How is gall removal surgery performed? Dietary nutrition during the postoperative period. Indications for laparoscopy of the gallbladder

Cholelithiasis is a fairly common pathology associated with impaired cholesterol or bilirubin metabolism and the formation of stones in the gall bladder. The disease is widespread in industrialized countries, where people pay little attention to their diet, preferring fried, fatty and spicy foods.

This disease is difficult to treat conservatively, therefore, in the presence of stones, many experts recommend surgical intervention, the “gold” standard of which is laparoscopy of gallstones and cholecystectomy. However, before moving on to therapeutic tactics, it is necessary to study the mechanism of stone formation.

Where do gallstones come from?

Liver bile is a special liquid that resembles plasma in its composition. It has such important components as water, cholesterol, bilirubin and bile acids. While these components are in balance with each other, this liquid promotes the binding of fats with water and their breakdown, the absorption of fatty acids and cholesterol in the intestines, prevents the development of putrefactive processes in the final sections of the digestive tract, stimulates its peristalsis (unidirectional contractions in order to promote the food bolus) .

If the secretion of cholesterol into bile increases or the concentration of bile acids decreases, as well as the contractility of the gallbladder (GB), stagnation and crystallization of its contents occur with the formation of large and small stones.

Predisposing factors to stone formation and the development of cholecystitis are:

• High body mass index.
• Insufficient physical activity.
• Eating foods rich in cholesterol and low in fiber.
• Anomalies in the development of the gallbladder, for example, congenital bending of its neck.
• Elderly age.
• Female.
• Pregnancy.
• Endocrine disorders.
• Chronic infectious diseases of the biliary tract.
• Alcohol abuse.
• History of surgical interventions on the stomach and intestines.

Proper nutrition and an active lifestyle are excellent prevention of stone formation

Surgical method for removing stones

There are several types of surgical interventions used for gallstone disease:

• Laparoscopic removal of stones from the gallbladder.
• Endoscopic cholecystectomy.
• Open abdominal surgery.

Currently, the laparoscopic method of removing stones from the gallbladder is gaining increasing popularity. Thanks to the latest technologies, it has become possible to minimize damage to the human body during surgery and reduce its duration.

Surgeons and patients themselves prefer laparoscopic gallbladder removal due to the following advantages:

• Low risk of complications.
• Short rehabilitation period.
• High cosmetic effect (scars after surgery are almost invisible).
• Low morbidity.
• Pain after surgery is minimized.
• The ability to walk and care for yourself on the first day after surgery.

Preparing for surgery

Before any surgical intervention, it is necessary to undergo a series of examinations that will help assess the patient’s body’s readiness for the procedure, as well as identify other chronic diseases and prevent the occurrence of complications associated with them. These include a general blood and urine test, biochemistry, blood glucose, Wasserman reaction, hepatitis test, coagulogram, blood group and Rh factor, ultrasound of the abdominal organs, ECG, chest x-ray. Consultation with a therapist and anesthesiologist is also necessary.

Ultrasound diagnostics is an important part of preoperative preparation

If the operation is permitted, the next stage of preparation is to refrain from eating 10–12 hours before the procedure and administer a cleansing enema on the eve of the intervention. The nurse also uses a razor to remove hair in the area of ​​the surgical field. The anesthesiologist conducts premedication - preliminary drug preparation of the patient for anesthesia.

How is surgery performed?

Laparoscopic surgery is performed under general anesthesia. First, carbon dioxide is injected into the abdominal cavity through a special needle, which raises the anterior abdominal wall and creates space for surgeons to work. Then, trocars, which are hollow tubes with valves, are inserted through small incisions.

Through them, various surgical instruments can be inserted and removed into the abdomen, an important part of which is the laparoscope (optical system). Next, the gallbladder is directly separated from other anatomical structures and removed through a small incision at the xiphoid process or near the navel.

The laparoscope allows you to display the image on the screen, as well as enlarge and reduce the image for the convenience of surgeons.

After removing the gallbladder, surgeons suture the surgical openings made and remove a special drainage to remove liquid contents from the abdominal cavity that may accumulate there as a result of inevitable injury to soft tissues during the intervention. The length of the operation is, on average, 45 minutes, but its duration can vary within certain limits depending on the extent of the pathological process and the anatomical characteristics of a particular person.

Period after surgery

Patients receive further treatment after cholecystectomy in the surgical department. After recovering from anesthesia, the patient is prohibited from getting out of bed and drinking water for the first 5–6 hours. After this time, you can consume liquid in small portions and try to get up. The first time it is better to do this under the supervision of medical personnel, so as not to lose consciousness or fall due to a sharp short-term decrease in pressure when changing body position.

Over the next 24 hours, patients are allowed to move independently around the department and drink water in normal quantities.

Dietary recommendations in the postoperative period include avoiding coffee, strong tea, alcoholic beverages, sweet foods, fatty and fried foods. Diet foods, dairy products, bananas, baked apples, etc. are allowed. If the operation was completed without complications, patients are discharged from the hospital on the 3rd day.

Organ-preserving operations

The gallbladder is an organ of our body like all the others, so its removal entails certain inconveniences and limitations. Let's consider the chain of biochemical changes caused by disruption of bile flow:

• More liquid consistency of bile.
• Violation of the protection of the duodenum from pathogenic microorganisms.
• Active proliferation of harmful bacteria.
• Gradual inhibition of the growth of “beneficial” microflora.
• Development of inflammatory processes in various parts of the gastrointestinal tract.
• Violation of food movement and absorption.

Today, there is an alternative to traditional cholecystectomy – laparoscopic cholecystolithotomy. As a result of surgery, the stone is removed from the gallbladder, while the organ itself is preserved. The list of indications for such an operation is quite narrow and includes a number of mandatory conditions:

• Absence of any symptoms when carrying stones.
• Single stones up to 3 centimeters in size, in a free state.
• Preserved contractility of the organ.
• No signs of inflammation of the gallbladder and duodenum.
• Absence of congenital anomalies in the structure of the gallbladder.
• No history of adhesive disease.

Cholecystolithotomy is allowed only in the presence of small stones

How is surgery and the postoperative period performed?

The beginning of the operation coincides with classic laparoscopic cholecystectomy. After inserting the instruments, an incision is made into the gallbladder and the stone is removed with a special clamp. Next, the incision is sutured with absorbable thread, the instruments are removed, and the surgical wounds are sutured with a cosmetic suture.

After surgery, patients are advised to eat small meals 4 or more times a day to restore normal bile secretion. Such patients are also prescribed litholytic drugs to prevent recurrent bile formation. Procedures are carried out to restore the contractility of the gallbladder. Monitoring the condition of the organ using ultrasound diagnostics at least 2 times a year.

Gallstone disease has become one of the most common phenomena among abdominal pathologies today, and surgery to remove gallstones is one of the methods to radically solve the problem.

Gallstone disease - what is it?

This is a disease associated with the formation of stones (calculi) in the bile ducts and gallbladder. It develops for the following reasons:

• stagnation or change in the composition of bile;
• inflammatory processes;
• violation of biliary excretion (dyskinesia).

There are three types of stones based on their composition. The most common (in 80-90% of cases) are cholesterol stones. Their formation is promoted by excess cholesterol content in bile. In this case, crystals form due to the precipitation of excess cholesterol. If the motility of the gallbladder is impaired, then these formations are not removed into the intestinal space, but remain inside it and begin to increase.

Pigment stones are formed due to increased breakdown of blood cells - red blood cells. Most often this can be observed with hemolytic anemia. There are also mixed formations. They are a combination of both forms. They contain cholesterol, bilirubin and calcium.

Is surgery necessary?

Anyone who has been diagnosed with gallstones sooner or later faces the question of whether surgical intervention is necessary or whether conservative treatment will be sufficient. It is worth mentioning that stones themselves are not a reason to remove the gallbladder. If they do not manifest themselves in any way and do not affect the normal functioning of other organs, then you don’t have to think about surgery. However, if there is pain in the gallbladder, a disturbance in the general condition, or jaundice, then it is necessary to urgently consult a surgeon. After the examination, it is he who will decide whether surgical intervention is necessary and what kind of intervention. But it must be taken into account that cholecystitis of the gallbladder implies an inflammatory process that has already begun. If you delay the decision excessively, then the chances of fully recovering health after surgery are sharply reduced. Even if there was a one-time attack, it is better to remove the gallstones.

Indications for surgery

When deciding whether surgery is necessary, specialists usually take into account the following factors:

• the presence of stones (concretions) of various sizes, occupying more than a third of the volume of the gallbladder;
• if the disease occurs with frequent attacks of pain in the gallbladder (biliary colic), then the operation is performed regardless of the size of the stones;
• if the stones are located both in the gallbladder and in the ducts;
• when the ability of the gallbladder to contract decreases or it completely shuts down;
• with the development of biliary pancreatitis;
• when the integrity of the walls of the gallbladder is violated;
• when the common hepatic duct is blocked.

There are international recommendations for determining the need for surgical intervention for gallstone disease. By summing up the scores assigned to various diagnostic indicators, the doctor determines whether surgery is required, as well as the relative and absolute indications for it.

Types of operations

As a rule, the process of formation of gallstones is a slow process. Of course, if you are unlucky and an ambulance takes you to a surgical hospital with an acute attack, which was diagnosed as cholecystitis of the gallbladder, then you have little choice. But in most cases, people who know about their problem discuss all the details in advance with the attending physician and determine the date of the planned surgical intervention.

In modern medicine, there are two methods for removing the gallbladder (cholecystectomy):

• open cholecystectomy is a traditional method that involves opening the abdominal cavity;
• Laparoscopic cholecystectomy is a more modern technique that is preferred today.

Open cholecystectomy

This operation to remove gallstones is a classic surgical procedure. Through a wide incision along the midline of the abdomen, the abdominal cavity is examined, the gallbladder is removed and, if necessary, drainage is performed (tubes are installed to ensure the outflow of the resulting exudate and other biological fluids).

Despite the emergence of more modern and high-tech methods, open cholecystectomy continues to remain relevant. This can be explained by the fact that some clinics do not have the equipment or specialists with the necessary qualifications to perform laparoscopic operations. In addition, there are certain contraindications for them.

Laparoscopy of the gallbladder

This is another type of surgery for gallstone disease. Today, this method is becoming more and more widespread due to its effectiveness, low trauma, and reduced recovery time. The operation is performed using a laparoscope - a special device that allows access to the damaged organ through several punctures in the abdominal wall, through which manipulators and, in fact, the laparoscope are inserted. This method allows not only to remove the gallbladder without leaving postoperative scars, but in some cases to remove only the stones, leaving the organ in place. A similar method is used not only for the treatment of cholelithiasis, but also for the removal of appendicitis, the treatment of inguinal hernias, some gynecological diseases, as well as diagnostic operations. Despite the obvious advantages of laparoscopic cholecystectomy, this method has its contraindications. These include:

• an abscess located in the surgical area;
• last three months of pregnancy;
• severe cardiopulmonary pathologies.

In addition, it must be taken into account that when performing a laparoscopic operation, in case of the slightest difficulty in its course, surgeons proceed to open cholecystectomy. Approximately 5% of laparoscopic operations end this way.

Preparing for surgery

Like any surgical procedure, surgery to remove gallstones requires certain preparation. In addition to the standard examination, which includes tests (general blood count and urine test, blood biochemistry, coagulogram - blood clotting test, liver tests), it is necessary to do an ultrasound of the abdominal cavity, ECG, chest X-ray, according to FGS indications and colonoscopy, as well as get a therapist's opinion. In addition, preparation for a planned operation includes the abolition of drugs that affect blood clotting. These include various anticoagulants, vitamin E, and nonsteroidal anti-inflammatory drugs. A few days before surgery, the diet for gallstone disease requires special attention. The menu should not contain heavy dishes, and starting from midnight on the day of the operation, food and drink should be completely excluded. The day before, in the morning and evening, cleansing enemas are done or special medications are taken. In the morning, take a shower using antibacterial soap.

Postoperative period

Today it is difficult to surprise anyone with cholecystectomy. This operation to remove gallstones has long been routine, and is done about as often as an appendectomy. The patient is allowed to turn in bed four hours after completion of the operation, during which he must not drink or make sudden movements. Then you can start drinking still water in small portions (1-2 sips, but not more than 500 ml). Six hours after laparoscopic surgery, the patient can get up. It is better to do this if one of the medical personnel or relatives is nearby, since after the body has been in a horizontal position for a long time and in a state of anesthesia, dizziness and fainting may occur when trying to get up. Already on the next day after the operation, the patient can move freely around the hospital.

After surgery, diet for gallstone disease is of great importance. The menu for the next day may include liquid food - oatmeal with water, dietary soups, fermented milk products. In the future, you can include boiled beef, chicken breast, baked apples or bananas in your diet. It must be remembered that in the first week after the operation, alcohol, coffee, sugar, fried and fatty foods are prohibited.

Litholytic therapy

If surgical intervention is impossible due to severe somatic diseases or bleeding disorders, as well as if the patient refuses surgery, litholytic therapy is performed. This is a method that uses drugs containing substances designed to dissolve formed stones. When starting it, you need to take into account that the duration of treatment can be from one to two years, and even if it is possible to completely dissolve the stones in the gall bladder, this does not guarantee that they will not appear again. In addition, during the treatment process, various complications of cholelithiasis may arise, including those that require surgical intervention.

Criteria for litholytic therapy

Another limitation of litholytic therapy is certain requirements for the criteria of the disease:

1. Gallstones must be cholesterol and not exceed 20 mm in size.
2. preserved, and the stones do not occupy more than half of its volume.
3. The cystic and common bile ducts must maintain their patency.
4. Less than two years have passed since the stones formed.
5. The history should include an uncomplicated course of the disease - moderate pain, rare attacks of hepatic colic.

Treatment is carried out under ultrasound control once every 3-6 months. If after six months there is no improvement, then it is considered ineffective, and the question of surgical intervention is raised again. If litholytic therapy was successful, then in order to timely detect newly formed stones in the gall bladder, ultrasound is performed at least once every three months.

- fairly common surgical intervention. It is prescribed when the patient can no longer be helped by compensatory therapy. The most common causes of this are chronic or acute calculous cholecystitis, painful biliary colic, cholelithiasis with inflammation of the ducts (cholangitis) or a large number of large stones, polyps, cholesterosis.

What types of interventions does modern surgery offer?

The classic method of removing the gallbladder is abdominal surgery, when the organ is removed through a large incision on the anterior abdominal wall, simultaneously cutting out the ducts and vessels.

To avoid the accumulation of fluids and the inflammatory process, a drain is placed and the incision is sutured. This operation is called laparotomy. Why is this technique still used? It helps in cases of large stones or extensive inflammation where there is a possibility of infection spreading.

With such an intervention, the patient requires long-term observation in a hospital setting, and a scar remains at the incision site.

A more gentle method of removing the gallbladder is laparoscopy. In this case, the diseased organ is removed through small punctures in the peritoneum using a special device - a laparoscope. This is a thin tube with a video camera. Only the apparatus and instruments come into contact with the patient’s tissues, as a result of which the possibility of infection is virtually eliminated.

Stages of laparoscopy:

1. General anesthesia with pulmonary intubation is used.
2. After thorough treatment with an antiseptic, the abdominal wall is punctured to insert instruments.
3. Special tubes called trocars are inserted into the punctures, and carbon dioxide is pumped into the abdomen to create an operating space.
4. The moment comes for removing the diseased organ, previously cut off from surrounding tissues and vessels, through one of the incisions. Vessels and ducts are clamped with special clips.
5. The doctor performs cholangiography (to rule out inflammation and other pathologies in the bile ducts). If cholangitis and other dangerous changes are detected, the ducts are removed.
6. After removing the instruments and pumping out the gas, the punctures are stitched up. Scars after healing are almost invisible.

The gallbladder removal time is usually 1–2 hours.

There are other reasons why you should choose laparoscopy. Its advantages also include rapid restoration of performance - after twenty days. Another plus: it is easier for patients to decide on such an operation, which reduces the number of advanced cases and the growth of pathologies.

The disadvantages of the laparoscopic method include:

• Exposure to gas introduced into the abdominal cavity causes an increase in pressure in the venous system, as well as on the diaphragm, which can be harmful for problems with the respiratory and cardiovascular systems.
• Limitation of diagnostic capabilities compared to abdominal surgery during intervention.
• This method cannot be used if there is any doubt about the presence of pathologies.

Modern surgery continues to seek opportunities for the most gentle removal of the gallbladder.

One of the actively developing methods is transluminal surgery, in which all actions are performed using natural openings in the human body.

The video camera is inserted through a single puncture near the navel, and the bladder is removed through an incision in the wall of an organ connected to a natural opening, such as the rectum.

If there are contraindications to the above-mentioned interventions, a non-traumatic operation from a mini-access is proposed, that is, an incision of 5–7 cm.

Reasons why cholecystectomy may not be postponed:

• detection of neoplasm;
• heart failure;
• prenatal condition;
• exacerbation of pancreatitis.

In case of peritonitis, laparoscopy is not used; abdominal surgery is needed. This also applies to calcification of the bladder walls. Many people are concerned about the question: is it possible to remove the gallbladder if you have diabetes? Doctors believe that it is possible with a compensated form of the disease. It is even advisable to carry it out even with asymptomatic stone carriers, because the complications of gallstone disease in diabetes are more pronounced.

It is also recommended to remove the organ if there are stones in the gall bladder, even if there is no pain, for those who live in remote areas or travel a lot. After all, they do not always have the opportunity to undergo emergency surgery.

How to prepare for surgery?

Before the intervention, it is necessary to undergo certain examinations.

These include:

• Ultrasound examination of the abdominal organs. It is necessary as a primary examination, since it has an important drawback - it is difficult to see stones in the final section of the common bile duct, hidden behind the pancreas.
• MRI of the bile ducts and abdominal area will reliably detect stones and other pathologies - scars, adhesions, foci of inflammation.
• Computed tomography will remove doubts about the condition of the tissues around the bladder and the presence of adhesions.
• The condition of the cardiovascular and respiratory systems is checked to avoid negative consequences of the operation (primarily ECG and fluorography).
• Laboratory tests of blood and urine will tell you about the condition of the body as a whole.

If the indicators do not prohibit intervention, doctors prescribe preoperative preparation:

• ten days before the appointed day, stop taking medications that affect blood clotting;
• on the day before the operation, they eat only light lean meals; after twelve at night before the intervention, you cannot eat or drink;
• cleansing enemas are given at night and in the morning;
• in the morning take a warm shower with antibacterial gels.

Usually, after a successful laparoscopic cholecystectomy, you can be discharged home in the coming days. But it is impossible to predict the occurrence of complications. Therefore, you need to prepare for a longer stay in the hospital, take the necessary things with you: clothes, hygiene products, books or a laptop. If you are discharged early, ask someone close to you to spend the first 24 hours with you.

Although the gallbladder is not a vital organ, surgical intervention does not go away without leaving a trace. Biochemical changes begin in the body.

Their main reasons are that bile protects less against infections and becomes liquefied. Its acids, on the contrary, become more aggressive. All this can cause pathologies of the gastrointestinal tract, in particular the duodenum. The most common of them are duodenitis, esophagitis, enteritis, colitis, gastritis. Observation by a gastroenterologist will be necessary.

Aggressive acids can also damage the walls of the stomach and cause inflammation, even cancer. And the bile forms stones again, already in the ducts. To prevent this from happening, you need to regularly conduct biochemical studies of the composition of bile. They will help identify so-called biliary insufficiency, that is, the filling of bile with dangerous components. To identify inflammation in the early stages, it is useful to regularly conduct duodenal examinations of the intestines.

Doctors combine all the negative consequences of the absence of this organ into one group - postcholecystectomy syndrome.

This complex includes pathologies such as:

• stones remaining in the bile ducts;
• narrowing of the duct when infused into the intestine;
• pancreatitis;
• chronic gastritis;
• inflammation of the intestinal organs.

To smooth out the unpleasant consequences, you will need compensatory drug therapy. Your doctor will likely prescribe pharmaceuticals that contain bile components.

These can be Allohol, Liobil, Cholenzym. Or stimulants of bile secretion - Cyclovalon, Osalmid. It will be necessary to prescribe medications that include ursodeoxycholic acid (Ursofalka, Ursosan, Enterosan and Hepatosan). As additional treatment, agents are taken to restore intestinal microflora and enzymes.

What will help you recover quickly?

After surgery is completed, you are prohibited from standing up or even drinking water for six hours. After this time, the patient can drink some water in small sips.

Nutrition in the hospital will be supervised by doctors, but upon returning home you need to control the diet yourself.

You can drink no more than one and a half liters per day. Allowed drinks include mineral water, warm tea, preferably green tea, one percent kefir, fruit and berry compotes, and herbal infusions.

Food you can eat during the week is mashed potatoes and slimy porridge. For dessert - jelly. Then you can add pureed dishes, crackers, puree soups, boiled fish, steamed meatballs. Do not forget that after removal of the gallbladder you will have to follow the diet throughout your life. Meals should be fractional, you should eat in small portions, six times a day. Diet table No. 5 is shown.

People with increased body weight after gallbladder removal should monitor their diet even more carefully. The same applies to those who suffer from constipation. Irregular bowel movements lead to stagnation of bile, which can cause an inflammatory process. Foods rich in fiber - vegetables and fruits - come to the rescue.

The gallbladder is a pear-shaped part of the digestive system that stores bile. It is localized under the liver, with which it is connected by a complex system of bile ducts. In some pathological conditions, the gallbladder can become inflamed and damage neighboring organ structures. If acute cholecystitis is not treated in a timely manner, there is a high probability of developing gallbladder rupture, peritonitis and septic shock. Removal of the gallbladder (cholecystectomy) in this case is the most adequate treatment strategy. Cholecystectomy allows you to prevent many undesirable events that can harm health and even take a person’s life.

General information

Is a gallbladder even necessary? If no pathological processes occur in this organ, then it performs the important function of accumulating and secreting bile. Hepatocytes (liver cells) continuously synthesize bile. This liquid is necessary for the absorption of fats and activation of further digestive processes. If inflammatory processes develop in the wall of the gallbladder, the rheological properties of bile begin to change. This subsequently leads to the formation.

Many patients ask the question: “If the gallbladder is removed, how long do they live?” It must be said that if the patient adheres to all the doctor’s recommendations, follows a diet and does not burden the digestive system, then the quality and duration of life do not suffer at all.

Localization of the gallbladder

Every day the liver produces up to 2000 ml of bile. Bile is excreted during meals. About 40-60 ml is excreted into the lumen of the duodenum, where it is then mixed with food. In diseases of the gallbladder, the outflow of bile is disrupted, which can lead to pain, biliary colic, and disruption of the pancreas.

Cholecystectomy in 90% of cases eliminates symptoms associated with gallbladder pathology. If there is no gallbladder, how to remove bile? The gallbladder performs a storage function and when it is removed, bile is supplied to the duodenum directly from the liver through the bile ducts.

Diseases

Why is the gallbladder removed? There are a number of gallbladder pathologies that require surgical treatment. They have different origins and affect this organ in different ways, however, in all cases the patient’s quality of life decreases and digestion processes are disrupted.

Acute cholecystitis

An unpleasant disease in which the mortality rate can reach 6%. What will be the consequences if removal is not performed for this disease? If treatment is not started on time, there is a high probability of developing necrosis, suppuration, rupture of the bladder and inflammation of the peritoneal layers. In most cases, this is a direct indication for surgery.

Choledocholithiasis

Choledocholithiasis is a pathological process in which a gallstone gets stuck in the lumen of the bile duct, which interferes with the outflow of bile. This condition occurs in almost 15% of people suffering from. Choledocholithiasis can be complicated by obstructive jaundice, cholangitis and pancreatitis. If there is choledocholithiasis with cholelithiasis, then the scope of surgical intervention expands. In such situations, it is necessary to carry out additional sanitization of the bile ducts with the installation and fixation of drainage tubes.

Cholelithiasis

Due to a certain set of circumstances, gallstones may form. There are a number of prerequisites for this process, but the main role is played by inflammation of the bile wall, a diet rich in cholesterol and impaired outflow due to. Stones in the gallbladder do not always lead to the development of obstructive jaundice. For many years, stones can lie quietly at the bottom and not bother anyone, but due to certain circumstances they are able to float up and block the lumen of the biliary tract in various areas. Localization at the exit of the gallbladder is considered prognostically favorable. If a calculus gets stuck in the area of ​​Vater's nipple, then there is a high chance of developing acute pancreatitis, which can be more dangerous than the underlying disease.

Gallbladder filled with stones

Clinically, cholelithiasis can be divided into symptomatic and asymptomatic forms. In the first case, patients complain of regular colicky pain, which is a direct indication for surgery. The majority of the population suffers from an asymptomatic type of gallstone disease. This was discovered relatively recently, thanks to new technologies that make it possible to visualize the presence of stones in the gallbladder. Previously, it was believed that asymptomatic stone carriage could lead to gallbladder cancer. It turned out that the probability is very small and does not justify the risk of surgery. Most people with asymptomatic cholecystitis do not need surgery, but the risk of complications increases every year. At the moment, the main indications for surgical intervention for asymptomatic stone carriers are:

• Gallstones more than 3 cm;
• Hemolytic anemia;
• Combined surgery for obesity.

Polyps

Polyps are peculiar outgrowths formed from the mucous membrane of the gallbladder. These formations can become malignant, that is, degenerate into a malignant tumor. If the polyp reaches a size of less than 1 cm, then it is subject to further observation using an ultrasound examination. Monitoring must be carried out every six months. If the polyp is larger than 1 cm or contains a vascular pedicle, then the probability of malignancy of such a neoplasm is 30%.

Stages of polyp formation

Dyskinesia

The gallbladder has a muscular layer that contracts when necessary and pushes bile through the bile ducts into the duodenum. If the coordination of contraction of the gallbladder and sphincters is disrupted, then disorders called dyskinesia occur. There are two types of this pathology – hypertensive and hypotonic. In the first case, the muscle layer of the gallbladder begins to actively contract, but the sphincters remain closed. In this case, the patient experiences intense colicky pain.

With hypotonic dyskinesia, the opposite happens - the sphincters open, but the muscular wall of the gallbladder does not contract. Clinically, this condition is accompanied by a nagging, dull pain in the right hypochondrium. In foreign countries, there are certain criteria that are an indication for surgery, however, in Russia, surgical treatment of dyskinesia is considered inappropriate.

Surgical techniques

To date, several types of operations to remove the gallbladder have been developed.

Open cholecystectomy

This technique is the oldest, but it is successfully used today. To perform it, it is necessary to make access to the anterior abdominal wall. The Kocher approach allows for a wide surgical field in which it is possible to perform manipulations on the organs of the upper digestive system (gallbladder, duodenum, biliary tract, liver). This operation allows for cholangiography, intraoperative ultrasound, as well as measurement and probing of the bile ducts.

Kocher access

Among the leading disadvantages are:

• Large postoperative wounds that leave a cosmetic defect;
• Long rehabilitation period;
• High probability of various postoperative complications.

If the gallbladder is removed laparotomically, intestinal problems may begin in the postoperative period. At the moment, they try to do open cholecystectomy only in cases of acute cholecystitis, complicated peritonitis, or in difficult situations when revision of organs is required.

Minimally invasive open cholecystectomy

Minimally invasive open cholecystectomy has been successfully used for more than forty years. The procedure was developed to reduce morbidity during cholecystectomy. The mechanism of the operation is to create a small size up to 7 cm long.

Advantages compared to traditional open cholecystectomy:

• Less traumatic;
• Can be prescribed to patients who have previously undergone abdominal surgery;
• High level of control over implementation.

Minimally invasive cholecystectomy is the operation of choice if there are any contraindications to laparoscopy. This procedure is also characterized by a longer postoperative and rehabilitation period.

Laparoscopy

The essence of the surgical technique comes down to the use of a laparoscope - a special device with which you can display an image of the abdominal organs on a monitor. To perform a laparoscopic cholecystectomy, it is necessary to make 3-4 punctures on the abdominal wall and insert a camera and manipulators there that allow certain actions to be performed inside the abdominal cavity. To gain more convenient access to organs, carbon dioxide is injected into the abdominal cavity. Thanks to this, the abdominal wall rises slightly, which eliminates unnecessary trauma and facilitates manipulation of the gallbladder. The laparoscopic camera transmits high quality images to the screen. After the gallbladder is removed from the liver, it is removed through one of the holes. Complications after removal of the gallbladder using the laparoscopic method are minimal compared to other surgical techniques.

Advantages of laparoscopic surgery:

• Minimum level of trauma and pain;
• Short postoperative and rehabilitation period;
• Low risk of postoperative complications;
• Quick return to work capacity.

In 5% of cases, cholecystectomy cannot be performed due to:

• Features of the structure of the biliary tract;
• Severe inflammatory process;
• The presence of connective tissue adhesions.

In such situations, it would be most appropriate to perform an open cholecystectomy.

Comparison of operational approaches

If we make a small summary, we can say that all surgical techniques differ only in the surgical approach. If it gets into the abdominal area, the surgeon’s tactics will not differ depending on the type of operation. In all cases, it is necessary to ligate the cystic duct and artery, and also separate the bladder from the liver. If necessary, drainage is installed in the abdominal cavity.

It is advisable to entrust the choice of surgical technique to a doctor. Only a specialist is able to assess the individual characteristics of the patient and his disease, and then select the appropriate surgical tactics. However, in case of an acute process that threatens the patient’s life, it is advisable to perform an open laparotomy, which will quickly remove the festered gallbladder. If cholecystitis is chronic or polyps grow on its mucosa, then in such situations it is recommended to prescribe laparoscopic removal of the bladder.

Progress of the operation

How is the gallbladder removed? Laparoscopic cholecystectomy is performed under general anesthesia. The duration of the manipulation can be from 40 minutes to 3 hours, it all depends on the individual characteristics and complexity of the case. The first step is to inject carbon dioxide into the abdominal cavity. This point is extremely important, because otherwise it will be difficult to perform manipulations on the organs. A special device called an insufflator is used to inject gas. It provides a constant supply of carbon dioxide, maintaining stable gas pressure in the abdominal cavity. Then punctures are made in the abdominal wall to introduce trocars - devices that provide access for instruments to the abdominal cavity without loss of gas.

A puncture is also made near the navel through which the laparoscope is inserted. This device is an optical tube through which the image is transmitted to the screen. At the same time, everyone present in the operating room can observe the progress of the operation. The laparoscope can provide 40x magnification, which makes visualization of organs even clearer.

It is also necessary to insert an electrical coagulator and clamps holding the gallbladder through the trocars. Using the electrical coagulation method, it is possible to separate the gallbladder from the liver and isolate important anatomical structures (arteries, ducts), which are subsequently clipped. After the surgeon is sure that the clips are applied securely, the clipped arteries and ducts are crossed. To facilitate the removal of a gallbladder filled with stones, the stones are pre-crushed, so they cannot always be seen after cholecystectomy.

If the operation went without complications, then you can do without subsequent drainage of the abdominal cavity, but most surgeons prefer to play it safe. Drainage is represented by a rubber or silicone tube, which is discharged through one of the postoperative openings. Drainage is necessary to remove fluid that may accumulate in the operated area. Laparoscopic removal of the gallbladder is less traumatic and more convenient for the patient, so rehabilitation after cholecystectomy takes much less time.

Postoperative period

The patient's condition after cholecystectomy is characterized by the appearance of general weakness and slight disorientation. After the operation is completed, the patient is placed in the intensive care unit for a couple of hours. This is done in order to carefully examine the patient and monitor how he recovers from anesthesia. If the patient has concomitant severe diseases or if the operation was accompanied by complications, then the length of stay in the intensive care unit increases. After the doctor is convinced that the patient’s life is not in danger, he is transferred to the surgical department for postoperative observation. After surgery, the patient is prohibited from eating or drinking for 6 hours. The patient is allowed to get out of bed after 5 hours. You need to climb slowly and gradually. First, it is better to sit for a while, make sure that there is no dizziness or sharp pain in the abdominal area. It is best to get out of bed in the presence of nurses.

Life without a gallbladder is almost no different from what it was before surgery. After removal of the gallbladder, patients are recommended to adhere to a certain diet for some time, which will reduce the load on the digestive organs and give the body time to adapt. Stool disturbances may occur within 2-4 months. Six months after the operation, bowel function returns to normal, and the patient begins to feel improvement. It must be said that with a long course of cholecystitis, other organs (bile ducts, pancreas) can also be affected. In such situations, removing the gallbladder will not eliminate all symptoms and additional treatment will be required to correct digestion.

The day after removal of the gallbladder, the patient is allowed to move freely around the department, eat liquid food and gradually return to their normal lifestyle. During the week after laparoscopic intervention, any consumption of alcohol, coffee, chocolate, fried, fatty, and smoked foods is completely prohibited. If the operation went without complications, the drainage is usually removed the next day. The drainage removal procedure is painless and does not take much time.

Young patients are allowed to go home the next day after surgery, while older patients should be observed in the hospital for at least 2 days. Upon discharge, the patient is given a certificate of incapacity for work, if necessary, as well as a discharge sheet, which will indicate the diagnosis, treatment recommendations and test results. A certificate of incapacity for work is issued no more than 3 days after discharge. If it needs to be extended, then it is best to contact a surgeon at your place of residence.

Diet

– this is the basis for preventing complications after removal of the gallbladder. For a month, it is advisable for the patient to stop drinking alcohol-containing drinks, simple carbohydrates and “heavy” foods. During the recovery period, it is recommended to follow a split diet - small portions 6-8 times a day. This will reduce the load on the digestive system and allow the body to adapt to new conditions. During the 30 days of the postoperative period, it is best to give preference to fermented milk products (kefir, cottage cheese, fermented baked milk). You need to introduce foods into your diet gradually. After a month, you need to consult with a gastroenterologist about expanding your diet.

Pharmacological treatment

After removal of the gallbladder, the need for pharmacological treatment is minimal. The severity of pain in the postoperative area is insignificant, so painkillers are prescribed according to indications. If a patient experiences a spasm of the muscular apparatus of the biliary tract or other digestive disorders caused by increased tone, then it is necessary to prescribe antispasmodics. Thanks to ursodeoxycholic acid preparations, it is possible to improve rheological properties and prevent the development of microcholelithiasis after removal of the gallbladder.

The information given in the text is not a guide to action. To obtain detailed information about your disease and methods of treatment, you should consult a specialist.

Complications

General recommendations after gallbladder removal include following a diet, limiting exercise, and caring for the surgical wound. By following these recommendations, most complications can be avoided. One of the most common complications that occurs after cholecystectomy is intestinal paresis. In this case, patients complain of heaviness in the abdominal area, bloating and impaired stool passage. What to do if constipation occurs after gallbladder removal? If there are no bowel movements within 3 days after surgery, this may indicate a severe bowel disorder, so you will need to consult a doctor. (votes: 1 , average rating: 5,00 out of 5)

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Removal of the gallbladder is considered one of the most common operations. It indicated for cholelithiasis, acute and chronic cholecystitis, polyps and neoplasms. The operation is performed open access, minimally invasive and laparoscopically.

The gallbladder is an important digestive organ that serves as a reservoir of bile necessary for digesting food. However, it often creates significant problems. The presence of stones and the inflammatory process provoke pain, discomfort in the hypochondrium, and dyspepsia. Often the pain syndrome is so severe that patients are ready to get rid of the bladder once and for all, just so as not to experience any more torment.

In addition to subjective symptoms, damage to this organ can cause serious complications, in particular, peritonitis, cholangitis, biliary colic, jaundice, and then there is no choice - surgery is vital.

Below we will try to figure out when you need to remove your gallbladder, how to prepare for surgery, what types of interventions are possible, and how you should change your life after treatment.

When is surgery needed?

Regardless of the type of planned intervention, be it laparoscopy or abdominal removal of the gallbladder, testimony for surgical treatment are:

• Cholelithiasis.
• Acute and chronic inflammation of the bladder.
• Cholesterosis with impaired bile excretion function.
• Polyposis.
• Some functional disorders.

Cholelithiasis is usually the main reason for most cholecystectomies. This is due to the fact that the presence of stones in the gall bladder often causes attacks of biliary colic, which recurs in more than 70% of patients. In addition, stones contribute to the development of other dangerous complications (perforation, peritonitis).

In some cases, the disease occurs without acute symptoms, but with heaviness in the hypochondrium and dyspeptic disorders. These patients also require surgery, which is performed as planned, and its main purpose is to prevent complications.

Gallstones can also be found in the ducts (choledocholithiasis), which is dangerous due to possible obstructive jaundice, inflammation of the ducts, and pancreatitis. The operation is always complemented by drainage of the ducts.

The asymptomatic course of gallstone disease does not exclude the possibility of surgery, which becomes necessary with the development of hemolytic anemia, when the size of the stones exceeds 2.5-3 cm due to the possibility of bedsores, with a high risk of complications in young patients.

Cholecystitis is an inflammation of the gallbladder wall, occurring acutely or chronically, with relapses and improvements replacing each other. Acute cholecystitis with the presence of stones is a reason for urgent surgery. The chronic course of the disease allows it to be carried out plannedly, possibly laparoscopically.

Cholesterosis It is asymptomatic for a long time and can be detected by chance, and it becomes an indication for cholecystectomy when it causes symptoms of damage to the gallbladder and disruption of its function (pain, jaundice, dyspepsia). In the presence of stones, even asymptomatic cholesterosis serves as a reason to remove the organ. If calcification occurs in the gallbladder, when calcium salts are deposited in the wall, then surgery is mandatory.

Presence of polyps is fraught with malignancy, therefore removal of the gallbladder with polyps is necessary if they exceed 10 mm, have a thin stalk, or are combined with cholelithiasis.

Functional disorders biliary excretion usually serves as a reason for conservative treatment, but abroad such patients are still operated on due to pain, decreased release of bile into the intestines and dyspeptic disorders.

There are also contraindications for cholecystectomy surgery, which can be general and local. Of course, if urgent surgical treatment is necessary due to a threat to the patient’s life, some of them are considered relative, since the benefits of treatment are disproportionately higher than the possible risks.

TO general contraindications include terminal conditions, severe decompensated pathology of internal organs, metabolic disorders, which can complicate the operation, but the surgeon will “turn a blind eye” to them if the patient needs to save life.

General contraindications to laparoscopy considered diseases of internal organs in the stage of decompensation, peritonitis, long-term pregnancy, pathology of hemostasis.

Local restrictions are relative, and the possibility of laparoscopic surgery is determined by the experience and qualifications of the doctor, the availability of appropriate equipment, and the willingness of not only the surgeon, but also the patient to take a certain risk. These include adhesive disease, calcification of the gallbladder wall, acute cholecystitis, if more than three days have passed from the onset of the disease, pregnancy in the first and third trimester, and large hernias. If it is impossible to continue the operation laparoscopically, the doctor will be forced to switch to abdominal intervention.

Types and features of operations to remove the gallbladder

Gallbladder removal surgery can be performed both classically, openly, and using minimally invasive techniques (laparoscopically, from a mini-access). The choice of method determines the patient’s condition, the nature of the pathology, the doctor’s discretion and the equipment of the medical institution. All interventions require general anesthesia.

Open surgery

Cavitary removal of the gallbladder involves a midline laparotomy (access along the midline of the abdomen) or oblique incisions under the costal arch. In this case, the surgeon has good access to the gallbladder and ducts, the ability to examine, measure, probe, and examine them using contrast agents.

Open surgery is indicated for acute inflammation with peritonitis and complex lesions of the biliary tract. Among the disadvantages of cholecystectomy using this method are major surgical trauma, poor cosmetic results, and complications (disruption of the intestines and other internal organs).

The course of open surgery includes:

1. An incision in the anterior abdominal wall, revision of the affected area;
2. Isolation and ligation (or clipping) of the cystic duct and artery supplying blood to the gallbladder;
3. Separation and extraction of the bladder, treatment of the organ bed;
4. Application of drainages (as indicated), suturing of the surgical wound.

Laparoscopic cholecystectomy

Laparoscopic surgery is recognized as the “gold standard” of treatment for chronic cholecystitis and cholelithiasis, and serves as the method of choice for acute inflammatory processes. The undoubted advantage of the method is considered to be minimal surgical trauma, short recovery time, and minor pain. Laparoscopy allows the patient to leave the hospital 2-3 days after treatment and quickly return to normal life.

Stages of laparoscopic surgery include:

• Punctures of the abdominal wall through which instruments are inserted (trocars, video camera, manipulators);
• Injection of carbon dioxide into the abdomen to provide vision;
• Clipping and cutting off the cystic duct and artery;
• Removal of the gallbladder from the abdominal cavity, instruments and suturing of the holes.

The operation lasts no more than an hour, but possibly longer (up to 2 hours) if there are difficulties in accessing the affected area, anatomical features, etc. If there are stones in the gallbladder, they are crushed before removing the organ into smaller fragments. In some cases, upon completion of the operation, the surgeon installs a drainage in the subhepatic space to ensure the outflow of fluid that may form as a result of surgical trauma.

Video: laparoscopic cholecystectomy, operation progress

Mini access cholecystectomy

It is clear that most patients would prefer laparoscopic surgery, but it may be contraindicated in a number of conditions. In such a situation, specialists resort to minimally invasive techniques. Mini-access cholecystectomy is a cross between abdominal and laparoscopic surgery.

The course of the intervention includes the same stages as other types of cholecystectomy: formation of access, ligation and intersection of the duct and artery with subsequent removal of the bladder, and the difference is that To carry out these manipulations, the doctor uses a small (3-7 cm) incision under the right costal arch.

A minimal incision, on the one hand, is not accompanied by major trauma to the abdominal tissue, and on the other hand, it provides a sufficient overview for the surgeon to assess the condition of the organs. This operation is especially indicated for patients with a strong adhesive process, inflammatory tissue infiltration, when the introduction of carbon dioxide is difficult and, accordingly, laparoscopy is impossible.

After minimally invasive removal of the gallbladder, the patient spends 3-5 days in the hospital, that is, longer than after laparoscopy, but less than in the case of open surgery. The postoperative period is easier than after abdominal cholecystectomy, and the patient returns home earlier to his usual activities.

Every patient suffering from one or another disease of the gallbladder and ducts is most interested in exactly how the operation will be performed, wanting it to be the least traumatic. In this case, there cannot be a definite answer, because the choice depends on the nature of the disease and many other reasons. Thus, in case of peritonitis, acute inflammation and severe forms of pathology, the doctor will most likely be forced to undergo the most traumatic open surgery. In case of adhesions, minimally invasive cholecystectomy is preferable, and if there are no contraindications to laparoscopy, laparoscopic technique, respectively.

Preoperative preparation

For the best treatment outcome, it is important to conduct adequate preoperative preparation and examination of the patient.

For this purpose, the following is carried out:

1. General and biochemical blood and urine tests, tests for syphilis, hepatitis B and C;
2. Coagulogram;
3. Clarification of blood type and Rh factor;
4. Ultrasound of the gallbladder, biliary tract, abdominal organs;
5. X-ray (fluorography) of the lungs;
6. According to indications – fibrogastroscopy, colonoscopy.

Some patients need consultation with specialized specialists (gastroenterologist, cardiologist, endocrinologist), all – with a therapist. To clarify the condition of the biliary tract, additional studies are carried out using ultrasound and radiopaque techniques. Severe pathology of internal organs should be compensated as much as possible, blood pressure should be brought back to normal, and blood sugar levels should be monitored in diabetics.

Preparation for surgery from the moment of hospitalization includes eating a light meal the day before, completely refusing food and water from 6-7 pm before the operation, and in the evening and morning before the intervention the patient is given a cleansing enema. In the morning you should take a shower and change into clean clothes.

If it is necessary to perform an urgent operation, the time for examinations and preparation is much less, so the doctor is forced to limit himself to general clinical examinations and ultrasound, allocating no more than two hours for all procedures.

After operation…

The length of time you spend in the hospital depends on the type of surgery performed. With an open cholecystectomy, the sutures are removed after about a week, and the length of hospitalization is about two weeks. In the case of laparoscopy, the patient is discharged after 2-4 days. Working capacity is restored in the first case within one to two months, in the second – up to 20 days after the operation. A sick leave certificate is issued for the entire period of hospitalization and three days after discharge, then at the discretion of the clinic doctor.

The next day after surgery, the drainage, if one was installed, is removed. This procedure is painless. Before the sutures are removed, they are treated daily with antiseptic solutions.

For the first 4-6 hours after removal of the bladder, you should refrain from eating and drinking water, and do not get out of bed. After this time, you can try to get up, but be careful, since dizziness and fainting are possible after anesthesia.

Almost every patient may experience pain after surgery, but the intensity varies with different treatment approaches. Of course, one cannot expect painless healing of a large wound after open surgery, and pain in this situation is a natural component of the postoperative condition. To eliminate it, analgesics are prescribed. After laparoscopic cholecystectomy, pain is less and quite tolerable, and most patients do not require pain medications.

A day after the operation, you are allowed to stand up, walk around the room, and take food and water. The diet after removal of the gallbladder is of particular importance. In the first few days you can eat porridge, light soups, fermented milk products, bananas, vegetable purees, and lean boiled meat. Coffee, strong tea, alcohol, confectionery, fried and spicy foods are strictly prohibited.

Since after cholecystectomy the patient is deprived of an important organ that accumulates and secretes bile in a timely manner, he will have to adapt to the changed conditions of digestion. The diet after removal of the gallbladder corresponds to table No. 5 (liver). You should not eat fried and fatty foods, smoked foods and many spices that require increased secretion of digestive secretions; canned food, marinades, eggs, alcohol, coffee, sweets, fatty creams and butter are prohibited.

First month after surgery you need to stick to 5-6 meals a day, taking food in small portions, you need to drink up to one and a half liters of water per day. It is allowed to eat white bread, boiled meat and fish, porridge, jelly, fermented milk products, stewed or steamed vegetables.

In general, life after removal of the gallbladder does not have significant restrictions; 2-3 weeks after treatment you can return to your usual lifestyle and work activity. The diet is indicated in the first month, then the diet gradually expands. In principle, you can eat everything, but you should not get carried away with foods that require increased bile secretion (fatty, fried foods).

In the first month after the operation, you will need to somewhat limit physical activity, not lifting more than 2-3 kg and not performing exercises that require tensing the abdominal muscles. During this period, a scar is formed, which is why restrictions are associated.

Video: rehabilitation after cholecystectomy

Possible complications

Usually, cholecystectomy proceeds quite well, but some complications are still possible, especially in elderly patients, in the presence of severe concomitant pathology, and in complex forms of damage to the biliary tract.

Among the consequences are:

• Suppuration of the postoperative suture;
• Bleeding and abscesses in the abdomen (very rare);
• Bile leakage;
• Damage to the bile ducts during surgery;
• Allergic reactions;
• Thromboembolic complications;
• Exacerbation of another chronic pathology.

A possible consequence of open interventions is often an adhesive process, especially in common forms of inflammation, acute cholecystitis and cholangitis.

Patient reviews depend on the type of surgery they underwent. The best impression, of course, is left behind by laparoscopic cholecystectomy, when literally the day after the operation the patient feels well, is active and is preparing for discharge. A more complex postoperative period and greater trauma during classical surgery also cause more serious discomfort, which is why this operation is scary for many.

Urgent cholecystectomy, for health reasons, is performed free of charge, regardless of the place of residence, solvency and citizenship of patients. The desire to remove the gallbladder for a fee may require some costs. The cost of laparoscopic cholecystectomy ranges on average between 50-70 thousand rubles, Removing a bladder from mini-access will cost approximately 50 thousand in private medical centers; in public hospitals it can cost 25-30 thousand, depending on the complexity of the intervention and the necessary examinations.

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Laparoscopy of the gallbladder - definition, general characteristics, types of operations

The term “gallbladder laparoscopy” in everyday speech usually means an operation to remove the gallbladder, performed using a laparoscopic approach. In more rare cases, this term may mean that people are removing stones from the gallbladder using laparoscopic surgery.

That is, “laparoscopy of the gallbladder” is, first of all, a surgical operation, during which either the complete removal of the entire organ is performed, or the stones present in it are removed. A distinctive feature of the operation is the access through which it is performed. This access is carried out using a special device - laparoscope, and therefore is called laparoscopic. Thus, laparoscopy of the gallbladder is a surgical operation performed using a laparoscope.

In order to clearly understand and imagine what the differences are between conventional and laparoscopic surgery, it is necessary to have a general understanding of the process and essence of both techniques.

So, a usual operation on the abdominal organs, including the gall bladder, is carried out using an incision in the anterior abdominal wall, through which the doctor sees the organs with his eye and can perform various manipulations on them with instruments in his hands. That is, it is quite easy to imagine a regular operation to remove the gallbladder - the doctor cuts the stomach, cuts out the bladder and stitches the wound. After such a conventional operation, a scar always remains on the skin in the form of a scar corresponding to the line of the incision made. This scar will never allow its owner to forget about the operation performed. Since the operation is performed using an incision in the tissue of the anterior abdominal wall, such access to the internal organs is traditionally called laparotomy .

The term "laparotomy" is formed from two words - "lapar-", which translates as belly, and "tomia", meaning to cut. That is, the general translation of the term “laparotomy” sounds like cutting the stomach. Since as a result of cutting the abdomen, the doctor is able to manipulate the gallbladder and other abdominal organs, the process of such cutting of the anterior abdominal wall is called laparotomy access. In this case, access refers to a technique that allows the doctor to perform any actions on internal organs.

Laparoscopic surgery on the abdominal and pelvic organs, including the gallbladder, is performed using special instruments - a laparoscope and trocar manipulators. A laparoscope is a video camera with a lighting device (flashlight), which is inserted into the abdominal cavity through a puncture on the anterior abdominal wall. Then the image from the video camera is shown on a screen on which the doctor sees the internal organs. It is based on this image that he will carry out the operation. That is, during laparoscopy, the doctor sees the organs not through an incision in the abdomen, but through a video camera inserted into the abdominal cavity. The puncture through which the laparoscope is inserted has a length of 1.5 to 2 cm, so a small and almost invisible scar remains in its place.

In addition to the laparoscope, two more special hollow tubes called trocars or manipulators, which are designed to control surgical instruments. Through hollow holes inside the tubes, instruments are delivered into the abdominal cavity to the organ that will be operated on. After this, using special devices on the trocars, they begin to move the instruments and perform the necessary actions, for example, cutting adhesions, applying clamps, cauterizing blood vessels, etc. Controlling instruments using trocars can be roughly compared to driving a car, airplane or other device.

Thus, laparoscopic surgery involves the insertion of three tubes into the abdominal cavity through small punctures 1.5–2 cm long, one of which is intended for obtaining an image, and the other two for performing the actual surgical procedure.

The technique, course and essence of the operations that are performed using laparoscopy and laparotomy are exactly the same. This means that the removal of the gallbladder will be performed according to the same rules and steps both using laparoscopy and during laparotomy.

That is, in addition to the classic laparotomy approach, laparoscopic access can be used to perform the same operations. In this case, the operation is called laparoscopic, or simply laparoscopy. After the words “laparoscopy” and “laparoscopic”, the name of the operation performed is usually added, for example, removal, after which the organ on which the intervention was performed is indicated. For example, the correct name for removing the gallbladder during laparoscopy would be “laparoscopic removal of the gallbladder.” However, in practice, the name of the operation (removal of part or the entire organ, enucleation of stones, etc.) is skipped, as a result of which only an indication of the laparoscopic approach and the name of the organ on which the intervention was performed remains.

Two types of gall bladder interventions can be performed using laparoscopic access:
1. Removal of the gallbladder.
2. Removing stones from the gallbladder.

Currently surgery to remove gallstones is almost never performed for two main reasons. Firstly, if there are a lot of stones, then the entire organ should be removed, which is already too much pathologically changed and therefore will never function normally. In this case, removing only the stones and leaving the gallbladder is unjustified, since the organ will constantly become inflamed and provoke other diseases.

And if there are few stones or they are small, then you can use other methods to remove them (for example, litholytic therapy with ursodeoxycholic acid preparations, such as Ursosan, Ursofalk, etc., or crushing stones with ultrasound, due to which they decrease in size and independently exit the bladder into the intestine, from where they are removed from the body along with food bolus and feces). For small stones, litholytic therapy with medications or ultrasound is also effective and avoids surgery.

In other words, the current situation is that when a person needs surgery for gallstones, it is advisable to remove the entire organ completely, rather than remove the stones. This is why surgeons most often resort to laparoscopic removal of the gallbladder, rather than stones from it.

Advantages of laparoscopy over laparotomy

Laparoscopy has the following advantages over major abdominal surgery:

• Little damage to the tissue of the anterior abdominal wall, since the operation uses four punctures rather than an incision;
• Minor pain after surgery, subsiding within 24 hours;
• A few hours after the end of the operation, the person can walk and perform simple actions;
• Short hospital stay (1 – 4 days);
• Rapid rehabilitation and restoration of working capacity;
• Low risk of postoperative hernia;
• Subtle or almost invisible scars.

Anesthesia for laparoscopy of the gallbladder

To perform laparoscopy, only general endotracheal anesthesia is used with the mandatory connection of a ventilator. Endotracheal anesthesia is gas and formally represents a special tube through which a person will breathe using a ventilator. If endotracheal anesthesia is not possible, for example, in people suffering from bronchial asthma, intravenous anesthesia is used, which is also necessarily combined with artificial ventilation.

Laparoscopic removal of the gallbladder - the course of the operation

Laparoscopic surgery is performed under general anesthesia, just like laparotomy, since only this method allows not only to reliably relieve pain and tissue sensitivity, but also to relax the abdominal muscles well. With local anesthesia, it is impossible to provide reliable relief of pain and tissue sensitivity in combination with muscle relaxation.

After putting a person under anesthesia, the anesthesiologist inserts a tube into the stomach to remove the liquid and gases present in it. This probe is necessary to prevent accidental vomiting and the entry of stomach contents into the respiratory tract with subsequent asphyxia. The gastric tube remains in the esophagus until the end of the operation. After the tube is installed, the mouth and nose are covered with a mask attached to a ventilator, with which the person will breathe during the entire operation. Mechanical ventilation during laparoscopy is absolutely necessary, since the gas used during the operation and pumped into the abdominal cavity puts pressure on the diaphragm, which, in turn, strongly compresses the lungs, as a result of which they cannot breathe on their own.

Only after the person has been put under anesthesia, gases and fluids have been removed from the stomach, and a ventilator has been successfully attached, the surgeon and his assistants begin to perform laparoscopic surgery to remove the gallbladder. To do this, a semicircular incision is made in the navel fold, through which a trocar with a camera and a flashlight is inserted. However, before the camera and flashlight are inserted, sterile gas, most often carbon dioxide, is pumped into the abdomen, which is necessary to straighten the organs and increase the volume of the abdominal cavity. Thanks to the gas bubble, the doctor is able to freely operate trocars in the abdominal cavity, minimally affecting neighboring organs.

Then, along the right hypochondrium, another 2 to 3 trocars are inserted, with which the surgeon will manipulate the instruments and remove the gallbladder. The puncture points on the abdominal skin through which trocars are inserted for laparoscopic removal of the gallbladder are shown in Figure 1.

Picture 1– Points at which a puncture is made and trocars are inserted for laparoscopic removal of the gallbladder.

The surgeon then first examines the location and appearance of the gallbladder. If the bladder is closed by adhesions due to a chronic inflammatory process, then the doctor first dissects them, releasing the organ. Then the degree of its tension and fullness is determined. If the gallbladder is very tense, the doctor first cuts its wall and sucks out a small amount of fluid. Only after this a clamp is applied to the bladder, and the common bile duct, the bile duct, is released from the tissues, connecting it to the duodenum. The common bile duct is cut, after which the cystic artery is isolated from the tissue. Clamps are applied to the vessel, it is cut between them and the lumen of the artery is carefully sutured.

Only after the gallbladder is freed from the artery and common bile duct, the doctor begins to isolate it from the hepatic bed. The bubble is separated slowly and gradually, cauterizing all bleeding vessels along the way with an electric current. When the bubble is separated from the surrounding tissue, it is removed through a special small cosmetic puncture in the navel.

After this, the doctor, using a laparoscope, carefully examines the abdominal cavity for bleeding vessels, bile and other pathologically altered structures. The vessels are coagulated, and all altered tissues are removed, after which an antiseptic solution is injected into the abdominal cavity, which is used to rinse it, after which it is sucked out.

This completes the laparoscopic operation to remove the gallbladder; the doctor removes all trocars and sutures or simply seals the punctures in the skin. However, a drainage tube is sometimes inserted into one of the punctures and left for 1 to 2 days so that the remaining antiseptic lavage fluid can flow freely from the abdominal cavity. But if during the operation practically no bile was poured out, and the bladder was not very inflamed, then the drainage may not be left.

It should be remembered that laparoscopic surgery can be converted to laparotomy if the bubble is too tightly fused with the surrounding tissues and cannot be removed using the available instruments. In principle, if any unsolvable difficulties arise, the doctor removes the trocars and performs a conventional extended laparotomy operation.

Laparoscopy of gallbladder stones - the course of the operation

The rules for inducing anesthesia, installing a gastric tube, connecting a ventilator and inserting trocars to remove stones from the gallbladder are exactly the same as for cholecystectomy (removal of the gallbladder).

After introducing gas and trocars into the abdominal cavity, the doctor, if necessary, cuts off adhesions between the gallbladder and surrounding organs and tissues, if any. Then the wall of the gallbladder is cut, the tip of the suction is inserted into the cavity of the organ, with the help of which all the contents are removed out. After this, the gallbladder wall is sutured, the abdominal cavity is washed with antiseptic solutions, the trocars are removed and sutures are placed on the punctures in the skin.

Laparoscopic removal of gallstones can also be converted to laparotomy at any time if the surgeon encounters any difficulties.

How long does gallbladder laparoscopy take?

Depending on the experience of the surgeon and the complexity of the operation, laparoscopy of the gallbladder lasts from 40 minutes to 1.5 hours. On average, laparoscopic gallbladder removal takes about an hour.

Where to have the operation?

You can undergo laparoscopic surgery to remove the gallbladder in the central regional or city hospital in the general department surgery or gastroenterology. In addition, this operation can be performed in research institutes dealing with diseases of the digestive system.

Laparoscopy of the gallbladder - contraindications and indications for surgery

Indication The following diseases require removal of the gallbladder using the laparoscopic method:

• Chronic calculous and non-calculous cholecystitis;
• Polyps and cholesterosis of the gallbladder;
• Acute cholecystitis (in the first 2–3 days from the onset of the disease);
• Asymptomatic cholecystolithiasis (gallbladder stones).

Carrying out laparoscopic removal of the gallbladder contraindicated in the following cases:

• Abscess in the gallbladder area;
• Severe diseases of the cardiovascular or respiratory system in the stage of decompensation;
• Third trimester of pregnancy (from 27 weeks to birth);
• Unclear location of organs in the abdominal cavity;
• Operations on the abdominal organs performed in the past via laparotomy;
• Intrahepatic location of the gallbladder;
• Acute pancreatitis;
• Obstructive jaundice resulting from blockage of the bile ducts;
• Suspicion of the presence of a malignant tumor in the gallbladder;
• Severe scarring in the hepatic ligament or neck of the gallbladder;
• Blood clotting disorders;
• Fistulas between the biliary tract and intestines;
• Acute gangrenous or perforated cholecystitis;
• “Porcelain” cholecystitis;
• Presence of a pacemaker.

Preparation for laparoscopy of the gallbladder

The following tests should be taken a maximum of 2 weeks before the planned surgery:

• General blood and urine analysis;
• Biochemical blood test with determination of the concentration of bilirubin, total protein, glucose, alkaline phosphatase;
• Coagulogram (APTT, PTI, INR, TV, fibrinogen);
• Blood type and Rh factor;
• Vaginal flora smear for women;
• Blood for HIV, syphilis, hepatitis B and C;
• Electrocardiogram.

A person is allowed to undergo surgery only if the results of his tests are within normal limits. If the tests show deviations from the norm, you will first have to undergo a course of necessary treatment aimed at normalizing the condition.

In addition, in the process of preparing for laparoscopy of the gallbladder, you should take control of the course of existing chronic diseases of the respiratory, digestive and endocrine systems and take medications agreed with the surgeon who will operate.

On the day before surgery, you should finish eating at 6:00 pm and drinking at 10:00 pm. From ten o'clock on the evening before surgery, a person must neither eat nor drink until the start of surgery. To cleanse the intestines on the day before surgery, you should take a laxative and give an enema. An enema should also be given in the morning immediately before surgery. Laparoscopic removal of the gallbladder does not require any other preparation. However, if in any individual case the doctor considers it necessary to perform any additional preparatory manipulations, he will say this separately.

Laparoscopy of the gallbladder - postoperative period

After the operation is completed, the anesthesiologist “wakes up” the person by stopping giving the anesthetic gas mixture. On the day of surgery, you should remain in bed for 4 to 6 hours. And after 4 to 6 hours after the operation, you can turn around in bed, sit down, stand up, walk and perform simple self-care actions. Also from this moment you are allowed to drink still water.

On the second day after surgery, you can start eating light, soft foods, for example, weak broth, fruits, low-fat cottage cheese, yogurt, boiled lean minced meat, etc. Food should be taken frequently (5 – 7 times a day), but in small portions. During the entire second day after surgery, you need to drink a lot. On the third day after surgery, you can eat regular food, avoiding foods that cause severe gas (legumes, brown bread, etc.) and bile secretion (garlic, onions, hot, salty, spicy foods). In principle, from 3 to 4 days after the operation you can eat according to diet No. 5, which will be described in detail in the corresponding section.

For 1–2 days after surgery, a person may experience pain in the area of ​​punctures on the skin, in the right hypochondrium, and also above the collarbone. These pains are caused by traumatic tissue damage and will completely disappear in 1 to 4 days. If the pain does not subside, but, on the contrary, intensifies, you should immediately consult a doctor, as this may be a symptom of complications.

During the entire postoperative period, which lasts 7–10 days, you should not lift heavy objects or perform any work related to physical activity. Also during this period you need to wear soft underwear that will not irritate painful punctures on the skin. The postoperative period ends on days 7–10, when the sutures from the punctures on the abdomen are removed in the clinic.

Sick leave for laparoscopy of the gallbladder

A sick leave certificate is given to a person for the entire period of stay in the hospital plus another 10 to 12 days. Since discharge from the hospital occurs on days 3 to 7 after surgery, the total sick leave for gallbladder laparoscopy ranges from 13 to 19 days.

If any complications develop, the sick leave is extended, but in this case the period of incapacity for work is determined individually.

After laparoscopy of the gallbladder (rehabilitation, recovery and lifestyle)

Rehabilitation after laparoscopy of the gallbladder usually proceeds quite quickly and without complications. Complete rehabilitation, including both physical and mental aspects, occurs 5 to 6 months after surgery. However, this does not mean that for 5–6 months a person will feel unwell and will not be able to live and work normally. Full rehabilitation means not only physical and mental recovery from stress and trauma, but also the accumulation of reserves, with which a person will be able to successfully withstand new tests and stressful situations without harm to himself or without developing any diseases.

And normal well-being and the ability to perform usual work, if it is not associated with physical activity, appears within 10 - 15 days after the operation. Starting from this period, for the best rehabilitation, the following rules should be strictly adhered to:

• Sexual rest should be observed for one month or at least 2 weeks after surgery;
• Eat right, avoiding constipation;
• Start any sports training no earlier than a month after surgery, starting with minimal load;
• For a month after surgery, do not engage in heavy physical labor;
• During the first 3 months after surgery, do not lift more than 3 kg, and from 3 to 6 months - more than 5 kg;
• For 3–4 months after surgery, follow diet No. 5.

Otherwise, rehabilitation after gallstone laparoscopy does not require any special measures. To speed up wound healing and tissue restoration, a month after surgery, it is recommended to undergo a course of physical therapy, which is recommended by the doctor. Immediately after the operation, you can take vitamin preparations, such as Vitrum, Centrum, Supradin, Multi-Tabs, etc.

Pain after laparoscopy of the gallbladder

After laparoscopy, pain is usually moderate or mild, so it can be easily relieved with non-narcotic analgesics, such as Ketonal, Ketorol, Ketanov, etc. Painkillers are used for 1 to 2 days after surgery, after which there is usually no need for their use , since the pain syndrome decreases and disappears within a week. If the pain does not decrease but intensifies every day after surgery, you should consult a doctor, as this may indicate the development of complications.

After the sutures are removed, on days 7–10 after surgery, the pain no longer bothers you, but may occur during any active actions or strong tension in the anterior abdominal wall (straining when attempting to defecate, lifting heavy objects, etc.). Such moments should be avoided. In the long-term period after the operation (a month or more) there is no pain, and if any appears, this indicates the development of some other disease.

Diet after laparoscopic gallbladder removal (diet after laparoscopy of the gallbladder)

The diet that should be followed after removal of the gallbladder is aimed at ensuring normal liver function. Normally, the liver produces 600–800 ml of bile per day, which immediately enters the duodenum and does not accumulate in the gallbladder, being released only as needed (after a bolus of food enters the duodenum). This entry of bile into the intestine, regardless of meals, creates certain difficulties, so it is necessary to follow a diet that minimizes the consequences of the absence of one of the important organs.

On days 3–4 after surgery, a person can eat pureed vegetables, low-fat cottage cheese, as well as boiled meat and low-fat fish. This diet should be maintained for 3 – 4 days, after which you switch to diet No. 5.

So, diet No. 5 involves frequent and fractional meals (small portions 5–6 times a day). All dishes should be chopped and warm, not hot or cold, and food should be prepared by boiling, stewing or baking. Frying is not allowed. The following dishes and products should be excluded from the diet:

• Fatty foods (fatty fish and meats, lard, high-fat dairy products, etc.);
• Roast;
• Canned meat, fish, vegetables;
• Smoked meats;
• Marinades and pickles;
• Spicy seasonings (mustard, horseradish, chili ketchup, garlic, ginger, etc.);
• Any offal (liver, kidneys, brain, stomachs, etc.);
• Mushrooms in any form;
• Raw vegetables;
• Raw green peas;
• Rye bread;
• Fresh white bread;
• Butter pastries and confectionery (pies, pancakes, pies, pastries, etc.);
• Chocolate;
• Alcohol;
• Cocoa and black coffee.

The following foods and dishes should be included in the diet after laparoscopic gallbladder removal:

• Low-fat varieties of meat (turkey, rabbit, chicken, veal, etc.) and fish (pike perch, perch, pike, etc.) boiled, steamed or baked;
• Semi-liquid porridges from any cereals;
• Soups with water or weak broth, seasoned with vegetables, cereals or pasta;
• Steamed or stewed vegetables;
• Low-fat or skim dairy products (kefir, milk, curdled milk, cheese, etc.);
• Non-acidic berries and fruits, fresh or in compotes, mousses and jellies;
• Yesterday's white bread;
• Jam or jam.

From these products, a diet is compiled and various dishes are prepared, to which you can add 45 - 50 g of butter or 60 - 70 g of vegetable oil per day before eating. The total daily intake of bread is 200 g, and sugar - no more than 25 g. It is very useful to drink a glass of low-fat kefir before bed.

You can drink weak tea, non-acidic juices diluted with water in half, coffee with milk, compote, rosehip infusion. The drinking regime (the amount of water consumed per day) can be different; it should be set individually, focusing on your own well-being. So, if bile is often secreted into the intestines, then you can reduce the amount of water you drink and vice versa.

3 – 4 months after strict adherence to diet No. 5, raw vegetables and unchopped meat and fish are included in the diet. In this form, the diet should be followed for about 2 years, after which you can eat everything in moderation.

Consequences of gallbladder laparoscopy

The main unpleasant and causing severe discomfort consequence of laparoscopic removal of the gallbladder is periodic releases of bile directly into the duodenum, which are called postcholecystectomy syndrome. The manifestations of this syndrome are the following symptoms:

• Stomach ache;
• Nausea;
• Vomit;
• Rumbling in the stomach;
• Flatulence;
• Diarrhea;
• Heartburn;
• Belching bitter;
• Jaundice and fever (rare).

Unfortunately, the manifestations of this syndrome can bother a person periodically and it is impossible to get rid of them completely for life. If signs of postcholecystectomy syndrome appear, you should switch to strict adherence to diet No. 5, and severe pain should be relieved by taking antispasmodics, for example, No-Shpa, Duspatalin, etc. Nausea and vomiting can be easily relieved with a few sips of alkaline mineral water, for example, Borjomi.

Complications of gallbladder laparoscopy

Directly during the operation The following complications of gallbladder laparoscopy may develop:

• Damage to the blood vessels of the abdominal wall;
• Perforation (hole) of the stomach, duodenum, colon or gallbladder;
• Damage to surrounding organs;
• Bleeding from the cystic artery or from the liver bed.

These complications arise during the operation and require conversion of laparoscopy to laparotomy, which is performed by the surgeon.

Some time after laparoscopy gallbladder, the following complications may occur due to tissue damage and removal of the organ:

• Bile leakage into the abdominal cavity from a poorly sutured stump of the cystic duct, liver bed or common bile duct;
• Peritonitis;
• Inflammation of the tissue around the navel (omphalitis).

Hernia after laparoscopy of the gallbladder

A hernia after laparoscopy of the gallbladder occurs extremely rarely - no more than 5 - 7% of cases. Moreover, as a rule, a hernia occurs in obese people. Also, the risk of hernia formation during laparoscopy of the gallbladder is slightly higher in those people for whom the operation was performed urgently, and not as planned. In general, this complication is rare after laparoscopy.
More about hernias

Laparoscopy of the gallbladder - reviews

Almost all reviews about laparoscopy of the gallbladder are positive, since people who have undergone this operation consider it to be quite quick, less traumatic and not leading to the need for a long hospital stay. In the reviews, people note that the operation is not scary, it goes quickly and is discharged on the 4th day.

It is worth mentioning separately what unpleasant moments people pay attention to: firstly, it is pain in the abdomen after surgery, secondly, it is difficult to breathe due to compression of the lungs by a gas bubble, which resolves within 2 - 4 days, and finally thirdly, the need to fast for a total of 1.5 - 2 days. However, these unpleasant sensations pass rather quickly, and people believe that they can be endured in order to benefit from the operation.

Cost of laparoscopy of the gallbladder (removal of the gallbladder or removal of stones)

Currently, the cost of laparoscopic removal of the gallbladder or stones from it ranges from 9,000 to 90,000 rubles, depending on the clinic and region of Russia. The most expensive surgeries are performed in highly specialized medical institutions, such as research institutes. However, doctors in city and regional hospitals often have no worse experience in performing such operations, and their cost is significantly lower.

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Why is gallbladder removal done?

When the contractility of the gallbladder decreases or disturbances occur in metabolic processes, bile stagnates. Its components crystallize and precipitate. At first the particles are small (microlites), but gradually they increase in size and turn into stones. Calculous cholecystitis, or cholelithiasis, develops.

The disease has two course options:

1. There are stones in the gall bladder, they move, but do not interfere with the flow of bile and do not lead to inflammation.
2. Stones disrupt the flow of bile, sometimes move into the bile ducts, block them, cause inflammation and the development of infection.

In what cases is the gallbladder removed? In case of a chronic course, it is not necessary to perform an operation; it is enough to observe changes in the organ and adhere to a certain lifestyle, including nutrition. The risk of complications in this case is low. But this form of the disease can be accompanied by a sluggish inflammatory process, which gradually spreads to other organs. Then the patient, together with the doctor, decides on the operation.

If the outflow of bile is disrupted, inflammation develops, and then infection, then it is almost impossible to eliminate the problem without surgical intervention. The operation to remove the gallbladder is carried out in order to prevent attacks of cholecystitis - colic, accompanied by acute pain, nausea, and vomiting.

In addition, the acute course of the disease leads to complications. There is a risk of spread of inflammatory and infectious processes to the liver, pancreas, and abdominal cavity. The patient may develop reactive hepatitis, cholangitis, pancreatitis, peritonitis, and intestinal obstruction. Pus accumulates in the gallbladder, inflammation intensifies, an abscess covers nearby tissues, and sometimes gangrene or perforation develops in the walls of the organ.

Stages and process of procedure behavior

The gallbladder can be removed during open cholecystectomy or laparoscopy. The first option has a wider list of indications, but it is more traumatic. The second one does not require a cavity tissue incision, but in some cases it cannot be used (for example, in case of acute inflammation or adhesions). The choice of method is made by the doctor based on the characteristics of the disease and its complications.

Many patients are concerned about how long the surgery to remove the gallbladder lasts. In both cases, the procedure takes from 30 to 90 minutes. Most often, its duration is 1 hour.

Open cholecystectomy is performed under general anesthesia.

During the operation, the doctor performs the following steps step by step:

1. An incision (15-30 cm) is made in the area of ​​the right hypochondrium or midline of the abdomen from the sternum to the navel.
2. Ligs the gallbladder using surgical thread.
3. It compresses vessels and ducts with special clips.
4. The gallbladder is cut off with a scalpel and removed.
5. Checks for the presence of stones in the bile ducts.
6. Sews up the incision, bringing the catheter out (to remove exudate).

Laparoscopic surgery is also performed under general anesthesia.

The doctor performs the following manipulations:

1. A special instrument (trocar) makes 3-4 punctures in the navel area and slightly higher, to the right.
2. A probe with a camera is inserted into one of the trocars, the image is displayed on the monitor, and the doctor is able to monitor his actions.
3. He inserts clamps through the trocars and places them on the vessels and bile duct.
4. Cuts off the gallbladder.
5. If the size of the bladder does not allow it to be removed through the hole, then the doctor first removes and removes the stones, and then the organ itself.
6. Ultrasound, laser or coagulation stops bleeding.
7. He sews up large holes and wounds, seals small ones with adhesive tape.

The surgeon works in a team; some actions can be performed by assistants. The progress of the operation is saved in video format.

Sometimes gallbladder removal is performed on a paid basis; the price of the operation depends on the level of the clinic, region, and the qualifications of the surgeon. On average, it ranges from 20 to 35 thousand rubles, but in some cases it can be much higher.

Postoperative period

When the gallbladder is removed, the patient has many questions about the recovery period, for example, what medications to take, how long to stay in the hospital, and when it will be possible to return to their normal lifestyle.

After open cholecystectomy, the sutures are removed after 6-8 days, and discharge from the hospital occurs on days 10-14, depending on the patient’s condition. You will be able to return to your normal work schedule after 1-2 months.

After laparoscopy, there is no need to remove sutures; you are discharged from the hospital after 2-4 days. After 2-3 weeks you can return to your previous activity.

The recovery period after any type of surgery includes following a diet, a comfortable activity regimen, and massage courses. As for medications, it is sometimes necessary to take mild choleretic drugs.

Complications after surgery

Surgery always carries a risk of complications. Any operation is traumatic, after which problems may arise such as slow healing of wounds, their suppuration, peritonitis, bleeding, internal abscess. Fortunately, the percentage of development of such complications is small.

What else are the risks of removing the gallbladder? Among the most common complaints of patients are pain in the right side, in the liver and stomach, and stool disorders.

Liver pain

For the most part, the liver is located on the right side: from the diaphragm (nipple level) to the lower edge of the ribs. For one and a half months after the gallbladder is removed, the liver may hurt. If the sensations are tolerable and are not accompanied by other symptoms, then this is normal. In this way, the body adapts to the changes that have occurred. If nausea, vomiting, fever, or digestion problems occur, you should consult a doctor.

After surgery, the liver still produces bile. Most often, it enters directly into the intestines, but in some cases, when the gallbladder is removed, the bile ducts can be clogged with secretions, causing symptoms of cholestasis to develop: dull pain in the right hypochondrium, yellowness of the skin and sclera, nausea, bitterness in the mouth, lethargy, drowsiness.

If the gallbladder is removed and the liver hurts, stagnation of bile is confirmed by the results of a biochemical blood test and treatment is prescribed: taking drugs with hepatoprotective and choleretic effects (Essentiale, Ursosan, Liv 52, etc.). Gradually, the body adapts to the changes, and the intrahepatic ducts partially replace the gallbladder without pain.

Pain in right side

After the gallbladder is removed, patients often experience pain on the right side.

This symptom can be caused by several reasons:

1. Damage to soft tissue during surgery and subsequent inflammation. Even with laparoscopy, wounds cannot be avoided; until they are completely healed, pain may be felt in the right side.
2. Adaptation of the digestive system to changed conditions. The pain is mild, does not require treatment, and disappears after 1-1.5 months.
3. Development of new and exacerbation of chronic diseases of the gastrointestinal tract: pancreatitis, hepatitis, duodenitis, gastric and duodenal ulcers, spasm of the bile ducts, biliary dyskinesia, etc.
4. Dietary disorder. Digesting spicy, fatty, too sour or salty foods requires a lot of bile. Since the gallbladder is no longer there, the body cannot provide it in sufficient quantities. Digestive disorders manifest themselves as pain.
5. Residual stone– the cause of biliary colic when the gallbladder is removed. During the operation, a small stone in the duct may go unnoticed. Subsequently, its displacement causes pain.

In order to determine what exactly caused the pain in the right side, you need to see a doctor. He will conduct an examination and, if necessary, prescribe treatment.

Stomach ache

When the gallbladder is removed, patients often complain of stomach pain. This unpleasant symptom is associated with changes occurring in the digestive system. After the operation, bile does not accumulate, and therefore its consistency and composition change: it becomes liquid, less active against pathogenic microflora, but aggressively affects the mucous membrane of the duodenum.

As a result, the motility of this section is disrupted, and food masses are thrown back into the stomach cavity and into the esophagus. Pain appears, gastritis, colitis, and enteritis develop. This condition requires consultation with a gastroenterologist.

Stool disorder

When the gallbladder is removed, digestive disorders may appear, which are often manifested by loose stools, less often by constipation. Diarrhea develops due to the rapid passage of bile acids through the duodenum and stimulation of the production of digestive juice ahead of time.

Another reason for loose stools is a violation of the intestinal microflora. As noted earlier, bile becomes less concentrated and has a worse effect on pathogenic microflora. The situation is aggravated by a decrease in the body’s immune forces due to the operation. Bacterial overgrowth syndrome develops, accompanied by periodic diarrhea, bloating and flatulence.

Due to the effect of bile acids on the mucous membrane, irritation of the duodenum occurs. The absorption of vitamins, minerals and nutrients is impaired. The stool may become watery, foul-smelling, or “greasy” or oily (if fat absorption is impaired).

The cause of constipation after gallbladder removal is most often a decrease in the amount of food consumed and the lack of fiber products in it. Therefore, it is important to follow the recommended diet and water regime.

Nutrition after surgery

After removal of the gallbladder, the functioning of the gastrointestinal tract changes. If previously the release of bile occurred after food intake, now it flows constantly in small portions. This leads to irritation of the mucous membrane, inflammation, and impaired motility of the duodenum. Changes in the composition of bile also negatively affect the process of digestion of food.

Correcting your diet helps you avoid many digestive problems and diseases of the gastrointestinal tract.

The general rules are:

• During the day you need to drink about 2 liters of water, including 1 glass before each meal.
• All food and drinks should be taken warm, the optimal temperature is about 35-40° C. Hot and cold are prohibited.
• To ensure that bile is removed from the body and does not irritate the intestinal mucosa, you need to eat as often as possible, 5-7 times a day. Portions may be small.
• Cooking and stewing are permitted methods of cooking. When frying, compounds are formed in the dish that provoke intense secretion of gastric juice, which leads to irritation of the mucous membrane and disruption of its functioning.

After removal of the gallbladder, you will have to give up strong coffee and tea, soda and alcohol, most sweets, legumes, mushrooms, sausages, canned food and smoked meats. All foods high in animal fat are prohibited: some types of fish, poultry, meat, lard. When preparing dishes, you should not add spices (especially hot ones), onions and garlic. Use salt to a minimum; it is best to add it to already prepared food.

Allowed recipes for gallbladder removal:

• soups based on vegetable, fish or low-fat meat broth;
• fish, poultry, beef or veal, steamed, boiled or stewed;
• Buckwheat and oatmeal are the most preferred side dishes; semolina should be avoided;
• for dessert you can prepare baked or stewed fruits;
• stewed, steamed or boiled vegetables;
• cottage cheese 9% fat, kefir, yogurt, fermented baked milk, bifidok - always fresh.

This diet is called “Table No. 5”. It is designed specifically for patients with liver and gallbladder diseases. 2 months after the operation, fats can be introduced into the diet: vegetable oils, small amounts of butter and sour cream. If you want something sweet, you are allowed to eat a little honey, marshmallows, marmalade, and dry cookies, but all this should be without cocoa, chocolate, nuts or seeds.

The gallbladder is not a vital organ. When inflammatory and infectious processes spread, not only its work is disrupted, but there is also a danger of developing complications - diseases of organs located nearby. Indications for removal of the gallbladder are the presence of stones in it, a violation of the outflow of bile, the development of inflammation and infection.

Medicines are not effective enough because they are unable to eliminate stones. Surgery to remove the gallbladder can be performed traditionally (open cholecystectomy) or laparoscopically. The second option is less traumatic, but in some cases cannot be used.

When a person has his gallbladder removed, he has a question: how to live after the operation? Activity restrictions will need to be observed for 1.5-2 months. A diet that helps the digestive organs adapt to changes - about a year. Otherwise, you don’t have to change your lifestyle.

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Preparation for laparoscopy of the gallbladder

Actions necessary in preparation for laparoscopy:

• mandatory ultrasound examination of the abdominal cavity is indicated;
• blood analysis;
• chest x-ray;
• medical examination;
• making a surgical verdict for the operation;
• cleansing the large and small intestines;
• before the operation, you cannot drink or eat from 12 o’clock at night (except for necessary medications);
• a few days before surgery, stop taking anti-inflammatory drugs, vitamin E, aspirin, and anticoagulants.

Gallbladder surgery (laparoscopy)

Laparoscopy of the gallbladder is performed under general anesthesia (anesthesia) in a special hospital, and lasts approximately one hour.

After preparing the surgical field, the surgeon makes four punctures in the abdominal wall, into which trocars (metal conductors in the form of hollow tubes) are inserted.

Sterile carbon dioxide is pumped into the abdominal cavity from cylinders, creating a working space for the surgeon to operate. Through one trocar (puncture), a laparoscope with a video camera and a light source is inserted. The color image from the video camera is sent to the monitor..

The surgeon’s endoscopic special instruments are inserted into other trocars:

• grips;
• forceps;
• coagulators;
• scissors;
• clamps.

After laparoscopy of the gallbladder, staples are applied to the blood vessels and bile ducts.

Bile is then sucked out of the gallbladder through a puncture. The bubble decreases in size, deflates, and is now easy to remove through the conductor.

The punctures in the abdominal wall are sutured, and the patient is sent for further observation and rehabilitation to the hospital for several days (3-5). Then the patient is prescribed limited physical activity and a special diet.

Nutrition after laparoscopy of the gallbladder should contain restrictions on the following products:

• alcohol;
• flour products;
• fried and fatty foods.

Indications for laparoscopy of the gallbladder

The main indication for cholecystectomy is calculous cholecystitis (inflammation of the gallbladder).

Typically, the inflammatory process in the gallbladder occurs in the presence of stones (calculi), consisting of dense crystalline formations of cholesterol.

Contraindications to laparoscopy of the gallbladder

Some clinical cases require a transition to classical open surgery when performing endoscopic intervention:

• the presence of scars and adhesions on the walls of the abdominal cavity after previous surgical operations;
• high degree of obesity;
• high blood loss during laparoscopy;
• large and numerous stones in the gall bladder;
• abscess in the gallbladder area;
• poor visibility of anatomical structures in the laparoscopy area;
• cardiovascular diseases;
• diseases of the respiratory system at the stage of decompensation;
• last trimester of pregnancy.

Benefits of gallbladder laparoscopy

The main advantages include:

• four small punctures on the abdomen, instead of a 15-centimeter incision;
• minimal pain after surgery;
• faster recovery of the body after laparoscopy;
• faster return to normal physical activity.

The temperature after laparoscopy of the gallbladder usually stays around 37-39 degrees for about seven days. About a week after the operation, the patient is fully recovered and recovering.

Complications after laparoscopy of the gallbladder

The most severe consequences after surgery:

• bile leakage;
• intra-abdominal bleeding;
• subphrenic abscesses;
• subhepatic abscesses;
• inflammatory process in the wound of the abdominal wall.