinched by the neck of the gallbladder. Since the neck is very narrow, when the gallbladder contracts, the polyp can be squeezed by its walls.

In this case, the patient feels sharp, cramping pains in the right hypochondrium. The heart rate increases ( over 90 beats per minute), the skin becomes pale and moist.

Complete obstruction of the gallbladder by a polyp
This complication occurs when the polyp is very large and closes the lumen of the neck of the gallbladder. Also, complete obstruction can be observed when there are several polyps, and they similarly fill the lumen of the gallbladder.

With complete obstruction, there is no outflow of bile from the gallbladder into the duodenum. First, bile begins to accumulate in the gallbladder. Due to its absence in the intestines, food fats are not digested and absorbed. The patient suffers from nausea and vomiting even after a small meal. He begins to lose weight, because the fats that he absorbs are not completely absorbed and are excreted from the body.

Further, bile begins to soak through the walls of the gallbladder and enter the bloodstream. Jaundice develops, which is accompanied by icteric staining of the skin and sclera. Unbearable skin itching occurs on the patient's body. There are also changes in the urine, which becomes dark in color.

Should a gallbladder polyp be removed?

Pseudopolyps include cholesterol and inflammatory polyps. A cholesterol polyp is a deposit of cholesterol plaques on the bladder mucosa, while an inflammatory polyp is a reaction of the gallbladder mucosa to an inflammatory process. With regard to these polyps, expectant management is adopted. They are under the supervision of an uzist and if they do not regress for a long time ( do not shrink in size) are removed.


A gallbladder polyp must be removed if:

• the diameter of the gallbladder polyp exceeds one centimeter;
• if it is an adenomatous polyp more than 5 millimeters in diameter;
• many polyps are revealed;
• there are destructive changes in the gallbladder;
• polyps are accompanied by stones in the gallbladder;
• The patient has a relative with cancer.

However, if the polyp exceeds the size of 18 millimeters, and the patient has relatives with cancer, then an open abdominal operation is performed. It involves a full incision of the abdominal wall to gain access to the gallbladder. Along with the gallbladder, the lymph nodes and parts of the liver are removed.

How to get rid of a polyp in the gallbladder?

Medical way to get rid of a polyp
This method is effective only in the case of cholesterol polyps. These polyps are cholesterol deposits on the lining of the gallbladder and are not true polyps. Therefore, to eliminate them, drug treatment can be used, which involves taking drugs that dissolve these deposits. These are preparations of chenodeoxycholic acid and ursodeoxycholic acid. These include ursosan and henofalk. These drugs help to reduce the concentration of cholesterol and dissolve cholesterol deposits.

Their dosage is strictly individual and is determined by the weight of the patient and the size of cholesterol deposits. So, the average daily dose for drugs containing ursodeoxycholic acid is 10 milligrams per kilogram of patient weight. For drugs with chenodeoxycholic acid, this dose is 15 milligrams per kilogram of body weight.

Approximate doses of drugs for cholesterol polyps

Surgical removal of polyps
The operation to remove a polyp of the gallbladder is called a cholecystectomy. This method of surgical intervention can be carried out endoscopically or in the usual classical way.

Most often, the removal is carried out using endoscopic techniques, that is, laparoscopic cholecystectomy takes place. If the size of the polyp exceeds 18 millimeters in diameter, and the patient has a burdened oncological history, then an open laparotomy operation is performed. During this operation, the gallbladder, part of the liver and regional lymph nodes are removed.

How to take ursosan with polyps in the gallbladder?

Mechanism of action
The drug has a hypocholesterolemic and hypolipidemic effect, which means a decrease in the concentration of both cholesterol and lipids ( fat). By stimulating the secretion of bile by hepatocytes, it contributes to the resolution of cholestasis ( bile stasis). Since bile stasis is one of the main factors in the formation of cholesterol deposits, its prevention stimulates their resorption. Also, the drug increases the solubility of cholesterol, forming liquid crystals with it. Thus, already formed cholesterol deposits are dissolved.

How to use?
Ursosan capsules are taken orally with a small amount of water. The course of treatment is from six months to a year. Ultrasound examinations are periodically performed to track the dynamics of growth or reduction of polyps.

The daily dosage is 10 milligrams per kilogram of the patient's weight. So, if a patient weighs 70 - 75 kilograms, then he needs 700 - 750 milligrams of the drug per day. Based on the fact that one capsule contains 250 milligrams, the daily dose will be contained in three capsules ( 250 x 3 = 750 milligrams for a 75 kilogram person). In the first three months of treatment, it is recommended to take one capsule in the morning, afternoon and evening. Further, the daily dosage can be taken once in the evening.

The drug is taken only with a well-functioning gallbladder. There should be no destructive changes in the bladder, the patency of the duct should be maintained, and the size of cholesterol polyps should not exceed 20 millimeters. Control ultrasound examination is carried out every six months.

What does adenomatous polyp of the gallbladder mean?

These polyps tend to grow extensively and invasively. Most often, one to three adenomatous polyps are diagnosed. An adenomatous polyp manifests itself most often with symptoms of cholestasis ( bile stasis).


Symptoms of an adenomatous polyp of the gallbladder are:

• bitter taste in the mouth
• nausea, occasional vomiting;
• pain syndrome;
• jaundice;
• hepatic colic.

A polyp is a benign neoplasm that is a consequence of hyperplasia of the mucous membranes.

They can affect various internal organs, including the gallbladder. Is such a diagnosis dangerous, and what to do in such a situation?

Often polyps in the gallbladder are detected in women older than 35 years. They can also appear in men, but in this case their character will be somewhat different. For women, hyperplastic polyps are most characteristic, for men - cholesterol ones.

What it is?

Polyps are growths of the superficial mucous membrane of the gallbladder, which can be single or multiple. Such neoplasms can reach rather large sizes (1-2 cm), or else form nets of small growths 1-2 mm high.

Despite the benign nature of polyps, if left untreated, they can become malignant. As a result, the patient may develop gallbladder cancer.

Classification

Polyps in the gallbladder can be represented by:

Cholesterol polyps are the most common and respond best to conservative treatment.

Causes

By filtering the blood, a continuous process of bile formation occurs in the liver tissues. Through the bile ducts, it enters the gallbladder, where a yellow-brown liquid accumulates. When food reaches the duodenum, the gallbladder contracts and releases bile, which aids in digestion and the breakdown of food.

With the development of pathological processes, the gallbladder decreases in volume, simultaneously losing the function of bile concentration. As a result, the fluid begins to stagnate, which provokes the appearance of mucous neoplasms.

The reasons for the formation of one or several polyps at once lie in the violation of metabolic processes and anomalies in the structure of the mucous membrane of the gallbladder. Blood relatives of a patient with polyps are automatically at risk.

Polyps in the gallbladder are most susceptible to persons with:

• pathologies of the endocrine system;
• disturbed fat metabolism;
• hypercholesterolemia caused by the abuse of junk food;
• hepatitis;
• urolithiasis;

In some cases, the formation of polyps can occur after suffering infectious diseases.

Symptoms of polyps in the gallbladder

The symptoms of the pathological process depend on the area in which the polyps formed. The most unfavorable is the case when polyposis growths are localized on the neck of the gallbladder or in its ducts. Such an anomaly creates a serious barrier to the movement of bile into the intestines, which is why the patient may develop such a dangerous and unpleasant pathology as obstructive jaundice.

If the location of the polyps are other parts of the gallbladder, then no specific clinical picture arises. However, it is still possible to suspect the disease. To do this, pay attention to the presence of the following signs:

1. Pain in the right hypochondrium, which occur due to stretching of the walls of the gallbladder due to stagnation of bile. The pains are dull, aching in nature. They occur periodically, they are given to the right hypochondrium, so patients often complain that they have a "liver hurts". Pain syndrome can occur against the background of the use of alcohol or fatty, fried foods. For this reason, most patients are unaware of the presence of polyps, associating malaise with stress or malnutrition.
2. Yellowing of the epidermis and mucous membranes of the eyes, mouth, etc.. In the presence of a polyp in the bile duct, obstructive jaundice develops, accompanied by the above abnormalities. A blockage in the bile duct prevents bile from escaping naturally, so it leaks through the walls of the bladder and enters the bloodstream. The patient suffers from itching, bouts of nausea, vomiting of bile masses may open. A characteristic sign of obstructive jaundice is the darkening of urine.
3. Hepatic colic. If the neoplasm has a long stem and is localized in the neck of the gallbladder, then when it is twisted, an attack of hepatic colic develops. Often this symptom occurs with a significant reduction in the diseased organ. If there is a torsion of the polyposis leg, the patient has a sharp attack of acute, cramping pain. He is tormented by symptoms of arterial hypertension and heart palpitations. At the same time, anxiety symptoms do not disappear when a person takes a comfortable posture, which indicates the development of hepatic colic.
4. Signs of dyspepsia. It is by its presence that one can judge polyps in the gallbladder. The degree of its severity may vary in each individual case. Typical manifestations of dyspeptic symptoms are bitterness in the mouth, bouts of nausea in the morning, the occurrence of vomiting when overeating. All these anomalies are the result of stagnant processes in the body. It also adversely affects digestion, which can lead to dramatic weight loss.

Despite this, patients rarely seek medical help with similar symptoms. But timely ultrasound helps to identify the polyp and determine its exact location.

What is the danger of a gallbladder polyp?

Polyps in the gallbladder are dangerous in terms of their ability to degenerate into a cancerous tumor. This probability ranges from 10-30%.

In addition, polyposis formations can cause suppuration in the diseased organ. Against the background of an increased level of bilirubin, brain intoxication may develop. These dangerous complications can only be avoided if you seek qualified medical help in a timely manner.

Diagnostics

The presence of polyps can be determined during an ultrasound diagnosis of the liver and gallbladder. On the monitor of the ultrasound machine, the specialist can clearly see the formation of a rounded shape, which is attached to the wall of the gallbladder and does not have an acoustic shadow.

To date, one of the most informative diagnostic methods is endoscopic ultrasonography. The procedure is carried out according to the principle of FGDS. A flexible endoscopic tube with an ultrasonic sensor at the end is inserted into the patient's duodenum. Since the duodenum is located in close proximity to the gallbladder, the picture during ultrasonography is much clearer.

Surgery

Surgery is the only effective way to treat polyps. However, it will not be possible to cope with the pathological process by removing only growths - it is necessary to remove the entire organ.

There are situations when surgery cannot be postponed. These include:

• the size of the polyp is 1 cm or more;
• parallel course in the gallbladder of other pathological processes: cholelithiasis or cholecystitis, which has passed into the phase of chronicity;
• rapid growth of build-up;
• the abundance of polyps;
• high risk of malignancy.

Laparoscopic cholecystectomy

In this case, the removal of the gallbladder is performed using endoscopic medical equipment. When carrying out manipulations on the anterior abdominal wall, several punctures are made through which special instruments, trocars, are introduced into the abdominal cavity. They are equipped with hollow tubes with valve devices at the ends. They are necessary for the safe separation of tissues. Only after placing the trocars, a laparoscope and a special eyepiece with a video camera are inserted into the punctures.

Before the operation, the patient undergoes repeated ultrasound diagnostics, CBC and a coagulogram. The procedure is carried out in several stages:

1. The doctor makes 4 incisions, after which he inserts trocars.
2. Working medical instruments are placed into the abdominal cavity through trocars.
3. A preliminary examination of the peritoneal organs is carried out.
4. The hepatoduodenal ligament is identified with the cystic artery and duct, which are then clipped (a procedure in which the artery and duct are ligated and crossed).
5. With the help of an electrocoagulator, the doctor separates the gallbladder and excised it.
6. Through the punctures made, the gallbladder is carefully removed from the abdominal cavity.

The advantages of laparoscopic cholecystectomy include:

• minor and short-term pain during the rehabilitation period;
• lack of prolonged stay in the hospital (as a rule, the patient is hospitalized for no more than 5 days);
• low risk of complications (adhesion formation, bacterial infection, etc.);
• the patient's ability to independently serve themselves after the procedure.

Open cholecystectomy

In this case, not punctures, but incisions are made in the patient's abdominal cavity. Manipulation is carried out through laparotomy - cutting the abdominal wall to gain access to the diseased organ. With polyps in the gallbladder, as a rule, an oblique laparotomy is performed. To gain access to the liver and gallbladder, an oblique incision is made along the edge of the costal arch.

The operation is carried out in stages:

1. The place where the preliminary incision was made is treated with antiseptic preparations.
2. An incision of 10-15 cm is made with a scalpel.
3. Fabrics are cut in layers.
4. As with laparoscopic cholecystectomy, the doctor locates the hepatoduodenal ligament and clips the artery and duct.
5. The gallbladder is separated from the liver bed and ligated, after which it is excised.
6. Together with the organs, resection of regional lymph nodes is performed.
7. The tissues in the incision area are sutured layer by layer, but in reverse order.

Laparotomic cholecystectomy is performed if the polyps have reached sizes from 15 to 18 mm. Doctors say that such polyposis growths are prone to malignancy, therefore, during surgery, the removal of the bladder along with regional lymph nodes is required. In parallel, a small piece of liver tissue is excised for examination under a microscope.

Open cholecystectomy is performed exclusively under general anesthesia, and only with the use of a ventilator. Postoperative sutures are removed for 6-7 days. On the first day after the intervention, the patient is only allowed to drink non-carbonated water, the next day - to eat in limited quantities. You can get up after the operation for 3-4 days. The duration of the rehabilitation period is about 14 days.

Nutrition rules

To avoid stagnation of bile and disruption of the digestive tract, you must adhere to a strict diet. Table number 5 involves the following activities:

• fractional meals (4-5 times a day at regular intervals);
• eating only easily digestible food (liquid, "broken" on a blender or grated through a sieve);
• complete rejection of confectionery and bakery products, muffins;
• the use of unsaturated and non-acidic juices, fruit drinks, herbal decoctions, herbal teas;
• complete exclusion of products containing caffeine and ethyl alcohol;
• refusal of carbonated drinks;
• drinking up to 2 liters of fluid per day;
• the use of semi-hard fat-free cheese, vegetable puree soups, boiled or oven-baked vegetables and fruits.

You can include a small amount of sweets and cookies in the diet. At the same time, it is necessary to control the level of consumed fats, protein and carbohydrates.

Such a diet is designed for six months, but sometimes it has to be followed for longer. During its duration, the patient is forbidden to drink alcohol and smoke.

Forecast

If the polyps in the gallbladder are small and not prone to growth, then the prognosis for their treatment is considered favorable. It is possible to stop the symptoms and reduce the risk of the spread of the pathological process by periodically conducting courses of conservative therapy.

However, the complexity of the situation lies in the fact that at the initial stages of development, the disease does not manifest itself in any way. Consequently, the symptoms appear already when the polyposis growths reach large sizes. And this is already fraught with their degeneration into malignant neoplasms.

To avoid such consequences, you do not need to wait for the symptoms to go away on their own. You should immediately consult a doctor and undergo an examination. The earlier the disease is detected, the more favorable the outcome of treatment will be.

Polyps are benign small growths that are often found on the walls of many internal organs. For example, polyps in the gallbladder are often diagnosed. This is a very specific pathology that is difficult to detect, and no less difficult to treat.

Most often, such formations have a spherical configuration, and are a benign growth of the mucous tissues of the organ.

, , , , ,

ICD-10 code

K82.8 Other specified diseases of gallbladder

Epidemiology

An unknown formation in the gallbladder was first discovered by the German pathologist R. Virchow, and this was back in the 19th century. Another scientist at the same time managed to examine the pathology in detail under a microscope and describe it. Since that time, the main cause of the disease began to be considered a disorder of the metabolism of fats in the body.

The second wave of polyposis research began from the time when a new type of diagnostics, ultrasound scanning, was introduced into practice.

According to the latest statistics, growths in the cavity of the gallbladder are present in 6% of people. In this case, most often the disease is detected in women older than 35 years.

Causes of polyps in the gallbladder

As it turned out, a violation of fat metabolism is not the only possible reason for the formation of polypous formations. They can also occur under the influence of other causes and factors:

• genetic disorders, burdened heredity (in the family there have already been cases of the development of polyps);
• infectious and inflammatory diseases in the biliary system;
• disorders of metabolic processes;
• dyskinesia of the bile ducts, other pathologies of the liver and bile excretion system.

An important role in the development of the disease is played by risk factors that should be considered in more detail.

Risk factors

• Hereditary predisposition is perhaps the most common factor in the development of the disease. First of all, this applies to adenomatous formations and biliary papillomas. At the same time, if there were cases in the family of the appearance of benign polyposis in other organs, then the risk of developing an outgrowth in the gallbladder also increases.

Heredity is of considerable importance for the occurrence of diseases, the complications of which are polyposis growths. For example, dyskinesia of the biliary system is considered such a disease.

• Infectious and inflammatory diseases - for example, cholecystitis, occur against the background of biliary stagnation, which is a trigger for the development of biliary outgrowths. A polyp of the gallbladder with cholecystitis is a relatively common occurrence. During the inflammatory reaction, the wall of the organ thickens, its shape and structure are disturbed. As a result of these changes, bile stasis appears, which leads to pain, dyspepsia, and belching. The consequence of this reaction is the growth of granulations in the walls of the bile organ, which becomes the root cause of the formation of post-inflammatory polyposis structures.
• Disorders of metabolic processes most often affect the formation of cholesterol formations. Over time, these formations increase and undergo calcification. Such processes are the result of a disorder of fat metabolism, when an excess amount of cholesterol circulates in the blood. Excess cholesterol is deposited inside the walls of not only blood vessels, but also the biliary system. The composition of bile already contains cholesterol: if stagnation of bile occurs, then its excess is soon deposited inside the bladder.
• Dyskinesia of the bile ducts cause dysfunction of the biliary system while maintaining the normal structure of the organ. Dyskinesia is accompanied by a failure of the contractility of the gallbladder, which complicates the entry of the bile mass into the duodenum: the secretion of bile no longer corresponds to certain digestive processes. The patient notes symptoms such as nausea after eating (especially after eating fats), pain, weight loss.

, , ,

Pathogenesis

As already mentioned, polyposis is a polyetiological disease, that is, it can have many causes of development.

The gallbladder has a three-layer thin wall, which consists of the outer shell, muscle layer and mucous tissue.

The mucous tissue lines the inner walls of the organ: it is on it that polyposis formations are formed. This tissue forms multiple folds, it is permeated with glands and covered with a single layer of epithelium.

Symptoms of polyps in the gallbladder

Symptoms in polypous neoplasms are not always characteristic and specific for this disease. The severity and variety of symptoms depend on many factors: the location of the formation, their multiplicity, size, etc.

It is dangerous if the polyposis node is located in the cervical part of the bladder, or inside the duct: in such a situation, there is a risk of blocking the bile outlet, which will cause jaundice.

In other localizations of the pathology, the symptoms may be latent or mild.

The first signs of polyps in the gallbladder are most often the following:

• dull pain on the right near the ribs (may be cramping), especially after taking fatty foods, after episodes of overeating, after drinking alcohol, after stress;
• jaundice, in which the skin, mucous membranes and sclera acquire a yellow tint (often jaundice is accompanied by skin itching, bouts of nausea and even vomiting);
• colicky pains - sharp, sharp, resembling hepatic colic in cholelithiasis (often indicates torsion and infringement of the polyp leg);
• the appearance of a bitter taste in the oral cavity, morning sickness, periodic unexplained vomiting.

It is worth noting that in most cases, polyposis inclusions do not manifest themselves in any way: they are discovered by chance, when diagnosing other diseases. Only when the formation increases to a significant size, or with the development of complications, is the above-described clinical picture revealed.

• A polyp 3, 4, 5, 6 mm in the gallbladder is considered a small formation and in most cases does not manifest itself by any external signs. Such growths are not removed surgically: they are monitored. If the node increases by more than 2 mm per year, then the question of its removal may be raised.
• A polyp in the gallbladder duct can cause blockage of the duct, which will manifest itself in the form of obstructive jaundice, which is the result of an increase in the content of bilirubin in the bloodstream. What are the symptoms of jaundice: yellow coloration of the skin and mucous membranes, skin itching, paroxysmal nausea. Auxiliary signs can be: dark urine, joint and muscle pain, fever.
• Pain in polyps in the gallbladder is usually clearly localized: this is the area of ​​​​the right hypochondrium, that is, the place of the projection of the liver and biliary system. The pains can be dull and aching, but most often they are cramp-like, spasmodic, and if the polypous leg is infringed, they are colicky (sharp, sudden and strong). With this nature of pain, the patient is always restless, he cannot find a place for himself and often changes his body position in search of the most comfortable position.
• Diffuse changes in the pancreas and gallbladder polyp are often diagnosed in combination with each other. Most often, such changes accompany cholecystopancreatitis - a combined inflammation affecting the pancreas and the biliary system. In addition to inflammation, age can also be the cause of diffuse changes: in this case, the echogenicity of the pancreas can remain normal, and the patient will not present any complaints.
• Diarrhea with gallbladder polyps is perhaps the most common symptom, along with nausea and vomiting. Diarrhea appears due to stagnation and impaired secretion of bile. This leads to the fact that the food in the intestines is poorly digested: for the normal absorption of fats, bile is needed. As a result, indigestion occurs - diarrhea.
• The temperature in gallbladder polyps may remain normal, but in the presence of inflammation in many cases it rises. Prolonged subfebrile temperature (may be observed for months) often indicates the presence of a chronic inflammatory process - cholecystitis. With hepatic colic, the temperature can rise sharply to about + 38 °. However, this symptom is atypical, since in many patients the temperature indicators remain unchanged. In itself, the presence of a polyp does not affect the change in temperature values.

Psychosomatics for gallbladder polyps

Directly polyposis nodes are not considered psychosomatic disorders, but they can be the result of such disorders. So, many neoplasms develop as a result of inflammatory processes, dyskinesias, circulatory disorders and trophism in the organ. Therefore, it cannot be argued that psychosomatics does not play any role in the mechanism of formation of polyposis inclusions.

A person acquires many diseases as a result of stress, frequent conflict situations, dissatisfaction with life, fears, etc. Experts say that people who experience or suppress negative emotions in themselves tend to “direct” them inside the body, which leads to the appearance of diseases. In addition to polyposis, such patients may suffer from gallstone disease, colitis, depression, and panic attacks.

One of the conditions for high-quality treatment of polyposis formations is the absence of stress and moral peace, supported by a healthy lifestyle and proper nutrition.

Gallbladder polyp in men

In male patients, cholesterol inclusions are most often found, and already in old age. The reasons are cholesterol deposits accumulated over the years, which increase over time and are permeated with calcium salts (calcified).

According to statistics, men are more likely than women to be overweight and malnourished, so they are more likely to have a violation of fat metabolism. With an increase in the amount of cholesterol in the blood, it is deposited inside the vascular walls and in the biliary system. If the patient simultaneously suffers from bile stasis, then the risk of polyposis growths increases several times.

Cholesterol polyposis nodes in the vast majority of cases do not cause any symptoms in the patient, so the patient seeks medical help already in the presence of significant cholesterol deposits.

Polyps in the gallbladder during pregnancy

Most doctors agree that if there is a polypous inclusion in the biliary system, it should be cured (removed) even before pregnancy planning begins. The bottom line is that during the period of the strongest hormonal changes, the risk of malignant degeneration of the polypous formation increases. That is, how the growth will behave is unknown. Performing surgery on a pregnant woman is also risky.

But what if the polyposis node was discovered already during pregnancy? Here the answer cannot be unambiguous. Most often, specialists decide to observe the pathology, to control the growth of education. If necessary, surgical treatment is prescribed, but after the birth of the baby.

Gallbladder polyps in children

Polypous inclusions can be found not only in middle-aged and elderly patients, but also in children. Most often they are detected in children under 10 years old: the danger is that at an early stage of development these formations are incredibly difficult to detect, and the delay in diagnosis can lead to quite serious consequences: digestive disorders, chronic pathologies of the digestive system, etc.

The appearance of polyposis structures can be due to many reasons. In children, for the most part, pathologies associated with a hereditary predisposition are found.

Rarely in children, the disease causes any clinical manifestations: polyposis nodes most often do not manifest themselves for a long time, and the initial signs may be similar to the symptoms of ordinary inflammation - cholecystitis. The diagnosis of polyposis is established only after a special diagnostic study.

stages

In medical circles, it is customary to distinguish three stages of polyposis development, although this classification is conditional, and it is often quite difficult to determine the exact stage. These are the following stages of development:

1. The first stage is considered initial, when the polyp is just beginning its development. The patient does not feel any discomfort, the function of the outflow of bile does not suffer.
2. The second stage is characterized by a significant growth of tissue, with the overlap of most of the bile duct or bladder. The outflow of bile is difficult, but possible.
3. The third stage is a complete overlap of the lumen of the duct or bladder with a polypous outgrowth. The exit of bile thus becomes impossible.

It is possible to accurately determine the stage of the polyposis process using ultrasound. It is not easy to do this solely by the presence of symptoms.

Forms

• A cholesterol polyp of the gallbladder is considered a pseudogrowth - that is, it does not consist of organ tissues, but is formed from cholesterol deposits on the wall of the bladder.
• The adenomatous polyp of the gallbladder comes from the glandular epithelium that covers the mucous tissues of the organ. Adenomatous growths are more likely than others to be malignant.
• A calcified polyp of the gallbladder is a polyposis growth in which calcified salts have been deposited. Sometimes calcification affects not only the polyposis node, but also the bladder wall (the so-called porcelain bladder), which is an extremely unfavorable condition that can degenerate into a cancerous tumor.
• A small polyp of the gallbladder is a growth whose size does not exceed 6-8 mm (in some cases up to 10 mm). Such growths are often treated conservatively, without resorting to surgical intervention.
• Multiple polyps in the gallbladder - especially those of a hereditary nature - are also called diffuse. In this situation, malignant neoplasms develop at the site of multiple polyposis in 80-100% of cases.
• A pedunculated polyp in the gallbladder is considered the most favorable, since it almost never degenerates into a malignant tumor. However, such an outgrowth can be dangerous: it can provoke bleeding, it can twist, infringe, which will require urgent surgical intervention.
• The parietal polyp of the gallbladder tightly adjoins the wall of the organ and has a wide base (not a leg). Such an outgrowth is most often advised to be removed: there is a great danger of malignancy of the formation.

, , , ,

Complications and consequences

Complications of polyposis formations in the gallbladder are not uncommon, for example:

• a polyp can degenerate into a cancerous tumor (malignancy);
• the polyposis leg may twist (if there is a polyp "on the leg");
• the polyp may enlarge and block the bladder cavity.

The growth of a gallbladder polyp is very difficult to control: often the disease is detected already when the formation becomes so large that it blocks the lumen of the organ. It is especially dangerous if the polyps are multiple: they gradually fill the entire space of the bladder. This leads to the fact that bile begins to accumulate, digestion is disturbed, and bile enters the bloodstream. As a result, the patient develops jaundice - a condition in which the skin and sclera turn yellow. In addition, urine becomes dark, itching of the skin develops.

Can gallbladder polyps disappear? Indeed, they can. But this does not happen so often: formations can disappear, the size of which does not exceed 10 mm, and the polyp itself had a leg. Polyposis formations with a diameter of more than 10 mm, located on a wide base, are not prone to self-elimination and are more likely to develop into a malignant tumor.

Even if the gallbladder polyp has resolved, the patient is subjected to follow-up studies once every 6 months, 2-3 times, to make sure there is no recurrence of the disease.

, , , , , , ,

Diagnosis of polyps in the gallbladder

Diagnosis is often limited to ultrasound and endoscopy. Additionally, laboratory tests may be prescribed.

• Analyzes that the doctor may prescribe for the diagnosis of polyposis formations:

1. blood biochemistry most often indicates the presence of biliary stasis, the signs of which are an increase in the level of bilirubin (more than 17 mmol / l), an increase in alkaline phosphatase (more than 120 U / l), an increase in the amount of cholesterol (more than 5.6 mmol / l);
2. Urinary OA helps to detect bilirubin and a decrease in the concentration of urobilinogen (less than 5 mg / l);
3. the coprogram demonstrates a decrease or absence of stercobilin.

• Instrumental diagnostics usually includes ultrasound, endoscopy, less often magnetic resonance and computed tomography.

1. the use of ultrasound is the most common type of study, which fully allows you to assess the size and localization of the polypous formation;
2. ultrasonography is a combination of ultrasound and an endoscope, which are inserted into the lumen of the duodenum 12;
3. magnetic resonance imaging is a more expensive type of diagnosis, which, however, allows you to consider even the smallest polyposis growths.

• A gallbladder polyp on ultrasound is a light nodule or speck with darker surrounding tissues. The light spot has a direction of growth from the wall into the cavity of the organ. The configuration of the neoplasm depends on the type of polyp: for example, if the growth has a leg, then it is clearly visible visually. With multiple formations on ultrasound, a number of specks growing into a darkened cavity are determined.
• Echo signs of a gallbladder polyp are determined by its type. So, with a cholesterol or inflammatory neoplasm, an absolutely white speck is found. With adenomatous growth, a dark spot is visualized with lighter surrounding tissues.
• A hyperechoic polyp of the gallbladder is a neoplasm that has a higher density for ultrasound waves. As a rule, most polyps are precisely hyperechoic formations.
• Gallbladder polyps can be seen more closely on MRI. Most specialists resort to magnetic resonance imaging in cases where it is necessary to differentiate a true polyp from a papilloma.
• CT of the gallbladder with polyps is not very informative, therefore it is rarely used, mainly for differential diagnosis.

, , , ,

Treatment of polyps in the gallbladder

In most patients, the treatment of polyps involves their surgical removal, since in many situations drug therapy does not bring the expected result. Medications can be helpful in getting rid of the underlying cause, which could cause the development of polyposis formations, as well as to eliminate painful symptoms. For example, for pain, it is appropriate to take antispasmodics and analgesics, and for cholestasis, choleretic drugs are taken.

If a patient has an elevated cholesterol level, then he will be prescribed treatment with special drugs that lower this level.

Treatment of polyps in the gallbladder without surgery

You can do without surgery only with polyposis formations of cholesterol origin. For conservative treatment, medications such as Ursofalk, Ursosan, Simvastatin, Holiver are most often chosen, and Drotaverine and Gepabene are also connected.

In addition to cholesterol formations, drug therapy can be used in relation to polyps, the diametrical size of which is indicated no more than 10 mm.

The need for surgical intervention should be assessed by the doctor in each specific case: if the polyposis node has a wide base and large dimensions, then it must be removed.

Medicines: principle of action and use

• Ursosan with polyps in the gallbladder is prescribed only if the growth is of cholesterol origin. Other types of formations are not amenable to treatment with Ursosan. The drug lowers the content of cholesterol and lipoproteins in the bloodstream. Its function also includes the prevention and elimination of cholesterol deposits.

Ursosan is drunk with a sufficient amount of water, at the rate of 10 mg per kg of the patient's body weight. The duration of the treatment course is 6-12 months.

You can not be treated with Ursosan in the destruction of the bladder, with obstruction of the ducts, and also if the polyposis growth has a significant size - more than 2 cm.

• Ursofalk with polyps of the gallbladder acts as a cholesterol solvent - its action is similar to that of Ursosan. Both of these drugs are used only for the cholesterol nature of polyposis structures. Ursofalk is taken for a long time, calculating the dose according to the formula 10 mg / kg of the patient's body weight. During the therapeutic course, the state of the neoplasm should be monitored periodically.

• Allochol with polyps of the gallbladder is prescribed to increase motility and secretion of bile. This drug is not suitable for the treatment of patients with obstructive disorders - with obstruction or poor patency of the bile ducts. Allochol may be useful in the presence of endogenous bile acid deficiency. Allohol is taken 2 tablets three times a day, immediately after meals. Duration of admission - up to a month.

• Ovesol with polyps in the gallbladder helps to eliminate biliary stasis, remove stones, and restore the kinetics of the biliary system. Ovesol is a herbal preparation belonging to the category of dietary supplements, therefore it has a mild, long-lasting effect and can be used for a long time. Drops are taken with water, 15-20 drops in the morning and evening (about ½ teaspoon). It is recommended to conduct three to four treatment courses every year for a duration of 1 month. Ovesol is contraindicated in case of complete blockage of the bladder or ducts by the growth.

vitamins

The inclusion of vitamins in the treatment regimen for polyposis formations plays an important role in helping to improve the quality of life of patients and blocking the further growth of polyps.

In the initial stages of the disease, it is appropriate to take vitamin complex preparations. It can be Centrum, Vitrum, Complivit, Biomax, Alphabet, etc. No special vitamins are required at the initial stage of the disease.

Running polyps are usually treated in a complex manner, with the additional use of herbal and vitamin remedies against the background of medical and / or surgical treatment.

• Vitamin B 2 - takes part in metabolic processes, helps to deliver oxygen to cells.
• Rutin - protects the vascular walls, relieves edema, improves blood circulation.
• Vitamin B 6 - stabilizes the function of the nervous system and the level of cholesterol in the body.
• Cocarboxylase - regulates carbohydrate metabolism, improves protein synthesis.
• Vitamin B 12 - strengthens the immune system, improves protein metabolism.
• Ascorbic acid - accelerates the restoration of damaged tissues and the removal of toxins.
• Vitamin B 9 - stabilizes the level of hemoglobin, strengthens the immune system.

The listed vitamins can be used both as part of complex preparations and independently, for example, in the form of injections.

Physiotherapy treatment

Carrying out physiotherapeutic procedures is contraindicated in case of exacerbation of chronic cholecystitis, in the presence of a single node in the biliary excretion system, or in case of widespread biliary polyposis.

After surgical treatment and removal of the gallbladder, mud therapy with the use of sulfide, silt, peat, sapropelic mud can be recommended, such therapy is advisable already in the early stages, 2-3 weeks after surgery.

Thermal procedures such as paraffin or ozocerite are not recommended either before or after surgery.

It is allowed to use mineral waters, exercise therapy, massage, climatotherapy. Diet is a must.

Exercises for a polyp of the gallbladder

It is very important for patients with polyposis formations in the biliary system to reconsider their physical activity. It is necessary to limit excessive motor activity, especially avoiding sudden movements. It is undesirable to lift weights, carry them, as these actions can cause the development of adverse consequences.

As for physiotherapy exercises, then with polyposis it is only welcome. Independently, at home, you can perform a set of simple exercises that will alleviate the condition and normalize the function of the biliary system. Exercises are performed regularly, without missing classes for a day.

1. The patient lies on his back, brings his legs bent at the knees to his chest, wraps his arms around them. A few minutes rolls left and right, back and forth.
2. The patient continues to lie on his back: he bends his legs in turn at the knees and brings them to the chest.
3. Lying on his back, the patient draws in the stomach as much as possible, after which he relaxes it. The required number of repetitions is ten.
4. The patient is standing, legs apart shoulder-width apart. Performs rotations of the upper half of the body in turn to the right and left.

If possible, a patient with a polyposis disease is recommended to practice yoga and breathing exercises.

Alternative treatment

It is not recommended to start alternative treatment of polyps in the biliary system if they are of significant size or have an increased likelihood of malignancy. It is better to discuss in advance the possibility of using alternative methods with your doctor.

Traditional healers advise to eat 3-4 garlic cloves at night to get rid of polyposis, eating Borodino bread with unrefined sunflower oil.

In addition, raincoat mushrooms have a good effect. You should collect fifteen old mushrooms with a diameter of about 3-4 cm, and pour them with 100 g of vodka. The medicine must be insisted for seven days in the dark, stirring it daily. It is not necessary to pre-wash the mushrooms. After a week, the mushrooms must be squeezed out, chopped well and mixed with 0.5 kg of butter and three tablespoons of honey. The mass can be stored in the refrigerator, using 1 tbsp. l. 30 minutes after eating.

No less useful is a mixture of aloe leaves, honey, butter and cognac. This mixture is consumed half an hour after a meal, washed down with a cup of hot green tea.

• Propolis for polyps in the gallbladder is taken in the form of a pharmacy alcohol tincture - one teaspoon per 30 ml of water, three times a day, 20 minutes before meals. The duration of such treatment should be two months, after which a two-week break is made, and the course is repeated.
• Treatment of polyps in the gallbladder with soda involves taking a solution of baking soda, starting with 1/5 teaspoon in a glass of water. The amount of soda is gradually increased, listening to the reaction of the body. If digestion is disturbed, or other adverse symptoms appear, then the dosage is reduced, or the treatment is completely stopped.
• Honey with polyps of the gallbladder is advised to use not as food, but as a medicine. Honey can be consumed on an empty stomach mixed with aloe, calendula, butter, olive oil, knotweed and other medicinal ingredients. It is optimal to consume honey twice a day, a few minutes before meals.
• Beaver jet: treatment of gallbladder polyps is carried out with the help of beaver jet tincture, which is taken one teaspoon three times a day, for a month. After a month, the dosage is gradually reduced to five to six drops per day. The total duration of treatment is up to 3 months. Instead of tincture, it is allowed to use dry powder of the beaver stream, but in a very small amount - the size of a match head. The powder is added to tea or coffee, or rolled into a piece of bread crumb and swallowed.
• Tripkhala with polyps in the gallbladder helps to cleanse and improve the functioning of the digestive system. It well stimulates the biliary function, lowers cholesterol, destroys harmful bacteria. The composition of the Ayurvedic remedy Triphala is represented by Amalaki, Haritaki and Bibhitaki. The optimal regimen is one to two tablets at night, once a day.

, , ,

Herbal treatment

The use of herbs for the treatment of polyps in the gallbladder is possible only with a small size of the formation. Large growths are removed only surgically.

Traditional healers advise to pay attention to such recipes:

1. Take 1 tbsp. l. celandine and chamomile, steamed in 200 ml of boiling water, leave overnight. Drink the medicine for a month, 1 tbsp. spoon half an hour before meals. The course can be repeated after 10 days.
2. Take 1 tbsp. l. tansy, 2 tbsp. l. burdock, 1 tbsp. l. calendula, elecampane and marigolds, half a tablespoon of wormwood: brew 1 tbsp. l. collecting 500 ml of boiling water, insist overnight. The medicine should be drunk hot, three times a day, 50 ml.
3. Pour 120 g of chaga with 500 ml of vodka, insist for two weeks. The medicine is added to tea three times a day, 1 tbsp. l., 30 minutes before eating.

• Treatment of gallbladder polyps with celandine is considered the most common. Medicines based on celandine are taken orally - however, it should be treated with caution in this way, since the plant is poisonous. Treatment should not last longer than 3-4 months. A second course is allowed only one year after the completion of the first course.

A medicine based on celandine is prepared at the rate of 1 tbsp. l. plants in 200 ml of boiling water. The infusion is kept in a thermos for 1-2 hours. They drink the medicine in a third of a glass three times a day 15-20 minutes before meals. If the patient does not tolerate this dosage (for example, diarrhea, nausea or difficulty breathing appears), then it can be reduced by taking 1-2 tbsp. l. infusion, dissolving in a third of a glass of water.

• Wormwood with polyps of the gallbladder is especially effective if the appearance of the formation is caused by infectious inflammatory diseases of the bile excretion system. Wormwood has antimicrobial and hemostatic properties, and also prevents the degeneration of a polypous growth into a cancerous tumor. Wormwood is considered a very useful plant, but the bitterness of this herb does not allow it to be used to treat children. To get rid of polyps, it is recommended to use wormwood flowers, after rolling them into a ball of bread: such balls can be easily swallowed and not even taste bitter.

For those who are not afraid of bitterness, this recipe is suitable: 1 tsp. wormwood is poured with 200 ml of boiling water and infused for twenty minutes. The resulting remedy must be drunk throughout the day.

• Celandine and chamomile for gallbladder polyps have an anti-inflammatory and cleansing effect: chamomile softens the effect of celandine, which can cause intoxication.

To prepare the medicine, steam one teaspoon of each herb in 250 ml of boiling water in a thermos, leave overnight. The next day, the medicine is filtered and drunk 25-30 ml 30 minutes before each meal. Treatment continues for two weeks, after which they take a break of 2-3 days. The total duration of treatment can be 2-3 months.

• Rosehip with polyps of the gallbladder is taken as an infusion, however, for its preparation, not the fruits, but the rhizomes of the shrub are used. One and a half tablespoons of crushed roots are brewed in 500 ml of boiling water, kept in a water bath for half an hour, then covered with a lid and infused for 2-3 hours. Next, the infusion is filtered, squeezed and drunk warm, 50 ml 20 minutes before meals, up to 4 times a day. The optimal duration of such treatment is up to one month. If necessary, 10 days after the first course of treatment, you can start a second course.
• Flax seeds with a gallbladder polyp have an anti-inflammatory, softening, wound-healing effect, and also reduce the level of cholesterol in the blood. Because of these properties, flaxseed is especially recommended for polyposis formations of cholesterol origin.

One tablespoon of flax seed is boiled for 10 minutes in 300 ml of water, filtered, cooled to a warm state, add 1-2 tsp. honey. The medicine is drunk 100 ml three times a day for 5-10 minutes before meals.

Homeopathy

Homeopathic medicines are prescribed individually. However, a number of the most common homeopathic remedies that are used for polyps in the biliary system can be distinguished:

• Aconitum;
• Apis;
• Belladonna;
• Berberis;
• Bryony;
• Cuprum;
• graphites;
• Kali carbonicum;
• Leptandra;
• Magnesia phosphorica;
• Nux vomica;
• Sepia;
• Sulfur.

For the treatment and prevention of complications prescribed:

• Levicor five grains daily for a month;
• Edas 113 - three drops in the morning and evening, for a month;
• Hepatonorm - eight grains in the morning, afternoon and evening for a month;
• Berberis plus - eight grains three times a day, for a month.

In order to determine the drug, its dosage and contraindications, you need to seek an internal consultation with a gastroenterological homeopath.

Surgery

Surgery is the only way to get rid of the growth in the gallbladder forever. This method has both positive and negative sides, because it will not be possible to remove only a polyp: the surgeon will have to remove the entire bladder.

• with a large build-up (more than 1 cm);
• in the presence of other pathologies in the biliary system (for example, calculi or chronic cholecystitis);
• with a rapid increase in neoplasm;
• with multiple polyposis;
• with a high probability of malignant degeneration of education.

• The operation for a polyp of the gallbladder is to remove the organ and is called cholecystectomy. Such an intervention can be performed laparoscopically, or using a classic incision. The second option is more traumatic and is rarely used today.
• Open removal of polyps in the gallbladder means making a surgical incision in the abdominal wall. Usually, the surgeon performs an oblique laparotomy at the border of the rib arch, exposing the liver and bladder.

The operation is carried out in stages:

• the doctor makes several layered incisions;
• clips vessels and bile canal;
• exposes the bladder, bandages it and resects it;
• if necessary, removes nearby lymph nodes;
• sutures the incision according to the layers of tissues.

An open operation is rarely done: mainly when the polypous outgrowth is multiple or has a significant size - more than 1.5-2 cm. Such an intervention is performed under general anesthesia (intubation anesthesia). The recovery period for the patient is at least 2 weeks. The sutures are removed one week after the operation.

• Laparoscopy of the gallbladder polyp is considered the most appropriate intervention due to the low trauma and rapid recovery of the patient in the postoperative period. Laparoscopy does not involve an incision in the abdominal wall: the surgeon makes several punctures into which special instruments and an endoscope are inserted to control the removal process.

During the operation, general anesthesia is used.

The stages of laparoscopy can be described as follows:

• the surgeon makes 4 punctures, through them introduces instruments into the abdominal cavity;
• examines internal organs through an endoscope;
• bandages the vessels and the bile duct;
• highlights the bubble, removes it using a special coagulator;
• removes the removed organ through a puncture.

After laparoscopy, the patient needs about 5-7 days to recover. Complications after the operation are practically excluded, healing is fast, scars become invisible after a few months.

• Removal of polyps in the gallbladder with a laser also involves the use of laparoscopic access. In this case, the polyposis growth is removed along with the bile organ. The laser in this case is used to dissect tissues, exfoliate and coagulate blood vessels. The period of recovery of the patient after the procedure of laser removal does not differ from such a period after an ordinary laparoscopy.

Contraindications to laser resection can be: impaired blood clotting, large body weight of the patient (over 125 kg), pregnancy, biliary tract obstruction, widespread peritonitis.

Prevention

Preventive measures should be aimed at eliminating factors that contribute to the formation of polyps. For example, it is necessary to maintain a normal metabolism in the body, to prevent the occurrence of biliary stagnation and inflammatory pathologies of the biliary system and liver.

If a person has a hereditary predisposition to the appearance of gallbladder polyps, then he is recommended to undergo regular diagnostics, monitoring the condition of the internal organs. It is preferable to have an abdominal ultrasound scan or MRI every year.

Any inflammatory processes in the digestive system should be treated promptly and fully. Self-medication, as well as the lack of adequate treatment, can lead to various adverse consequences, including the development of polyposis.

In addition, for the purposes of prevention, the following rules must be observed:

• eat fully, regularly, without overeating and hunger strikes;
• lead a healthy lifestyle;
• avoid stress and depression;
• eat a sufficient amount of plant foods, control the intake of fats and simple carbohydrates into the body.

Thanks to a healthy lifestyle, it is possible to prevent the development of many pathologies, including polyps in the gallbladder.

Definitely, those young people who have malignant tumors do not go into the army. But a gallbladder polyp is a benign tumor, therefore it is not a direct contraindication for military service. However, not everything is so simple.

Whether a conscript will be taken into the army with this diagnosis depends on many factors. This is the type of polyp, and its "prescription", as well as its effect on the functionality of the biliary system.

As a rule, if a polyp of the gallbladder is found in a young man and an appropriate diagnosis is made, then he is granted a deferment from conscription for six months. If in the future the diagnosis is confirmed, and the doctor points out obvious violations of the functioning of the liver and the biliary system, then the conscript may be released from service. If the state of health is determined as satisfactory, then the young man is called up on a general basis.

Polyps in the gallbladder are pathological neoplasms on the walls of the mucous cavity, rushing to grow inside the organ. Each polyp has a stalk or a wide base and a body. Polypous structures in the cavity of the gallbladder differ in morphological terms, which is caused by the nature of the occurrence of foci. Treatment tactics include medical and surgical intervention.

Surgery is an undesirable outcome for any patient, so it is important to consider many risks when polyps appear.

• On the one hand, clinicians tend to remove the smallest pathological growths everywhere because of the risk of malignancy.
• On the other hand, it is recommended to refrain from surgery, to observe the state of the tumor during the year.

Such a difference in opinion is due to the fact that many polyps in the gallbladder are nothing more than the deposition of sand or stones, excess cholesterol. In other cases, polyps do occur, are accompanied by certain symptoms, and predetermine the prognosis for the patient.

Indications for removal

High oncogenic risks and the widespread spread of cancer are pushing surgeons to radically solve the problem at the very beginning.

Unconditional indications for surgical intervention are:

• or diffuse polyposis;
• Dynamic growth of the polyposis focus;
• Large neoplasm, more than 2 cm;
• The appearance of characteristic symptoms;
• Burdened anamnesis in relation to diseases of the organ;
• Oncological risks due to cases of cancer of the hepatobiliary system in close relatives.

Mechanical blockage of the ducts due to the growth of the polyp, infringement or torsion of the pedicle of the growth is also considered an indication for removal.

Regarding the growth criteria, the intensity of the increase in volume is also distinguished. So, if the polyp grows more than 2 mm per year, then a decision is made to remove the tumor.

Small polyp (up to 5 mm)

Is it necessary to perform an operation if the polyp is 5 mm, localized or the number of units in the polyposis focus is from 1 to 3 units? Usually, in such a situation, removal is postponed until the first characteristic symptoms appear. It is important to carry out 1 time in 3 months. At the same time, blood and urine tests are taken, and the patient's condition is fully monitored.

Removal is only necessary in the following cases:

1. malignancy- small polyps can also change according to the oncogenic type;
2. blockage of the ducts- with localization in the lumen of the glands;
3. Regular damage to the polyp in the presence of stones, inflammation.

The determining criterion in the removal of even small polyps is the impact on the functionality of the digestive system, the health of the hepatobiliary structures in general, and the general condition of the patient.

How to delete - basic methods

Removal of polyps in the gallbladder is an important aspect of modern surgery and oncology. High oncological risks are due not only to heredity, but also to the constant impact of internal or external negative factors.

There are the following well-known methods for removing pathological foci:

• Videolaparoscopic cholecystectomy (abbreviation LCE). The technique involves the removal of the organ by the latest endoscopic methods, at the early stages of the development of various complications associated not only with polyposis, but also with other diseases of the gallbladder. The technique is not used for advanced oncology.
• Classic cholecystectomy (abbreviation TCE). The method of removal through the abdominal surgical access by incision in the right hypochondrium or from the middle part of the abdominal cavity. In addition to the complications associated with all abdominal operations, the method is traumatic, leaves scars due to a deep skin incision, the white line of the abdomen, and the abdominal region.
• Laparoscopic cholecystectomy. It involves the removal of an organ without a deep incision. It is considered the golden mean in modern surgery. Surgical access is carried out by punctures in the abdominal cavity and the introduction of endoscopic instruments through them. The only drawback is the impossibility of completing the operation in 6% of all cases, which requires traditional cholecystectomy.

All these methods are used in order to remove the gallbladder.

With a complication of polyposis or with metastases, it is possible to remove lymph nodes, parts of the liver, and other neighboring organs.

Removal of polyps in the gallbladder without removal of the gallbladder - organ-preserving techniques

The main way to remove polyps without removing the organ itself is endoscopic polypectomy. The polyp is removed using a special diathermic loop. So, the growth is wrapped around the loop, the pathological focus is pulled together and cut off. At the same time, coagulation of the vessels takes place to prevent bleeding.

With a large polyp, its partial excision is carried out, and after the extraction of fragments and coagulation.

Unfortunately, this method of treatment is practically not used due to the lack of certainty in the postoperative period. During the manipulation, the surface of the bladder is still damaged, complications develop, and new foci may appear in place of the scar tissue.

Thus, the treatment of multiple or diffuse polyps is effective only with cholecystectomy.

Preparatory stages

Preparation for any volume of surgical intervention begins on an outpatient basis. Given the possibility of a planned operation, patients usually have time to fully prepare for the upcoming manipulation.

Outpatient training includes the following steps:

1. Reducing physical activity (in the last days before manipulation, rest should be observed in general);
2. Diet correction, it is recommended to switch to medical nutrition a month before the operation;
3. For 14 days, it is necessary to exclude the use of drugs that affect blood coagulation;
4. Taking a course of antibiotic therapy with active inflammation;
5. Cancellation of life-sustaining medications on the eve of surgery.

During the day of the operation, the patient moves to the clinic, where the last stage of preparation is carried out:

• enema bowel cleansing,
• determination with the type of drug for anesthesia,
• the introduction of relaxing drugs to reduce the stress factor.

Simultaneously with outpatient training, a whole range of diagnostic measures is prescribed. Patients must pass all general clinical tests, undergo instrumental examination.

On the day of the operation, an additional physical examination of the patient is carried out for a possible deterioration in well-being, and they are prepared for the introduction of anesthesia.

How to remove - the course of the manipulation

All operations on the gallbladder, regardless of operational access, are performed under general anesthesia, according to vital indications.

An approximate algorithm for performing an abdominal operation is as follows:

1. Introduction of anesthesia;
2. An incision in the peritoneum or in the right hypochondrium up to 30 cm;
3. Isolation of the gallbladder;
4. Clamping of the ducts and blood vessels with a clip;
5. Separation of the gallbladder from the liver;
6. Stop bleeding (laser coagulation, ultrasound or catgut suture);
7. Sewing up the surgical wound.

The total duration of the operating period is 60-90 minutes.

During laparoscopic cholecystectomy, surgical access is provided through several punctures, and a similar scenario is performed with special tools with regular monitoring of what is happening on the computer monitor. In some cases, they switch to the path of traditional cholecystectomy.

Possible Complications

Given the severity and sufficient volume of surgical intervention, the body is under severe stress associated with the removal of the organ.

In this regard, the following complications may develop:

• Violation of the motility of the muscular structures of the small intestine;
• Liquefaction of bile and greater susceptibility to bacterial damage;
• Damage to the mucous membranes of the digestive organs by bile acids;
• The development of chronic pathologies: colitis, enteritis, gastritis, esophagitis.

In the absence of the gallbladder, the compensatory capabilities of the body are activated, which help the patient recover as soon as possible. After the operation, a long-term medical treatment is prescribed. It is important to comply with all the requirements of the doctor, protective regime, food discipline.

An important aspect of the postoperative period is the correction of nutrition. Compliance with proper nutrition will be required throughout the life of the patient.

The normalization of the diet is due to the following features:

• Now the bile secretion is sent directly to the intestinal sections;
• A sharp decrease in the concentration of bile makes it difficult to digest food;
• The activity of enzymes that are involved in the breakdown also decreases.

Diet is required to help the body digest the food it receives.

It is important to follow the three main rules of the late postoperative period:

1. Eat only boiled or steamed food;
2. Eat food in small portions, chewing slowly (you can gradually increase the number of servings);
3. Gradually reduce the volume of servings while increasing the frequency of meals to 6-7.

All these rules allow the liver to prepare the necessary amount of enzymes that will digest the incoming food bolus.

Attention! If you continue to eat your usual food, neglect the rules of nutrition, then you can achieve a serious complication - stagnation of bile in the ducts, the development of acute cholestasis.

Such a diet is indicated for 18 months to give the body the opportunity to adapt to a new state, to cope with the digestive processes according to the age needs of the patient. After a while, you can start eating lean meat, fish, avoiding smoked meats, pickles.

Physical activity is indicated 1-2 months after the operation. All this time it is better to observe the protective regime, to exclude hypothermia, viral and colds.

Additionally, a whole series of medications is prescribed to normalize and maintain the necessary balance of microflora in order to avoid secondary inflammatory processes. Patients are recommended to undergo diagnostics at least 2 times a year regarding the current clinical situation.

You can make an appointment with a doctor directly on our resource.

Be healthy and happy!

Hundreds of suppliers bring hepatitis C medicines from India to Russia, but only SOF.SAFE will help you buy sofosbuvir and daclatasvir, while professional consultants will answer any of your questions throughout the therapy.

Polyps in the gallbladder are pathological neoplasms on the walls of the mucous cavity, rushing to grow inside the organ. Each polyp has a stalk or a wide base and a body. Polypous structures in the cavity of the gallbladder differ in morphological terms, which is caused by the nature of the occurrence of foci. Treatment tactics include medical and surgical intervention.

Should a gallbladder polyp be removed?

Surgery is an undesirable outcome for any patient, so it is important to consider many risks when polyps appear.

• On the one hand, clinicians tend to remove the smallest pathological growths everywhere because of the risk of malignancy.
• On the other hand, it is recommended to refrain from surgery, to observe the state of the tumor during the year.

Such a difference in opinion is due to the fact that many polyps in the gallbladder are nothing more than the deposition of sand or stones, excess cholesterol. In other cases, polyps do occur, are accompanied by certain symptoms, and predetermine the prognosis for the patient.

Indications for removal

High oncogenic risks and the widespread spread of cancer are pushing surgeons to radically solve the problem at the very beginning.

Unconditional indications for surgical intervention are:

• Multiple polyps of the gallbladder or diffuse polyposis;
• Dynamic growth of the polyposis focus;
• Large neoplasm, more than 2 cm;
• The appearance of characteristic symptoms;
• Burdened anamnesis in relation to diseases of the organ;
• Oncological risks due to cases of cancer of the hepatobiliary system in close relatives.

Mechanical blockage of the ducts due to the growth of the polyp, infringement or torsion of the pedicle of the growth is also considered an indication for removal.

Regarding the growth criteria, the intensity of the increase in volume is also distinguished. So, if the polyp grows more than 2 mm per year, then a decision is made to remove the tumor.

Small polyp (up to 5 mm)

Is it necessary to perform an operation if the polyp is 5 mm, localized or the number of units in the polyposis focus is from 1 to 3 units? Usually, in such a situation, removal is postponed until the first characteristic symptoms appear. It is important to conduct an ultrasound of the gallbladder polyp once every 3 months. At the same time, blood and urine tests are taken, and the patient's condition is fully monitored.

Removal is only necessary in the following cases:

1. malignancy- small polyps can also change according to the oncogenic type;
2. blockage of the ducts- with localization in the lumen of the glands;
3. Regular damage to the polyp in the presence of stones, inflammation.

The determining criterion in the removal of even small polyps is the impact on the functionality of the digestive system, the health of the hepatobiliary structures in general, and the general condition of the patient.

How to delete - basic methods

Removal of polyps in the gallbladder is an important aspect of modern surgery and oncology. High oncological risks are due not only to heredity, but also to the constant impact of internal or external negative factors.

There are the following well-known methods for removing pathological foci:

• Videolaparoscopic cholecystectomy (abbreviation LCE). The technique involves the removal of the organ by the latest endoscopic methods, at the early stages of the development of various complications associated not only with polyposis, but also with other diseases of the gallbladder. The technique is not used for advanced oncology.
• Classic cholecystectomy (abbreviation TCE). The method of removal through the abdominal surgical access by incision in the right hypochondrium or from the middle part of the abdominal cavity. In addition to the complications associated with all abdominal operations, the method is traumatic, leaves scars due to a deep skin incision, the white line of the abdomen, and the abdominal region.
• Laparoscopic cholecystectomy. It involves the removal of an organ without a deep incision. It is considered the golden mean in modern surgery. Surgical access is carried out by punctures in the abdominal cavity and the introduction of endoscopic instruments through them. The only drawback is the impossibility of completing the operation in 6% of all cases, which requires traditional cholecystectomy.

All these methods are used in order to remove the gallbladder.

With a complication of polyposis or with metastases, it is possible to remove lymph nodes, parts of the liver, and other neighboring organs.

Removal of polyps in the gallbladder without removal of the gallbladder - organ-preserving techniques

The main way to remove polyps without removing the organ itself is endoscopic polypectomy. The polyp is removed using a special diathermic loop. So, the growth is wrapped around the loop, the pathological focus is pulled together and cut off. At the same time, coagulation of the vessels takes place to prevent bleeding.

With a large polyp, its partial excision is carried out, and after the extraction of fragments and coagulation.

Unfortunately, this method of treatment is practically not used due to the lack of certainty in the postoperative period. During the manipulation, the surface of the bladder is still damaged, complications develop, and new foci may appear in place of the scar tissue.

Thus, the treatment of multiple or diffuse polyps is effective only with cholecystectomy.

Preparatory stages

Preparation for any volume of surgical intervention begins on an outpatient basis. Given the possibility of a planned operation, patients usually have time to fully prepare for the upcoming manipulation.

Outpatient training includes the following steps:

1. Reducing physical activity (in the last days before manipulation, rest should be observed in general);
2. Diet correction, it is recommended to switch to medical nutrition a month before the operation;
3. For 14 days, it is necessary to exclude the use of drugs that affect blood coagulation;
4. Taking a course of antibiotic therapy with active inflammation;
5. Cancellation of life-sustaining medications on the eve of surgery.

During the day of the operation, the patient moves to the clinic, where the last stage of preparation is carried out:

• enema bowel cleansing,
• determination with the type of drug for anesthesia,
• the introduction of relaxing drugs to reduce the stress factor.

Simultaneously with outpatient training, a whole range of diagnostic measures is prescribed. Patients must pass all general clinical tests, undergo instrumental examination.

On the day of the operation, an additional physical examination of the patient is carried out for a possible deterioration in well-being, and they are prepared for the introduction of anesthesia.

How to remove - the course of the manipulation

All operations on the gallbladder, regardless of operational access, are performed under general anesthesia, according to vital indications.

An approximate algorithm for performing an abdominal operation is as follows:

1. Introduction of anesthesia;
2. An incision in the peritoneum or in the right hypochondrium up to 30 cm;
3. Isolation of the gallbladder;
4. Clamping of the ducts and blood vessels with a clip;
5. Separation of the gallbladder from the liver;
6. Stop bleeding (laser coagulation, ultrasound or catgut suture);
7. Sewing up the surgical wound.

The total duration of the operating period is 60-90 minutes.

During laparoscopic cholecystectomy, surgical access is provided through several punctures, and a similar scenario is performed with special tools with regular monitoring of what is happening on the computer monitor. In some cases, they switch to the path of traditional cholecystectomy.

Possible Complications

Given the severity and sufficient volume of surgical intervention, the body is under severe stress associated with the removal of the organ.

In this regard, the following complications may develop:

• Violation of the motility of the muscular structures of the small intestine;
• Liquefaction of bile and greater susceptibility to bacterial damage;
• Damage to the mucous membranes of the digestive organs by bile acids;
• The development of chronic pathologies: colitis, enteritis, gastritis, esophagitis.

In the absence of the gallbladder, the compensatory capabilities of the body are activated, which help the patient recover as soon as possible. After the operation, a long-term medical treatment is prescribed. It is important to comply with all the requirements of the doctor, protective regime, food discipline.

An important aspect of the postoperative period is the correction of nutrition. Compliance with proper nutrition will be required throughout the life of the patient.

The normalization of the diet is due to the following features:

• Now the bile secretion is sent directly to the intestinal sections;
• A sharp decrease in the concentration of bile makes it difficult to digest food;
• The activity of enzymes that are involved in the breakdown also decreases.

Diet is required to help the body digest the food it receives.

It is important to follow the three main rules of the late postoperative period:

1. Eat only boiled or steamed food;
2. Eat food in small portions, chewing slowly (you can gradually increase the number of servings);
3. Gradually reduce the volume of servings while increasing the frequency of meals to 6-7.

All these rules allow the liver to prepare the necessary amount of enzymes that will digest the incoming food bolus.

Attention! If you continue to eat your usual food, neglect the rules of nutrition, then you can achieve a serious complication - stagnation of bile in the ducts, the development of acute cholestasis.

Such a diet is indicated for 18 months to give the body the opportunity to adapt to a new state, to cope with the digestive processes according to the age needs of the patient. After a while, you can start eating lean meat, fish, avoiding smoked meats, pickles.

Physical activity is indicated 1-2 months after the operation. All this time it is better to observe the protective regime, to exclude hypothermia, viral and colds.

Additionally, a whole series of medications is prescribed to normalize and maintain the necessary balance of microflora in order to avoid secondary inflammatory processes. Patients are recommended to undergo diagnostics at least 2 times a year regarding the current clinical situation.

In women from 30 to 50 years old, polyps of the uterus and cervix are increasingly being diagnosed. If symptoms of pathology are detected, you should immediately consult a doctor.
Folk remedies for polyps in the nose of a child right here. But keep in mind that the child's body may not respond to such treatment as expected.

Nutrition Features

In the early postoperative period, significant restrictions on food preferences are recommended. So, the food should be semi-liquid, frayed, in order to reduce any load on the intestines. Food is consumed warm, in small portions several times a day.

It is important to exclude fast food, heavy complex dishes, it is necessary to limit salt to 1 teaspoon per day. It is unacceptable to completely exclude salt because of the risks of developing electrolyte disorders.

The diet should be based on:

• fresh fruits and vegetables;
• meat and fish cutlets;
• pureed or cereal side dishes;
• slimy soups in low-fat broth.

From drinking, preference should be given to jelly, a decoction of rosehip berries, and herbal infusions. Providing the right diet for several years will allow the body to quickly adapt to the new state and the changes that have occurred.

What else is important to know about the consequences of gallbladder removal, learn from this video:

Removal of polyps in the gallbladder is determined by vital indications. Despite the ubiquity of oncological diseases, each situation is considered from a variety of angles. If necessary, they try to save the organ, but explain to patients the possible risks, consequences and benefits of radical removal methods.

Can a uterine polyp come out with menstruation, read our article here.