Planned surgery to remove the gallbladder. Laparoscopy of the gallbladder (removal of stones or the entire organ by laparoscopic surgery) - advantages, indications and contraindications, preparation and course of the operation, recovery and diet. Brief description

Removal of the gallbladder is a fairly common operation on the organs of the peritoneal cavity.

Most often, the reason for the removal of the gallbladder is acute or chronic cholecystitis, cholelithiasis.

Less commonly, the bladder is removed for reasons of congenital pathologies, tumors. Why is this operation performed, what are the indications, how long does it take, and what complications can occur after removal of the organ?

Gallbladder removal methods

To date, to remove stones from the gallbladder, doctors use different methods of getting rid of stones in the gallbladder.

The method of open cholecystectomy is a traditional abdominal operation, for which a wide incision is made in the wall of the peritoneum.

Usually, open surgery is used in cases where the organ is severely inflamed or infected, or if large stones have formed in it.

Laparoscopic cholecystectomy is a minimally invasive procedure for removing an organ through small incisions in the peritoneum.

The operation is carried out using special tools. During the operation, the doctor is in contact with the organ only through instruments, so that the risk of inflammation and infection after the operation is minimal.

Often, laser stone crushing is used to remove stones from the gallbladder. To get the laser to the gallbladder, doctors make a puncture in the peritoneum.

The doctor acts with a laser directly on the stones themselves. The removal of stones with a laser is done for about 20 minutes.

The splitting of stones with a laser has some contraindications. So, laser exposure is contraindicated for people over 60 years old, for patients with a weight of 120 kg or more, and with a severe general condition of the patient.

Laser stone removal also has its drawbacks. In some cases, the patient may get a burn of the mucous membrane, which later degenerates into an ulcer.

In addition, the sharp edges of crushed stones can scratch the bladder from the inside or clog the bile ducts.

In some cases, doctors suggest using ultrasound to crush stones. During the procedure, the stones are crushed using a shock wave. The stones are crushed and then exit through the bile ducts.

In what cases is the gallbladder removed?

Removal of the gallbladder has been a topic of medical discussion for many years.

the patient constantly hurts his right side, there are infectious processes in the organ that do not go away after complex therapy;
inflammatory enlargement of the organ;
persistent jaundice;
indications for surgery - cholangitis, which is not treatable, especially against the background of blockage of the biliary tract;
early changes in the liver, in which the functions of the organ are impaired - a frequent indication for removal of the organ;
the question of surgery is also raised in secondary pancreatitis.

All of the above are only general indications for the removal of an organ.

In each case, the doctor takes into account the individual condition of the patient and the presence of complications that may require urgent removal of the bladder.

To determine the method of surgical intervention and the general condition of the patient, doctors prescribe a complete diagnostic examination.

Preparation for removal of an organ involves an ultrasound examination, which helps to study the condition of the bladder itself and nearby organs - the liver, pancreas.

Ultrasound allows you to see the presence of formations in the bladder and their volumes.

MRI visualizes stones and other pathologies of the organ and ducts (scarring, inflammation).

CT is prescribed in cases where the doctor needs to examine the perivesical tissues and the condition of other organs of the peritoneum.

Laboratory tests for bilirubin, transaminases, alkaline phosphatase, thymol test should be done to find out what condition the liver and pancreas are in.

A high-quality in-depth examination and preparation for surgery will help eliminate possible complications and decide whether the organ really needs to be removed.

Many patients are interested in the question: where does the bile go after the removal of the organ? The gallbladder is a reservoir where bile is deposited "in reserve".

Removal of the organ is carried out in stages

In the bubble, the liquid is stored all the time until the process of processing food. After the removal of the organ, the body gets used to working without a bubble for some time.

Most often in this case, the body stores unused bile in the ducts. How much time passes before the establishment of this process, even a doctor cannot say with accuracy.

How is the operation going?

Preparing for surgery helps eliminate some of the risks and surprises during gallbladder removal.

A week before surgery, the patient should stop taking drugs that reduce blood clotting. The day before removal, you need to eat only light food, and after midnight, do not eat anything at all.

To cleanse the intestines, the doctor may prescribe special medicines or enemas. In the morning, before the procedure itself, the patient needs to take a shower with antibacterial soap.

If laparoscopy was chosen to remove the gallbladder, then the doctor makes several incisions in the peritoneum through which he introduces a device with a camera and special tools.

To date, doctors have recognized the superiority of laparoscopy over the traditional type of surgery.

Why is laparoscopy so popular lately:

the most important advantage of the operation is a closed technique, in which the doctor does not come into contact with organs and tissues, due to which the risk of infections and infections is significantly reduced;
the operation is less traumatic, which is undoubtedly very good for the patient;
hospitalization after removal of the organ lasts only a couple of days;
the incisions are small, which means that the scars in the future will not be so noticeable;
the patient will be able to work in 20 days;
Another undoubted advantage of such treatment is that it is easier for the patient to decide on laparoscopy than on an open operation, so every year there are fewer and fewer cases of advanced bile pathologies.

It should be noted that along with the undoubted advantages, laparoscopy also has some disadvantages.

So, to improve the view, the doctor injects carbon dioxide under a certain pressure into the patient's peritoneum.

As a result of this, pressure on the diaphragm and in the veins increases, so breathing and heart work are a little more difficult. For patients with a problematic heart and respiratory system, this is a serious disadvantage.

Laparoscopy does not give the doctor the opportunity to examine the organs during the procedure, unlike the open method, when the doctor examines the organs with his own eyes.

Laparoscopy is undesirable in such situations:

very serious condition;
severe problems with breathing and heart function;
jaundice, which has developed due to blockage of the bile ducts;
excessive bleeding;
adhesions in the upper part of the peritoneum;
last weeks of pregnancy;
acute pancreatitis;
peritonitis in the peritoneum.

Despite the growing popularity of laparoscopy, the open method does not give up its position. Open cholecystectomy is prescribed in cases where there are reasons for refusing laparoscopy.

In addition, in 3-5% of cases, laparoscopy ends with an open operation, as unforeseen circumstances arise.

Often the reasons for an open operation are the inability to perform a laparoscopy, since there is no necessary equipment or an experienced specialist for this.

Recovery and complications after surgery

A person with a diseased gallbladder is interested in how long recovery after surgery lasts. After the operation to remove the gallbladder, the patient is taken to the ward, where anesthesia passes for about an hour and the patient wakes up.

In some cases, after anesthesia, nausea and vomiting may occur, which are stopped by special drugs.

Pain after removal of the gallbladder may occur a few hours after the operation, the diseased side must be anesthetized.

The first day after the operation, the patient should not eat anything, and from the second day they begin to gradually introduce food. How much and what you can eat the patient - only the attending physician decides.

Within 2-3 days after removal of the organ, the patient gradually begins to walk.

Recovery after removal of the gallbladder in a hospital lasts from 1 to 7 days, after which, if the patient does not have a high temperature, severe pain, constipation and problems with tests, he is allowed to go home for further rehabilitation.

In some cases, complications may occur after gallbladder removal. The patient has pain in the right side, the temperature rises, constipation and other intestinal disorders are observed.

Often, temperature and pain appear after taking fried or fatty foods, which is why it is so important to monitor the nutrition of a patient with a removed gallbladder.

When such unpleasant symptoms appear, doctors advise taking medications that will relieve pain and bloating and help digest food.

In addition, the doctor may prescribe folk medicines: decoctions and infusions of herbs and other herbal ingredients that improve digestion.

Constipation and diarrhea are common problems that bother after gallbladder removal. Diarrhea and constipation occur due to the growth of bacteria in the small intestine.

Bile, which is stored in the gallbladder, improves digestion and destroys dangerous microbes in the intestines.

The bile from the liver is much weaker and is not able to cope with pathogens, which is why the microflora in the intestine is disturbed.

To make constipation and diarrhea disappear, you need to remove sweets from the diet, replacing them with healthy berries. In addition, in this case, doctors recommend taking medications such as pro- and prebiotics, which will restore the microflora.

It often happens that the bladder has already been removed, but the right side and stomach still hurt. What are the reasons for this phenomenon?

Dysfunction of the sphincter of Oddi - substances that enter the bile mucosa can increase the tone of the sphincter, and if the organ is removed, then this tone decreases markedly.

So, bile can enter the intestines not only in the process of processing food. In this case, the patient has pain in the right side, stomach, stool disorders, nausea, heartburn appear after removal of the gallbladder.

The right side can hurt after eating and at night, in addition, pain can be given to the shoulder blade and arm, encircle.

If the patient's right side hurts, the temperature rises, which is accompanied by chills and profuse sweat, yellowing of the skin, nausea, vomiting, and even impaired consciousness, then this may indicate the onset of acute cholangitis.

The causes of this condition are inflammation of the bile ducts or stones in the bile ducts.

With untimely detection, the condition may noticeably worsen, which threatens with an abscess and even peritonitis.

If the patient has a pain in the right side, then this may also indicate a condition such as cholelithiasis. The reasons for this condition are stones in the ducts, which can freely exit through the ducts or remain in them.

Stuck stones can cause the most unpleasant symptoms: the patient complains that his right side hurts, in addition, jaundice is observed.

After removal of the gallbladder, the patient must adhere to three rules:

medical treatment after removal of the gallbladder should help the patient adapt to a new way of processing food. As part of the treatment, doctors prescribe hepatoprotectors;
the patient's nutrition should be sparing, fractional, dietary, the food intake regimen should be constant. How much to adhere to the dietary regimen, the doctor decides individually;
gymnastics for the abdominal wall will help improve the general condition and avoid negative consequences. How much you need to do gymnastics, the attending physician decides.

Recovery after removal of the gallbladder is a rather lengthy process. The patient may have side pain, fever and other unpleasant symptoms.

It is important to understand that any deviations from the norm should be reported to the doctor immediately.

In a person who has undergone cholecystectomy, life is divided into two stages. The first refers to the preoperative period, the second - after it. The operation is not prescribed from scratch, therefore, the final stage of the first period of life was a certain kind of physical and psychological suffering associated with periodic pain, regular visits to the attending physician, doubts and worries about the upcoming surgical intervention. The postoperative period begins with the fact that “everything is behind us”, and ahead is a period of rehabilitation filled with some uncertainties. However, life after removal continues. The main task at this stage, which worries the patient, is the question of changes in the process of digestion.

The gallbladder, as an organ, is endowed with certain functions. In it, as in a reservoir, bile accumulates and concentrates. It tends to maintain optimal pressure in the bile ducts. But with the diagnosis of calculous cholecystitis, or cholelithiasis, the functions of the gallbladder are already limited, and it practically does not take part in the digestive process.

Throughout the course of the disease, the body independently removes the gallbladder from the digestive process. Using compensatory mechanisms, he fully adapts to new conditions in which the function of the gallbladder is already disabled. The function of bile secretion is assumed by other organs. Therefore, the removal of an organ that has already been removed from their life cycle does not cause a serious blow to the body, since adaptation has already taken place. Through the operation, the organ that contributes to the spread of infection, generating the inflammatory process, is removed. In this case, only relief can come for the patient.

Prompt decision-making on the part of the patient about the upcoming operation largely contributes to the successful outcome of the surgical intervention and a short period of rehabilitation. With timely decision-making, the patient protects himself from complications that may occur as a result of delaying the timing of surgical intervention, casting doubt on the satisfactory condition of the patient in the postoperative period.

Discharging from the hospital, the former patient, and now a person undergoing rehabilitation, is protected from constant visits to manipulation rooms and the constant care of the attending physician. Duodenal sounding and dubazh remained in the life that was before the operation.

True, there are exceptions when the patient does not agree to a surgical intervention for a long time, allowing the disease to affect the body for a long time. An inflammatory process spreading from the walls of the gallbladder can affect neighboring organs, causing complications that develop into concomitant diseases. As a rule, against the background there are problems in the form of gastric ulcer and duodenal ulcer, inflammation of the head of the pancreas, gastritis or colitis.

Patients with complications after gallbladder surgery need additional treatment after discharge from the hospital. The nature of the treatment and the duration of the procedures are prescribed by the leading patient's doctor. The main issue facing both the group of operated patients without obvious signs of complications and patients with complications is the process of nutrition. The diet in the postoperative period is not strict, but excludes animal fats that are difficult to digest by the body:

pork fat
lamb fried
brisket.

Subject to a strict diet in the preoperative period, patients are allowed to gradually introduce new foods into the diet, excluding spicy canned food, strong tea, coffee, and the use of alcoholic beverages is strictly prohibited.

The occurrence of a relapse

Surgery does not affect the composition of bile produced by the body. The production of hepatocytes by stone-forming bile may continue. This phenomenon in medicine is called "Biliary insufficiency". It consists in a violation of physiological norms in an increase in the amount of bile produced by the body and its increasing pressure in the bile ducts. Under the influence of excess pressure, the toxic fluid changes the structure of the mucous membranes of the stomach and intestines.

With a negative prognosis up to the formation of a low-quality tumor. Therefore, the main task in the postoperative period is a biochemical study of the composition of bile, carried out at regular intervals. As a rule, a duodenal examination of the duodenum is performed. It cannot be replaced by ultrasound, since ultrasound is unable to give an appropriate result.

A clear indicator of the occurrence of relapse, or secondary formation of stones, is the placement in the refrigerator of a 5 ml sample taken for analysis for a 12-hour period. If sedimentation is observed in the liquid within the allotted time, bile is capable of forming new stones. In this case, drug treatment is prescribed with drugs containing bile acids and bile, being stimulants of bile production:

lyobil
cholenzim
allahol
cyclovalone
osalmid.

All are used as replacement therapy for biliary insufficiency. A mandatory appointment in such cases is ursodeoxycholic acid, which does not cause intoxication and is harmless to the mucous membranes of the intestines and stomach. It is taken, depending on the prescription, from 250 to 500 mg, once a day, preferably at night. Preparations containing ursodeoxycholic acid:

Ursosan
Hepatosan
Enterosan
Ursofalk.

Stones can be re-formed, but not in the gallbladder, but in the bile ducts. An exclusion from the diet of foods containing high cholesterol in large quantities can serve as a reducing factor for relapse:

fried and spicy foods
concentrated broths
egg yolks
brain
fatty fish and meats
alcohol
beer.

All of the above products are a significant complication for the pancreas and liver.

Dietary nutrition in the postoperative period

Proper nutrition is the key to health after cholecysectomy

Nutrition during the rehabilitation period after removal of the gallbladder is given special attention. The main point is its regularity. The volume of food should be small, and the frequency of meals should be from 4 to 6 times a day. Food, as a stimulant of the bile-forming process, in this case is an irritant for the digestive organs, thus preventing the stagnation of bile. As a natural irritant, food contributes not only to the formation, but also to the excretion of bile from the bile ducts into the intestines.

The most powerful product that promotes bile distillation is. In general, all vegetable fats have a strong choleretic effect. For patients who are prone to fullness, it is advisable to limit or minimize the consumption of foods high in carbohydrates:

sugar
potato
confectionery and pasta
muffin.

Patients who have undergone surgery to remove the gallbladder are not recommended sanatorium treatment, with the exception of patients with complicated cholecystitis or other concomitant diseases. Depending on the severity of the operation, patients are not recommended for heavy physical exertion, or physical work that puts tension on the abdominal press, for 6 to 12 months after the operation. Heavy physical activity can initiate the formation of postoperative hernias. Full, and especially obese patients, it is recommended to wear a bandage during this period.

After the discharge of the patient from the hospital, medical specialists attach great importance to physiotherapy exercises. Specially designed exercises stimulate the abdominal organs to produce and drain bile. Such a “massage” with the help of physical exercises allows you to speed up the process of restoring the functions of damaged tissues of the abdominal region.

Possible consequences of surgery

As a rule, in patients in life after removal of the gallbladder, no negative consequences occur. This is ideal, but in the real world, a person who has undergone surgery is subject to a whole range of symptoms, in particular psychological ones, called "Postcholecystectomy Syndrome".
The sensations accumulated over the years of the disease do not let the patient go even after such a fait accompli as an operation to remove the gallbladder. The former patient is also tormented by dryness and pain in the right hypochondrium, and the appearance of fatty foods also causes intolerance and nausea.

All these symptoms relate to the psychological state of the patient and have little to do with the internal processes occurring inside the patient, like a bad tooth that has already been removed, but it continues to give a painful sensation. But if such symptoms continue for a long time, and the operation was not performed in a timely manner, therefore, the causes may be hidden in the development of concomitant diseases. The main reasons leading to negative consequences after removal of the gallbladder:

Diseases of the gastrointestinal tract
Reflux
Pathological changes in the bile ducts
Poorly performed operation
Exacerbated diseases of the pancreas and liver
chronic hepatitis
Dysfunction of the sphincter of Oddi.

To prevent postcholecystectomy syndrome, a thorough examination of the patient is carried out, both before surgery and in the postoperative period. Great importance is given to the general condition of the patient and the presence of concomitant or chronic diseases. A direct contraindication to surgical intervention to remove the gallbladder may be the presence of pathologies in the patient's body.

Basic diet in the postoperative period

Gallbladder removal is not a death sentence!

The possibility of certain nutritional problems associated with the removal of the gallbladder can be solved by an individual diet for the patient, avoiding the methods of drug exposure to the body. Such an approach to the patient can completely neutralize the postcholecystectomy syndrome that occurs after surgery.

The main point is not the products allowed for use during the rehabilitation period of post-surgical intervention, but the mode of the nutrition process. Food should be divided into small portions and taken frequently at regular intervals. If the patient before the operation ate food 2-3 times a day, then in the period after the operation, he needs to receive from 5 to 6 servings a day. Such nutrition is called fractional and is designed specifically for patients of this profile.

Excludes foods high in animal fats, fried and spicy foods. The focus is on the temperature of the cooked food. For patients, the use of highly chilled or highly heated food is not recommended. The use of carbonated drinks is strictly not recommended. Such recommendations are associated solely with the absence of the gallbladder. Special recommendations include the frequent use of drinking water. Before each meal, the patient is instructed to drink a glass of water, or 30 ml per kilogram of body weight. Water relieves the aggression of bile acids produced by the ducts and is the main source of protection for the mucous membranes of the duodenum and gastrointestinal tract.

In addition, water stops the passage of bile that occurs at the initial moment after the operation, when a change in duodenal motility can occur and bile can return to the stomach. At such times, the patient may experience heartburn or bitterness in the mouth. Water resists this process, being a natural neutralizer. Dyspeptic disorders - flatulence, bloating, rumbling, constipation, diarrhea, can also be stopped by taking a glass. Visiting swimming pools, open reservoirs is very useful, because water is a source of soft natural massage for the muscles and internal organs of the abdominal cavity. Water procedures are shown after 1-1.5 months after the surgical intervention.

In addition to swimming, walking is very useful for patients who have undergone gallbladder removal. A daily walk for 30-40 minutes helps to remove bile from the body and prevents its stagnation. Morning light physical exercises in the form of charging are also recommended. Press exercises are unacceptable, which can be started only a year after surgery.

Bread. Yesterday's baking, coarse grinding, gray or rye. It is not recommended to eat muffins, pancakes, pancakes, puff pastries.
Cereals. Buckwheat, oatmeal. Grains should be well boiled.
Meat, fish, poultry. Low fat varieties. The cooking process is boiled, steamed or stewed.
The fish is baked. The use of broths is excluded. Soups are prepared on vegetable broths.
Spices, spices, seasonings, sauces are not recommended.
Eggs. Only in the form of a protein omelet. The yolk must be excluded.
except for whole milk. Sour cream - no more than 15% fat.
Fats. Fats used in food should not be of animal origin.
Vegetables. Fresh, boiled or baked. Particular preference is given to pumpkin and carrots. It is not recommended to use legumes, garlic, onions, radishes, sorrel.
Berries and fruits. Preference is given to sweet varieties. Cranberries and Antonovka apples are not recommended for use.
Sweets. Honey, molasses, natural marmalade on agar-agar, preserves, jams. It is completely necessary to abandon cocoa products, confectionery, ice cream.
Beverages. The diet should not include carbonated, hot or cold drinks. Rosehip decoction, sweet juices, dried fruit compote are recommended.

In conclusion, it should be noted that prevention after surgery to remove the gallbladder consists in complex physiotherapy, which includes ozone therapy. Ozone, being a natural antibiotic, enhances immunity, destroys colonies of bacteria, viruses and fungal diseases. Ozone helps to correct the functioning of hepatocytes, which are responsible for the formation of bile.

All materials on the site are prepared by specialists in the field of surgery, anatomy and related disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

“Cholelithiasisthe disease is one of the most common chronic diseases in adults, ranking third after cardiovascular disease and diabetes,” – writes Doctor of Medical Sciences Ilchenko A.A., one of the leading experts on this issue in the country. The reasons for its development are a number of factors, in particular heredity, women taking oral contraceptives, obesity, eating a lot of cholesterol.

Conservative therapy can be effective only at the pre-stone stage of the disease, which at this stage is diagnosed only with the help of ultrasound. The next steps are surgical intervention. The operation for stones in the gallbladder can be reduced to the complete removal of the gallbladder, the removal of stones invasively or naturally (after crushing, dissolution).

Types of surgery, indications for carrying out

At the moment, there are several options for surgical intervention:

Cholecystectomy- removal of the gallbladder.
Cholecystolithotomy. This is a minimally invasive type of intervention that involves preserving the gallbladder and removing only deposits.
Lithotripsy. This procedure involves crushing the stones with ultrasound or laser and removing the fragments.
Contact litholysis- dissolution of stones by direct injection of certain acids into the cavity of the gallbladder.

In most cases, cholecystectomy is the removal of the gallbladder. A sufficient indication is the detection of stones and the characteristic symptoms of the disease. Mainly, it is severe pain and disturbances in the work of the gastrointestinal tract.

Important! Definitely, the operation is performed with acute cholecystitis (purulent inflammation) or choledocholithiasis (presence of stones in the bile ducts).

In the asymptomatic form, the operation may not be performed unless polyps are found in the gallbladder, its walls are calcified, or stones exceed 3 cm in diameter.

While preserving the organ, there is a high risk of recurrence - according to some reports, up to 50% of patients experience recurrent stone formation. Therefore, cholecystolithotomy is prescribed only if the removal of the organ is an unjustified risk to the patient's life.

Cholecystolithotomy and cholecystectomy can be performed through an incision or laparoscopically. In the second case, there is no violation of the tightness of the body cavity. All manipulations are carried out through punctures. This technique is used more often than the usual, open one.

Lithotripsy can be indicated for single small stones (up to 2 cm), the stable condition of the patient, the absence of complications in history. In this case, the doctor must ensure the preservation of the functions of the gallbladder, its contractility, the patency of the outflow tract of liquid secretion.

Contact litholysis is used as an alternative method when other methods are ineffective or impossible. It is developed and used mainly in the West, in Russia you can find only a few reports of a successful operation. It allows you to dissolve only stones of a cholecysteric nature. A big plus is that it can be used for any size, quantity and location.

Preparing for the operation

If the patient's condition allows, it is better to extend the time before surgery to 1 - 1.5 months. During this period, the patient is prescribed:

special diet.
Reception of funds with antisecretory activity and antispasmodics.
A course of polyenzymatic preparations.

Before the operation, the patient must pass general blood tests, urine tests, EEG, fluorography, and undergo a study for the presence of a number of infections. Mandatory is the conclusion of medical specialists who are registered with the patient.

Cavity (open) cholecystectomy

The operation is performed under general anesthesia. Its duration is 1-2 hours. A contrast agent is injected into the bile duct for better visualization. It is necessary to control the absence of stones in it. The incision is made either under the ribs or along the midline near the navel. First, the surgeon clamps with metal clips or sews up all the vessels and ducts that are connected with the gallbladder with self-absorbable threads.

The organ itself in a blunt way (to avoid cuts) is separated from the liver, adipose and connective tissue. All ligated ducts and vessels are excised, and the gallbladder is removed from the body. A drainage tube is placed in the wound to drain blood and other body fluids. This is necessary so that the doctor can monitor whether a purulent process has developed in the body cavity. With a favorable outcome, it is removed in a day.

All fabrics are sutured in layers. The patient is transferred to the intensive care unit. Until the action of anesthesia is over, you need strict control over his pulse and pressure. When he wakes up, he will have a tube in his stomach and a drip in his vein. Important! It is necessary to relax, not to try to move, to get up.

Laparoscopy

The cholecystectomy operation is also performed under general anesthesia, its duration is somewhat less than with open surgery - 30-90 minutes. The patient is placed on his back. After the onset of anesthesia, the surgeon makes several punctures in the wall of the abdominal cavity and introduces trocars there. Holes are created in different sizes. The largest one is used for visualization with a camera attached to the laparoscope and organ extraction.

Note. A trocar is a tool that can be used to gain access to the body cavity and maintain the tightness of its walls. It is a tube (tube) with a stylet (pointed rod) inserted into it.

The patient is injected with carbon dioxide into the body cavity with a needle. This is necessary to create sufficient space for surgical procedures. At least twice during the operation, the doctor will tilt the table with the patient - first, to move the organs in order to reduce the risk of damage, and then to move the intestines down.

The bubble is clamped by an automatic clamp. The duct and the organ itself are isolated using instruments inserted into one of the punctures. A catheter is inserted into the duct to prevent its compression or ejection of its contents into the abdominal cavity.

Explore the functions of the sphincter. Examine the duct to make sure that there are no stones in it. Make an incision with microscissors. The same goes for blood vessels. The bubble is carefully removed from its bed, while monitoring for damage. All of them are sealed with an electrocautery (an instrument with an electrically heated loop or tip).

After complete removal of the gallbladder, aspiration is performed. All fluids accumulated there are sucked out of the cavity - secrets of the glands, blood, etc.

With cholecystolithotomy, the organ itself is opened and stones are removed. The walls are sutured, and the damaged vessels are coagulated. Accordingly, the transection of the ducts is not carried out. Operative removal of stones without removal of the gallbladder is practiced quite rarely.

Lithotripsy

The full name of the procedure is extracorporeal shock wave lithotripsy (ESWL). It says that the operation is carried out externally, outside the body, and also that a certain type of wave is used, which destroys the stone. This is due to the fact that ultrasound has a different travel speed in different media. In soft tissues, it spreads quickly without causing any damage, and when it passes into a solid formation (stone), deformations occur that lead to cracks and destruction of the calculus.

This operation can be indicated in approximately 20% of cases with cholelithiasis. Important! It is not carried out if the patient has any other formations in the direction of the shock wave or if he must constantly take anticoagulants. They inhibit the formation of blood clots, which can complicate the healing of possible injuries, recovery after surgery.

The operation is performed under epidural anesthesia (injection of an anesthetic into the spine) or intravenous. Before the ultrasound, the doctor selects the optimal position of the patient during the ultrasound and brings the device-emitter to the selected place. The patient may feel slight jolts or even pain. It is important to remain calm and not move. Often, several approaches or sessions of lithotripsy may be needed.

The operation is considered successful if there are no stones and their parts larger than 5 mm. This happens in 90-95% of cases. After lithotripsy, the patient is prescribed a course of bile acids, which help dissolve the remaining fragments. This procedure is called oral litholysis (from the word per os - through the mouth). Its duration can be up to 12-18 months. Removal of sand and small stones from the gallbladder is carried out through the ducts.

The option of dissolving stones with a laser is possible. However, this new technique is still under development and there is little information about its implications and effectiveness. The laser as a shock wave is conducted to the stone through the puncture and is focused directly on it. Evacuation of sand occurs in a natural way.

Contact litholysis

This is an operation to remove stones with the complete safety of the organ. With the cure of the underlying disease, she has a very good prognosis. In Russia, the technique is under development, most of the operations are carried out abroad.

It includes several stages:

Imposition of a microcholecystotomy. This is a drainage tube through which the contents of the gallbladder are removed.
Assessment by injection of a contrast agent of the number and size of stones, which allows you to calculate the exact amount of litholytic (solvent) and avoid it from entering the intestines.
The introduction of methyl tert-butyl ether into the cavity of the gallbladder. This substance effectively dissolves all deposits, but can be dangerous for the mucous membranes of neighboring organs.
Evacuation through the drainage tube of bile with litholytic.
The introduction of anti-inflammatory drugs into the cavity of the gallbladder to restore the mucous membrane of its walls.

Complications

Many surgeons believe that cholecystectomy eliminates not only the consequences of the disease, but also its cause. The doctor Karl Langenbuch, who performed this operation for the first time in the 19th century, said: “It is necessary [to remove the gallbladder] not because it contains stones, but because it forms them.” However, some modern experts are sure that with an unexplained etiology, surgical intervention will not solve the problem, and the consequences of the disease will bother patients for many years.

Statistics confirm this in many respects:

The following factors increase the risk of complications:

Excess weight of the patient, his refusal to comply with the doctor's prescriptions, diet.
Errors during the operation, damage to neighboring organs.
The elderly age of the patient, the presence of a history of other diseases of the gastrointestinal tract.

The main danger of operations that do not involve the removal of the gallbladder is the recurrence of the disease, and, accordingly, all its unpleasant symptoms.

Recovery period after surgery

For several months, patients will have to follow certain recommendations, and the doctor's instructions regarding nutrition will have to be followed for life:

In the first months after surgery (even minimally invasive), physical activity should be limited. Exercises such as “bicycle”, swinging arms from a prone position are useful. Exact gymnastics can be recommended by the attending physician.
The first weeks you need to wash only in the shower, preventing the wound from getting wet. After hygiene procedures, it must be treated with an antiseptic - iodine or a weak solution of potassium permanganate.
Within 2-3 weeks, the patient must adhere to diet No. 5 (excluding fried, salty, fatty, sweet, spicy), take choleretic drugs. After the expiration of this period, it is allowed to take such products only in very limited quantities.
It is advisable to get used to eating fractionally, 5-6 times a day with breaks in the first month after the operation at 1.5-2 hours, later - 3-3.5 hours.
An annual visit to sanatoriums is recommended, especially preferably 6-7 months after the operation.

The cost of surgical intervention, the operation under the compulsory medical insurance policy

The most frequent operations described are open and laparoscopic cholecystectomy. Their price when contacting a private clinic will be approximately the same - 25,000 - 30,000 rubles in medical institutions in Moscow. Both of these varieties are included in the basic insurance program and can be carried out free of charge. The choice in favor of a public or private company lies entirely with the patient.

Lithotripsy of the gallbladder is not carried out in every medical center and only for money. The average cost is 13,000 rubles per session. Contact litholysis is not yet carried out in large quantities in Russia. Cholecystolithotomy can cost from 10,000 to 30,000 rubles. However, not all medical institutions provide such services.

Laparoscopic gallbladder removal surgery is well tolerated by patients. A minimum of complications and a short rehabilitation period are its main advantages.

Gallbladder disease is far from always amenable to conservative treatment, therefore, to alleviate the patient's condition, doctors offer surgery. Today, laparoscopy of the gallbladder is among the most commonly used methods of minimally invasive surgical treatment and examination. The operation is performed with minimal damage to the abdominal wall, but allows you to completely remove the diseased organ and stones accumulated in it.

Laparoscopic cholecystectomy is a gentle surgical intervention that is performed through miniature incisions on the right side of the abdominal cavity.

The absence of a large wound surface area allows patients to be discharged from the hospital after 2-3 days. The recovery period lasts less than during the operation with a full opening of the abdominal wall - laparotomy.

There are 2 types of laparoscopic interventions for cholelithiasis. In the first case, a complete removal of the organ and neoplasms inside it is performed. In the second, with the help of a special tool, only stones are removed from the gallbladder, but the organ itself remains. This type of operation is considered ineffective today and is used much less frequently than removal of the gallbladder, since the risk of re-stone formation is high.

Comparing the approach of laparoscopic removal of the gallbladder with cholecystectomy, there are clear advantages to the newer surgical technique. Laparoscopic cholecystectomy is not accompanied by serious damage to the integrity of tissues in the abdominal cavity - all manipulations are performed by the surgeon through several small punctures. In addition, the physical condition of the patient after removal of the gallbladder is much better. Insignificant pain disappears within a day and a half, and already 3-4 hours after the operation you can walk.

When stones were removed from the gallbladder or the entire organ was removed laparoscopically, the following is noted:

there is no need for a long stay in the hospital;
the body recovers quickly, and a person can return to the usual mode;
occurs much less frequently;
scars at the puncture sites are almost invisible.

Contraindications and indications for laparoscopic cholecystectomy

calculous cholecystitis (in chronic form);
sticking of cholesterol deposits on the walls of the organ;
an attack of acute cholecystitis;
asymptomatic calculus in the gallbladder.

From the gallbladder and the bladder itself is not carried out if the found gallstone fragment is very large. In such cases, the recommendation of surgeons is to remove the organ through the opening of the abdominal wall.

Laparoscopic removal of the gallbladder has a list of contraindications to surgery. It cannot be performed for all pathologies associated with a high degree of risk that a serious postoperative complication will occur. These states include the following:

severe disease of the respiratory and cardiovascular systems;
problems with blood clotting that cannot be corrected;
inflammation of the peritoneum (peritonitis);
obesity (2 and 3 degrees);
the presence of a pacemaker.

In addition to the above, there are contraindications to laparoscopy for local cholelithiasis, which are detected both in the process of preparing for the operation and after it has begun:

atypical location of the gallbladder (in the liver);
a significant change in the structure of the tissues of the ducts and adjacent organs;
acute pancreatitis;
obstructive jaundice as a result of blockage of the bile ducts;
malignant neoplasm in the gallbladder;
laparoscopic operations in the upper segment of the abdominal cavity, transferred earlier.

Preparing for the operation

Laparoscopic cholecystectomy is a procedure that requires high skill from the surgeon. For it to go well, the patient must prepare in advance for a planned operation. In chronic diseases, it is necessary to visit specialists and undergo a course of treatment.

Preoperative examination should also begin in advance. You will need ultrasound diagnostics of the abdominal organs. Sometimes specialists prescribe an x-ray of the gallbladder and ducts (retrograde cholangiography), in which a contrast agent is injected into the patient through a probe.

Be sure to do tests:

biochemical - liver tests (alkaline phosphatase, AST, ALT);
total blood and urine;
RW (analysis for syphilis);
HIV test;
hepatitis virus test (B and C).

If the patient's medical documents do not contain a mark on the blood type and the presence of the Rh factor, then this study will also have to be done before the operation.

On the day before the operation to remove gallstones, you can not eat, later than 18 hours. Drinking is allowed only until 10 pm. This recommendation is not accidental - the body must have time to digest what is eaten and cleanse itself. To help him in this, enemas are given to the patient in the evening and in the morning of the operation day. Proper preparation for laparoscopy of the gallbladder contributes to the fastest possible recovery.

Procedure for laparoscopic gallbladder removal

During the operation, the patient lies on his back. The surgeon is between his spread legs (if the French technique is used) or to the left of the operated person (when the doctor adheres to the American technique of manipulation). The most convenient method is determined by the doctor himself.

Laparoscopic cholecystectomy is performed in several stages.

Nitrous oxide or carbon dioxide is pumped into the patient's abdominal cavity.
Through a puncture (make from 3 to 5 holes), a trocar and special instruments are inserted.
An examination of the gallbladder and adjacent organs is carried out using an inserted video camera that transmits an image to the monitor.
By coagulation, the gallbladder is cut off from anatomical adhesions, the cystic artery and duct are separated, and a clip is applied to them.
Separate the gallbladder from the liver bed.
Remove the bubble from the abdominal cavity.
After removal of the gallbladder, the organs in the abdominal cavity are examined.

Laparoscopy of the gallbladder is performed with 4 punctures, which are done in a certain sequence.

Slightly above (below) the navel.
In the midline under the sternum.
On the right side, 4-5 cm below the ribs, vertically drawn from the middle of the clavicle.
At the height of the navel along the line corresponding to the anterior edge of the armpit.

With a significant increase in the liver, another puncture is made. After the operation, the doctor sews up the holes. After overgrowing, they look like barely noticeable scars.

Usually, general anesthesia is performed during laparoscopy of the gallbladder, but local anesthesia may be used. The operation to remove gallstones requires mandatory tracheal intubation. A tube inserted into the airways allows air to flow freely and prevents stomach contents from entering the lungs.

Laparoscopic cholecystectomy can last from half an hour if the procedure is carried out for the purpose of diagnosis, and up to 3 hours when it is necessary to remove the bladder with stones.

Postoperative period

After the operation, the anesthesiologist wakes the patient up and checks his reactions. The first 4-6 hours you need to observe bed rest. When this time passes, it is allowed to roll over on one side, sit on the bed. After another hour, you can walk a little. Then the doctors give the go-ahead for the patient to drink some water without gas. While a person is in the hospital, he is recommended to perform breathing exercises so that there is no unpleasant consequence of artificial lung ventilation - pneumonia.

The day after laparoscopic cholecystectomy, you need to drink a lot and start eating food that will not irritate the stomach and intestines:

light broth;
fermented milk products (yogurt, low-fat cottage cheese);
mashed boiled lean meat;
fruits that do not cause gas formation.

After 3-4 days, dietary table No. 5 is shown. The main recommendation of doctors regarding nutrition: you need to eat often and little by little.

Do not worry if in the first days after laparoscopy of the gallbladder there is pain in the puncture area. Unpleasant sensations are a consequence of damage to the integrity of tissues, but they will disappear by the 4th day. Then the patient is discharged home.

If the pain gets worse instead of getting better, you should immediately contact your doctor. Perhaps, a complication associated with the presence of gas residues in the abdominal cavity or irritation of the membrane lining its inner wall - the peritoneum, makes itself felt. Other possible complications of laparoscopic cholecystectomy:

internal bleeding;
damage to the integrity of nearby organs;
prolapse of a stone in the abdominal cavity;
leakage of bile from the gallbladder and poorly applied internal sutures;
inflammatory processes (omphalitis, peritonitis).

For 10 days after the operation, it is forbidden to lift heavy things, as well as to perform any work that involves physical activity. In order not to irritate the puncture sites, doctors advise wearing soft underwear.

To remove postoperative sutures, you must contact the clinic at the place of residence. This should be done 7-10 days after the operation.

Recovery

It is much easier and faster than in cases where a laparotomy is performed. Within six months, the body will be strong enough to function normally even at high loads without the threat that a complication will arise. And to engage in the usual work, which does not require significant physical effort, is allowed already 2 weeks after the removal of the gallbladder.

refrain from having sex for 2-4 weeks;
eat foods that prevent;
stick to diet number 5;
don't lift heavy things.

Athletes who have had a laparoscopic procedure are advised by most physicians to return to training a month after the operation. During the first classes, the load should be minimal.

Postoperative rehabilitation involves monitoring the patient's health. To do this, you need to do an ultrasound of the abdominal cavity one month and one year after the intervention. At the same time, take a biochemical blood test and consult a gastroenterologist.

1-2 times a year it is necessary to undergo a course of sanatorium treatment:

intake of mineral water prescribed by the doctor;
therapeutic baths (with radon, coniferous extract, as well as carbonic and mineral);
electrophoresis with succinic acid;
physiotherapy.

Preparatory measures for the procedure for the removal of gallbladder

Laparoscopy is one of the types of modern technology in surgery, in which the operation is performed by a puncture (through small incisions). It is used as an operative method for examining the abdominal organs. The method has become widespread due to the minimal consequences after the procedure.

Before the operation, it is necessary to undergo a complete medical examination. The patient is sent for laboratory tests:

Urine (general and biochemical tests);
Analysis for hepatitis;
Blood test for HIV;
General blood analysis;
Determination of the blood group;
Rh factor;
Magnetic resonance imaging (MRI);
Fluorography;
Ultrasound examination of the abdomen (ultrasound).

As far as the results of the analyzes are within the normal range, the outcome of the procedure will be so much more favorable.

It is important to consult with your doctor first. Be sure to report if there is an allergy to medications, individual intolerance to the components. The doctor should explain to the patient how the procedure for removing the organ will take place, how long it will take, explain where the bile enters and goes after the removal of the bladder, familiarizes with the possible consequences, what complications there are.

Before laparoscopy, the attending physician prescribes a special diet to cleanse the body. This helps relieve stress on the digestive system. For 2-3 weeks, exclude: fried, fatty, smoked, spicy foods, carbonated drinks, legumes, dairy products, bread. Alcohol in any form is prohibited. Light vegetable soups, cereals are allowed. Proper nutrition reduces stress on the stomach.

Serious preparation for the operation is important for the success of laparoscopy. The patient may be prescribed laxatives. On the day of the procedure, you can not drink liquids and eat. The patient is given an enema before the organ is removed. In the operating room, you must remove all items from yourself: earrings, rings, watches, glasses, contact lenses, etc.

Description of laparoscopy of the gallbladder

Planned is not difficult, low-traumatic. With normal health and the state of health of the patient, the procedure is quick and easy. Features of the procedure when removing an organ:

The patient is placed on the operating table on his back.
Apply general anesthesia.
Process the area where the puncture will be carried out.
The procedure is performed with sterile medical devices and equipment (endoscopic instruments, aspirator, laparoscope, trocar, insufflator).
During laparoscopy to remove the gallbladder, 4 incisions (punctures) are made on the abdomen. If the surgical method of laparoscopy fails, then a decision is made on emergency abdominal surgery. An incision is made on the right side of the abdomen.
With the help of devices, the duct of the organ is blocked.
Then there is a laparoscopic removal of the gallbladder (the best option is through the navel), the remaining bile is removed.
Drainage is put in place of the organ. It will produce an outflow of fluid from the site of removal of the organ.
laparoscopy through a puncture.
After the removal of the organ, a suture is applied to each puncture, after healing, the scar almost does not remain (healed incisions are not noticeable).

Open surgery (laparotomy)

It is carried out under the influence of anesthesia. The patient is made an incision with a scalpel (about 15 cm) and the gallbladder is removed. Then a control examination is carried out, stitches are applied to the incision. The operation takes an average of 4 hours.

Laparoscopy can be done in Evpatoria.

Operation time

The first step is the preparation phase. The results of analyzes and the state of the gallbladder for the operation are evaluated. Based on the severity of the disease and the anatomical features of the organ, the time of the operation is planned.

It will be better for a person if the operation takes place quickly, so the effect of anesthesia on the body will take less time. The removal procedure takes approximately 1 hour. The surgeon cannot say exactly how many hours the operation will take. Sometimes the operation lasts up to 6 hours.

Reasons affecting the duration and course of the surgical process:

The presence of concomitant inflammatory processes of the abdominal organs.
Human composition.

The rehabilitation period depends on the quality of the operation.

Postoperative period

In the course of a successful operation, the person is transferred to the intensive care unit. The patient comes out of anesthesia. The first hours the patient should lie down and be under medical supervision. It is forbidden to get out of bed on your own and walk, eat, drink. The patient is taking painkillers. If there is pain in the abdomen and does not go away, but becomes sharper, the seam bleeds, the wound is pouting, you should immediately inform the doctor.

Possible complications after laparoscopic cholecystectomy

The operation does not pose serious consequences for the body and human life, as it is performed laparoscopically and is less traumatic. But the following postoperative consequences may occur:

Progression of chronic diseases;
Dangerous formation of intra-abdominal hematoma;
Peritonitis;
There were blood clots in the feces;
The development of a cyst in the bed of the gallbladder;
Can burn in the abdomen;
A bump or seal appears at the site of the seam;
Problems with the intestines (violation of the stool, flatulence);
Sore throat, cough;
Relapses of hepatic colic;
Formation of stones in the bile ducts.

To avoid negative consequences, it is necessary to follow the prescribed recommendations of the doctor, adhere to the diet. If you notice any warning signs, contact your doctor immediately.

Contraindications for laparoscopic cholecystectomy

There are no absolute contraindications to the procedure. Removing the gallbladder helps a person get rid of the unpleasant symptoms and subsequent complications of the disease. But there are cases in which the operation should be postponed:

Pregnancy. First and last trimester.
Attacks of acute cholecystitis.
Poor results of blood tests, urine. In this situation, drug therapy is first carried out, after improvement, they proceed to laparoscopy.
Large hernias.
Poor blood clotting.
Severe condition of the patient. Having a cholecystectomy can aggravate your health.
Recent abdominal surgery.
Mirizzi syndrome.
Infectious diseases at the time of the procedure.

The operation to remove a non-functioning gallbladder is safe for a person, provided that the laparoscopy is competently prepared and performed by a highly qualified surgeon.

After laparoscopy, the patient must always follow a diet. The amount of allowed food is gradually added to the diet. It is advisable to limit physical activity on the body for six months.