The removal of the gallbladder is all about cholecystectomy. Extensive operation to remove the gallbladder how many holes are done when removing the gallbladder

To date, there is not a single conservative treatment method that would 100% help get rid of stones in bile ducts (choledocholithiasis). The most effective way to treat cholecystitis is considered an operation to remove the gallbladder (cholecystectomy). In modern clinics, it is carried out as a gentle as possible using laparoscopy in just 2-4 punctures on the body. Through a read hours after the procedure, the patient can already get up, and after a few days I will write home.

Causes of gallstone disease

Gallbladder is a small organ, shaped resembling a bag. Its main function is the production of bile (aggressive fluid necessary for normal digestion). Constant phenomena lead to the fact that the individual components of bile fall into the sediment, from which the stones are further forming. There are several reasons for this:

• Disturbance in nutrition. Abuse of high cholesterol products, fatty or salted food, long-term use of highly mineralized water leads to a violation of metabolism and the formation of stones in biliary ducts.
• Reception of certain types of drugs, especially hormonal contraceptives, increases the risk of calculatory (bubble inflammation with stone formation) cholecystitis.
• Lifeline lifestyle, obesity, compliance with long-term low-calorie diets leads to disorders of digestive functions and stagnation in biliary tract.
• The anatomical features of the structure of the gallbladder (the presence of bends or inflexibs) prevent the normal conclusion of bile and can also provoke calculous cholecystitis.

Than dangerous stones

As long as the stones are in the cavity of the gallbladder, a person may not even guess about their availability. It is worth the clusters to start moving along the biliary ducts, as a person overwhelm the bouts of the bile colic, which are from a few minutes to 8-10 hours, there are dyspeptic disorders (difficult and painful digestion, accompanied by pain in the epigastric region, feeling the cutting of the stomach, nausea and vomiting, severity in right hypochondrium).

Choledocholitiasis (stones in the bile duct) are dangerous due to the possible development of inflammation of ducts, pancreatitis, obtuctive jaundice. Often, large accumulations of concrections when moving become the cause of other dangerous complications:

• perforations - the gap of the gallbladder or ducts;
• peritonitis - inflammation of the peritoneum, resulting from the outpouring in her bile cavity.

Long-term stagnation of bile can lead to the occurrence of polyps organs and their malignancy (illustrative). Acute cholecystitis with the presence of stones serves as a reason for the urgent hospitalization and purpose of surgical treatment, but even the asymptomatic course of pathology does not exclude the possibility of carrying out the operation in the presence of the following testimony:

• risk of hemolytic anemia;
• a sedentary lifestyle, to exclude lying patients;
• jaundice;
• cholangitis - inflammation of intrahepatic or biliary ducts;
• cholesteroz - disruption of metabolic processes and accumulation on the walls of the gallbladder cholesterol;
• calcine is a cluster on the walls of the organ of calcium salts.

Indications for the removal of gallbladder

Initially, the concrections formed in the bowels of the gallbladder have small dimensions: from 0.1 to 0.3 mm. They can come out independently when conducting physiotherapy or drug treatment. If these methods turned out to be ineffective, with time the size of the stones increases (some concrections can reach in diameter 5 cm). They are no longer able to be painlessly pass through bile ducts, so doctors prefer to resort to removal of the body. Other indications for the purpose of the procedure are:

• the presence of sharp stones that increase the risk of perforation of the organ or its parts;
• mechanical jaundice;
• sharp clinical symptoms - severe pain, increase in body temperature, diarrhea, vomiting;
• narrowing of biliary tract;
• anomalies of the anatomical structure of the organ;
• patient desire.

Contraindications

Cholecystectomy has common and local contraindications. If you need an emergency operational intervention, which arose in mind the threat of a person's life, some of them are considered relative and may not be taken into account by the surgeon, since the benefits of treatment exceeds possible risks. Common contraindications include:

• acute myocardial infarction - the defeat of the heart muscle caused by circulatory disorder due to thrombosis (blockage) of one of the arteries;
• stroke - acute violation of cerebral circulation;
• hemophilia - a violation of blood coagulation;
• peritonitis - inflammation of the abdominal cavity of a large area;
• obesity 3 and 4 degrees;
• the presence of a pacemaker;
• gallbladder cancer;
• malignant tumors on other organs;
• other diseases of the internal organs in the decompensation stage;
• pregnancy in late dates.

Local contraindications are relative and under certain circumstances may not be taken into account. These restrictions include:

• inflammation of the gall duct;
• ulceal duodenal or stomach disease;
• cirrhosis of the liver;
• atrophy of the gallbladder;
• acute pancreatitis - inflammation of the pancreas;
• jaundice;
• adhesive disease;
• calcification of the walls of the organ;
• large hernia;
• pregnancy (1 and 2 trimester);
• abscess in the field of biliary tract;
• acute gangrenous or perforated cholecystitis;
• surgical intervention on the abdominal cavity organs conducted by laparotomic access.

Types of surgical intervention and their features

Cholecystectomy can be carried out by a classic way (with the help of a scalpel) or using minimally invasive techniques. The choice of the method depends on the state of the patient, the nature of the pathology, equipping the medical center. Each method has its advantages and disadvantages:

• The strip or open operation to remove the gallbladder is a median laparotomy (incision of the front abdominal wall) or oblique cuts under the rib arc. This type of surgical intervention is shown in acute peritonitis, complex lesions of biliary tract. During the procedure, the surgeon has good access to the affected body, it can consider in detail the location of its location, assess the state, and the bile ducts. The minus is the risk of developing complications and cosmetic skin defects (scars).
• Laparoscopy is the newest method of surgery, due to which the removal of stones occurs after 2-4 small lanes (0.5-1.5 cm) on the abdominal wall. The procedure is a "gold standard" treatment of chronic cholecystitis, an acute inflammatory process. With laparoscopy, the surgeon has limited access, so it cannot assess the state of the internal organs. The advantages of minimally invasive techniques are considered:

1. minimum pain in the postoperative period;
2. fast disability;
3. reducing the risk of early postoperative complications;
4. reducing the number of days in the hospital;
5. minimum cosmetic defects on the skin.

• Mini-access cholecystectomy is a single laparoendoscopic access method through the navel or the zone of right hypochondrium. Such actions are carried out with the minimum number of stones and the absence of complications. The pros and cons of cholecystectomy are completely coincided with standard laparoscopy.

Preparation for the operation

Before holding any kind of cholecystectomy in the hospital, a surgeon and anesthesiologist are visited. They tell how the procedure will be held, about the anesthesia used, possible complications and take written consent to treatment. To begin preparations for the procedure is desirable before hospitalization in the department of gastroenterology, clarifying the doctor with a recommendation on a diet and lifestyle, to pass tests. This will help easier to transfer the procedure.

Preoperative

To clarify possible contraindications and achieve the best results of treatment, it is important not only to properly prepare for the procedure, but also to undergo a survey. The preoperative diagnostics includes:

• General, biochemical analysis of blood and urine - rent in 7-10 days.
• Clarifying the analysis of the blood group and the Rh factor - for 3-5 days before the procedure.
• Study on syphilis, hepatitis C and B, HIV - 3 months before cholecystectomy.
• Coagulogram - tests for the study of the hemostasis system (blood clotting analysis). It is more often carried out in conjunction with common or biochemical analyzes.
• Ultrasound of the gallbladder, biliary tract, abdominal organs - 2 weeks before the procedure.
• Electrocardiography (ECG) - diagnosis of pathologies from the cardiovascular system. It is carried out in a few days or a week to cholecystectomy.
• Fluorography or radiography of the chest organs - helps to identify pathology from the heart, lungs, diaphragms. Rent for 3-5 days to cholecystectomy.

Only those people are allowed to cholecystectomy, the results of the analyzes of which are within the normal range. If diagnostic tests revealed deviations, you must first undergo a course of treatment aimed at normalizing the state. Parts of patients, in addition to general analyzes, it may be needed to consult narrow specialists (cardiologist, gastroenterologist, endocrinologist) and refinement of the state of biliary tract with ultrasound or x-ray with contrast.

Since hospitalization

After hospitalization, all patients, with the exception of those who need emergency operational intervention, undergo preparatory procedures. General steps include compliance with the following rules:

1. On the eve before holding cholecystectomy, the patient prescribed light food. The last time you can eat no later than 19.00. On the day of the procedure, it is worth abandoning any food and water.
2. On the eve of the evening you need to take a shower, if necessary, shave your hair from the abdomen, make a cleansing enema.
3. The day before the procedure, the doctor may assign light laxatives.
4. If you take any medications, you should clarify the doctor about the need for their cancellation.

Anesthesia

For cholecystectomy uses general (endotracheal) anesthesia. With local anesthesia, it is impossible to fully control the breathing, to stop the pain and sensitivity of the tissues, relax muscles. Preparation for endotracheal anesthesia consists of several stages:

1. Before the operation, the patient gives soothing means (tranquilizers or medications with an anxiolytic effect). Thanks to the stage of premedication, a person comes to surgical interference calmly, in a balanced state.
2. In front of cholecystectomy, an introductory introduction of anesthesia is carried out. For this, the sedative means for falling asleep prior to the start of the main stage of the procedure.
3. The third stage is the provision of muscle relaxation. For this, minelaxants are introduced intravenously - drugs that voltage and contribute to relaxing smooth muscles.
4. At the final stage, the intubation tube is introduced through the larynx and it is connected to an end to the artificial ventilation of the lungs.

The main advantages of endotracheal anesthesia are maximum safety for the patient and control over the depth of drugs. The ability to wake up during surgery is reduced to zero, as if eliminating the possibility of failures in the operation of the respiratory or cardiovascular system. After leaving the anesthesia, there may be a confusion of consciousness, moderate dizziness, headache, nausea.

How does cholecystectomy occur

The stages of cholecystectomy may differ slightly, depending on the selected methods of excision of the gallbladder. The choice of the method remains behind the doctor who takes into account all possible risks, the condition of the patient, the size and features of the stones. All surgical interventions are held only with the written consent of the patient and under general anesthesia.

Laparoscopy

Operations on the organs of the abdominal cavity through punctures (laparoscopy) today are not considered rare or innovative. They are recognized as the Gold Standard of Surgery and are used to treat 90% of diseases. Such procedures are held in a short time and suggest minimal blood loss for the patient (up to 10 times less than with the usual method of surgery). Laparoscopy passes according to the following scheme:

1. The doctor completely disinfects the skin, at the point of puncture with special chemical reagents.
2. On the front abdominal wall, 3-4 deep outbreaks are made about 1 cm long.
3. Then, with the help of a special device (laparoplator), carbon dioxide is pumped under the abdominal wall. Its task is to raise the peritoneum, while expanding the operational field viewing zone.
4. Through other cuts, light source and special laparoscopic devices are introduced. Optics are connected to the camcorder, which transmits a detailed color image of the organ to the monitor.
5. The doctor controls his actions, looking at the monitor. Using tools, it cuts out the artery and bubble duct, then the organ itself removes.
6. Drainage is put on the site of the exchanger body, all bleeding wounds are migrated to electric shock.
7. At this stage, laparoscopy is completed. The surgeon removes all the instruments, sews or strips the place of puncture.

Extensive operation

Open surgical intervention today is extremely rare. Indications for the appointment of such a procedure are: Spike organ with nearby soft tissues, peritonitis, complex lesions of biliary tract. Live operating is carried out according to such a scheme:

1. After the patient's introduction into a medical sleep state, the surgeon is disinfected by surface tissues.
2. Then a small incision is performed about 15 cm long on the right side.
3. Neighboring organs are forcibly moved to ensure maximum access to the damaged zone.
4. Special clips (clips) are put on artery and bubble ducts that prevent the fluid outflow.
5. The damaged organ is separated and removed, the processing of the organ layer is treated.
6. If necessary, impose drainage, and an incision is sewn.

Cholecystectomy minidosta

The development of a single laparoendoscopic access method allowed surgeons to conduct operations on excision of internal organs, reducing the number of operating access. Such a method of surgical intervention has become very popular and is actively used in modern surgery clinics. The operation of the operation of the minidostype consists of the same stages as standard laparoscopy. The only difference is to remove the damaged organ, the doctor makes only one puncture 3-7 cm under the right edge arc or by introducing instruments through a navel ring.

How much does the operation last

Cholecystectomy is not considered a complex surgical procedure, which would require long-term manipulations or attracting several surgeons. The duration of the operation and the period of location in the hospital depends on the selected method of operational intervention:

• Laparoscopy on average leaves one to two hours of time. Stay in the hospital (if in the course of the operation or after it did not arise complications) is 1-4 days.
• The operation of the minidostype lasts from 30 minutes to one and a half hours. After surgery, the patient remains under the supervision of doctors for another 1-2 day.
• Open cholecystectomy takes from one and a half to two hours of time. After the operation, a person spends at least ten days in the hospital, provided that there was no complications during the procedure or after it. It takes up to three months to complete rehabilitation. Surgical seams are deleted in 6-8 days.

Postoperative period

If drainage was installed during the operation, it is removed the day after the procedure. Before removing the seams, the skin is drawing daily and treated with antiseptic solutions. The first few hours (from 4 to 6) after cholecystectomy should be refrained from meals, drink, is forbidden to get up from bed. A few days later, small walks on the ward, eating and water are allowed.

If the procedure has passed without complications, the unpleasant feelings are minimized and more often associated with the disorder from anesthesia. Light nausea, dizziness, feeling of euphoria are possible. Pain after cholecystectomy occurs when choosing an open method of surgical intervention. Analgesics are prescribed to eliminate this unpleasant symptom, no more than 10 days. After laparoscopy pain in the abdominal area is quite tolerant, so most patients do not need to appoint painkillers.

Since the operation involves excision of an important body that takes direct participation in the process of digestion, the patient is appointed a special healing table No. 5 (liver). Diet must be strictly observed throughout the first month of rehabilitation, then the diet can be gradually expanding. At first, after cholecystectomy, it is worth limiting physical activity, not to perform exercises that require the tension of the muscles of the press.

Rehabilitation and recovery

Return to the familiar lifestyle for the patient after laparoscopy occurs quickly and without complications. On the full restoration of the body leaves 1 to 3 months. When choosing an open strength excision method, the rehabilitation period is delayed and is about six months. Good health and ability to return to the patient in two - three weeks after treatment. Starting from this period, you must follow the following rules:

• For a month (at least three weeks), it is necessary to adhere to peace, to observe the bed regime, combining half an hour of loads and 2-3 hours of rest.
• Any sports training or increased physical exertion is allowed not earlier than three months after the open operation and 30 days after laparoscopy. Starting with minimal loads, avoiding exercises on the press.
• During the first three months, not lifting weights more than three kilograms, starting from the fourth month - no more than 5 kg.
• To accelerate the healing of postoperative wounds, it is recommended to undergo a course of physiotherapy procedures, take vitamin preparations.

Diet pattern

On the eighth-ninth day, if the operation has passed successfully, the patient is discharged from the hospital. At this rehabilitation stage it is important to establish proper nutrition of the house, according to the therapeutic table No. 5. There is a fractional, preferred by dietary products. All daily food must be divided by 6-7 servings. Daily calorie dishes: 1600-2900 kcal. It is desirable at one time that bile was developed only during food. The last meal must be no later than two hours before sleep.

To dilute the concentration of bile during this period, doctors recommend a lot of drinks - up to two or two and a half liters of fluid per day. It may be a broth of richness, non-acidic sterilized juices, non-carbonated mineral water. The first few weeks under the ban are all fresh fruits and vegetables. After two months, the diet can be gradually expanding, making focus on protein food. Preferred culinary processing of dishes - cooking, cooking for a pair, extinguishing without fat. All food must be neutral (about 30-40 degrees): not too hot or cold.

What you can eat if the gallbladder is removed

The diet should be built so that the body is easier to cope with the incoming food. A day is allowed to eat no more than 50 grams of creamy oil or 70 grams of vegetable, all other animal fats are preferably completely eliminated. The total bread rate is 200 grams, preference is worth giveing \u200b\u200bproducts from whole grain flour with the addition of bran. The basis of the diet after the operation to remove the gallbladder should be the following products:

• low-fat varieties of meat or fish - turkey fillets, chicken, beef, pike perch, heck, perch;
• semi-liquid porridges from any croup - rice, buckwheat, mankey, oats;
• vegetable soups or first dishes on broth from lean chicken, but without frying onion with carrots;
• vegetables cooked for a pair, stewed or boiled (allowed after a month of rehabilitation);
• degreased dairy or fermented milk products - kefir, milk, prostrochash, yogurt without dyes or food additives, cottage cheese;
• non-acid berries and fruits;
• jam, jam, mousse, souffle, jelly, up to 25 grams of sugar per day.

List of prohibited products

To maintain the digestive system from the diet, it is worth completely eliminating fried dishes, pickled foods, sharp or smoked food. Under the absolute ban are:

• fat meat - goose, lamb, duck, pork, fat;
• fish - Salmon, Salmon, Mackerel, Kambala, Kilka, Sardines, Haltus, Som;
• fatty milk foods;
• meat broths;
• ice cream, drinks with ice, soda;
• alcohol;
• preservation;
• mushrooms;
• raw vegetables;
• acidic vegetable puree;
• chocolate;
• sdob, confectionery, pastries;
• by-products;
• acute seasonings or sauces;
• cocoa, black coffee;
• fresh wheat and rye bread;
• sorrel, spinach, onions, garlic.

The consequences of cholecystectomy

After laparoscopic removal of the organ in some patients, postcholycystectomic syndrome is manifested with a periodic emergence of such unpleasant sensations as nausea, heartburn, meteorism, diarrhea. All the symptoms are successfully fixed by a diet, taking digestive enzymes in tablets and antispasmodics (if necessary to eliminate pain syndrome).

It is impossible to reliably establish other consequences after removing the gallbladder with stones, but the patient will definitely inform possible problems and give recommendations for their elimination. More often arise:

• Digestion disorder. Normally, the bile is produced in the liver, then enters the gallbladder, where accumulates and becomes more concentrated. After removing the accumulating organ, the liquid directly enters the intestines, while its concentration is lower. If a person to eat big portions, the bile cannot immediately process all the food, because of what happened: a feeling of gravity in the stomach, bloating, nausea.
• Risk of recurrence. The absence of a gallbladder is not a guarantee that new stones will not appear again after a while. You can solve the problem by observing a diet, reducing the consumption of cholesterol, leading an active lifestyle.
• Excess bacterial growth in the intestine. Concentrated bile not only better digest food, but also destroys some of the harmful bacteria and microbes living in the duodenum. The bactericidal effect of the liquid flowing directly from the liver is much weaker. Hence many patients after removing the bubble, frequent constipation, diarrhea, flatulence are concerned.
• Allergy. After the operation, the digestion system undergo a number of changes: the motor function of the gastrointestinal tract slows down, the composition of the flora changes. These factors can serve as a starting mechanism for the development of allergic reactions to some food, dust, pollen. Allergothes are carried out to identify the stimulus.
• Stast bile. Eliminated using a safe procedure - duodenal probing. A special tube is introduced through the esophagus through which a solution that helps speed up the brying is entered.

Possible complications

In most cases, surgical treatment is successful, which allows the patient to quickly recover and return to a normal lifestyle. Unforeseen situations or worsening of well-being are more often found at a curriculous method of surgery, but also complications after removing the gallbladder, the laparoscopic method is not excluded. Among possible consequences allocate:

• Damage to the internal organs, internal bleeding during damage to blood vessels. More often occurs at the site of the introduction of a trocar (laparoscopic manipulator) and stops using the applies of seams. Sometimes bleeding is possible from the liver, then resort to the method of electrocoagulation.
• Damage to ducts. It leads to the fact that in the abdominal cavity begins to accumulate bile. If damages were noticeable at the laparoscopy stage, the surgeon continues the operation in the open method, otherwise it is necessary to need re-surgical intervention.
• Putting the postoperative seam. Complication occurs very rarely. Antibiotics and antiseptic drugs are prescribed to relieve suppuration.
• Subcutaneous emphysema (accumulation of carbon dioxide under the skin). It often occurs in obese patients due to the contact of the tube is not in the cavity of the belly, but under the skin. The gas is removed after the operation with the needle.
• Thromboembolic complications. It is extremely rare and lead to thrombosis of the pulmonary arteries or the lower hollow vein. The patient is assigned to the bed mode and the reception of anticoagulants - drugs that reduce blood coagulation.

Medical treatment during relapses

To maintain the functionality of the gastrointestinal tract, medical therapy is prescribed prevention of congestion phenomena. Treatment After removal of the gallbladder involves the use of the following groups of drugs:

• Enzymes - help to split food, improve the work of the digestive system, stimulate the production of the pancreas. As part of such drugs there are pancreas enzymes, splitting proteins, fats and carbohydrates. Enzyme preparations are well tolerated, and by-phenomena (constipation, nausea, diarrhea) occur extremely rarely. Popular tablets include:

1. Mezim (1 tablet while eating);
2. Festal (1-2 tablets before or after meals);
3. Libil (1-3 tab. After meals);
4. Enterosan (1 capsule 15 minutes before meals);
5. Hepatosan (1-2 capsules 15 minutes before meals).

• The choleretic means - protect the liver from the stagnation of the hepatic secret, normalize the digestion and work of the intestine. Most of these medicines have a plant basis and rarely cause side effects. Popular medicines with choleretic agents include:

1. Swivel (1 tablet 1-3 times a day);
2. Cyciscovalon (0.1 grams 4 times a day);
3. Allohol (1-2 tablets 3-4 times a day);
4. Osalmid (1-2 tablets 3 times a day).

• Litholitic medicines (hepatoprotectors) - restore damaged liver cells, enhance the production of bile, dilute and improve its composition. Such medicines have proven well:

1. URSOFALK (patients with weight up to 60 kg 2 capsules per day, over 60 kg - 3 cap.);
2. Ursosan (10-15 mg of preparation per day).

How much is the operation on the bustling bubble

The price of the procedure depends on the equipment used, the complexity of surgical manipulations and qualifications of the doctor. The cost of the procedure may vary depending on the patient's residence region. Emergency cholecystectomy is carried out for free, regardless of citizenship and place of residence of the patient. Approximate prices for procedures in Moscow are presented in the table:

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The removal of the gallbladder is considered one of the most frequent operations. It it is shown in gallstone disease, acute and chronic cholecystitis, polyps and neoplasms. The operation is carried out open access, miniinvasive and laparoscopically.

The gallbladder is an important digestive organ that serves as a bile reservoir required to digest food. However, it often creates significant problems. The presence of stones, the inflammatory process provoke pain, discomfort in the hypochondrium, dyspepsia. Often pain syndrome is so pronounced that sicks are ready once and forever get rid of the bubble, just not to experience more torment.

In addition to subjective symptoms, the defeat of this body can cause serious complications, in particular, peritonitis, cholangitis, bile colic, jaundice, and then there is no choice - the operation is vital.

Below, let's try to figure out when you need to remove the gallbladder, how to prepare for operations, what kind of interventions are possible and how to change your life after treatment.

When do you need an operation?

Regardless of the view of the planned intervention, whether it is a laparoscopy or a strip removal of a gallbladder, indications To surgical treatment are:

• Cholelithiasis.
• Acute and chronic inflammation of the bubble.
• Cholestrosis with impaired jelly function.
• Polyposis.
• Some functional disorders.

cholelithiasis

Cholelithiasis It is usually the main reason for most cholecystectomy. This is due to the fact that the presence of stones in the bustling bubble often causes the bouts of bile colic, which is repeated more than 70% of patients. In addition, concrections contribute to the development and other hazardous complications (perforation, peritonitis).

In some cases, the disease proceeds without sharp symptoms, but with severity in the hypochondrium, dyspeptic disabilities. These patients also need an operation that is carried out in a planned manner, and its main goal is to prevent complications.

Bile stones Can be found in ducts (choledocholitiasis), which is a danger due to possible obtuctive jaundice, inflammation of ducts, pancreatitis. The operation is always complemented by drainage of ducts.

The asymptomatic course of gallstone disease does not exclude the possibility of an operation that becomes necessary in the development of hemolytic anemia, when the size of the stones exceeds 2.5-3 cm in connection with the possibility of laying out, with a high risk of complications in young patients.

Cholecystitis

Cholecystitis - This is the inflammation of the wall of the gallbladder, flowing acutely or chronically, with relapses and improvements that reduce each other. Acute cholecystitis with the presence of stones serves as a reason for an urgent operation. The chronic course of the disease allows its planning, possibly - laparoscopically.

Cholesteroz Long flows asymptomatic and can be detected by chance, and by the indication to cholecystectomy, it becomes when it causes symptoms of the damage to the gallbladder and the violation of its function (pain, jaundice, dyspepsia). If there are stones, even asymptomatic cholesterosis serves as a reason for the removal of the body. If calcine occurred in the gallbladder, when calcium salts are laid in the wall, the operation is carried out at mandatory.

The presence of polyps It is fraught with light quality, therefore the removal of the gallbladder with polypami is necessary if they exceed 10 mm, have a thin leg, combined with a biliary disease.

Functional disorders Jellery usually serve as a reason for conservative treatment, but abroad such patients are nevertheless operated due to painful syndrome, reducing the ejection of bile in the intestines and dyspeptic disorders.

To cholecystectomy operation, there are contraindications, which can be common and local. Of course, if necessary, urgent surgical treatment in view of the patient's life threat, some of them are considered relative, since the benefits of treatment are incommensurable above the possible risks.

TO common contraindications These are terminal states, a heavy decompensated pathology of internal organs, exchange violations that may complicate the operation, but they will close the eye on them, if the patient needs to be preserved.

Common contraindications to laparoscopy The diseases of the internal organs in the decompensation stage, peritonitis, a long time pregnancy, hemostasis pathology, are considered.

Local restrictions Relatively, and the possibility of a laparoscopic operation is determined by the experience and qualifications of the doctor, the presence of appropriate equipment, readiness not only a surgeon, but also a patient to go for a certain risk. These include adhesive disease, calcification of the wall of the gallbladder, sharp cholecystitis, if more than three days, pregnancy I and III, trimester, large hernia passed from the beginning of the disease. If it is impossible to continue the operation laparoscopically, the doctor will be forced to go to harsh intervention.

Types and features of gallbladder removal operations

Gallbladder Removal Operation It can be carried out both classically, in an open method, and with the involvement of minimally invasive techniques (laparoscopically, from a minidostype). The choice of the method determines the patient's condition, the nature of the pathology, the discretion of the doctor and equipping the medical institution. All interventions require general anesthesia.

left: Laparoscopic cholecystectomy, Right: Open operation

Open operation

The long-distance removal of the gallbladder implies the median laparotomy (access along the middle line of the abdomen) or oblique cuts under the rib arc. At the same time, the surgeon has good access to the bustling bubble and ducts, the ability to examine them, measure, signal, explore using contrasting substances.

The open operation is shown in acute inflammation with peritonitis, complex lesions of biliary tract. Among the deficiencies of cholecystectomy, this method can be indicated by a large operational injury, a bad cosmetic result, complications (disorder of intestinal work and other internal organs).

The course of the open operation includes:

1. Incision of the front wall of the abdomen, revision of the affected area;
2. Selection and dressing (or clipping) of bubble duct and artery, blood supplying gallbladder;
3. Separation and removal of the bubble, processing of the organ layer;
4. The imposition of drainage (according to indications), the embedding of the operating room.

Laparoscopic cholecystectomy

The laparoscopic operation is recognized as the "gold standard" treatment with chronic cholecystitis and bile disease, serves as a choice of acute inflammatory processes. The undoubted advantage of the method consider small operational injury, a short period of recovery, a slight pain syndrome. Laparoscopy allows the patient to leave the hospital already 2-3 days after treatment and quickly return to a familiar life.

Stages of laparoscopic operation include:

• Pulp the abdominal wall, through which instruments (trocars, video cameras, manipulators) are introduced;
• Discharge in the belly of carbon dioxide to provide a review;
• Clipping and cutting off the bubble duct and artery;
• Removing the gallbladder from abdominal cavity, tools and suturing holes.

The operation lasts no more than an hour, but perhaps longer (up to 2 hours) in the difficulties of access to the affected area, anatomical features, etc. If there are stones in the bustling bubble, they will be blocked before the extraction of the organ into smaller fragments. In some cases, upon completion of the operation, the surgeon establishes drainage in the sunset space to provide fluid outflow, which may be formed due to the operating injury.

Video: Laparoscopic cholecystectomy, operation

Cholecystectomy minidosta

It is clear that most patients would prefer a laparoscopic operation, but it can be contraindicated under a number of states. In such a situation, specialists resort to mini-invasive techniques. Cholecystectomy has a mini-savageous one as the average between the extension operation and laparoscopic.

The course of intervention includes the same stages as the other types of cholecystectomy:forming access, dressing and intersection of duct and artery with subsequent removal of the bubble, and the difference is that for these manipulations, the doctor uses a small (3-7 cm) incision under the right edge arc.

gallbladder Removal Stages

The minimum incision, on the one hand, is not accompanied by a large trauma of belly tissues, on the other, gives a sufficient overview of the surgeon to assess the state of the organs. This operation is especially indicated by patients with a strong adhesive process, inflammatory tissue infiltration, when the introduction of carbon dioxide and, accordingly, laparoscopy is impossible.

After a 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 an open operation. The postoperative period proceeds easier than after long cholecystectomy, and the patient returns home to the usual affairs.

Each patient, suffering from one or another disease of the gallbladder and ducts, most of all is interested in how the operation will be carried out, wanting it to be the least traumatic. There may be no definite answer in this case, because the choice depends on the nature of the disease and many other reasons. So, with peritonitis, acute inflammation and severe forms of pathology, the doctor is most likely forced to go on the most traumatic open operation. In case of adhesive process, mini-invasive cholecystectomy is preferable, and if there are no contraindications to laparoscopy - laparoscopic technique, respectively.

Preoperative preparation

For the best result of treatment, it is important to carry out adequate preoperative preparation and examination of the patient.

To this end, they are carried out:

1. General and biochemical blood tests, urine, research on syphilis, hepatitis B and C;
2. Coagulogram;
3. Clarification of blood group and rear factor;
4. Ultrasound of the gallbladder, biliary tract, abdominal organs;
5. Radiography (fluorography) of the lungs;
6. According to indications - fibrogastroscopy, colonoscopy.

Parts of patients need consultation of narrow specialists (gastroenterologist, cardiologist, endocrinologist), all - therapist. To clarify the state of the biliary paths, additional studies are carried out using ultrasound and X-ray-contrast techniques. The heavy pathology of the internal organs should be maximally compensated, the pressure should be put back to normal, control blood sugar levels in diabetics.

Preparations for the operation from the moment of hospitalization includes the admission of light food on the eve, a complete refusal of food and water from 6-7 in the evening before the operation, and in the evening and in the morning before intervention, the patient spend a cleansing enema. In the morning you should take a shower and change clothes into clean clothes.

If it is necessary to perform an urgent time operation for examinations and training is significantly less, therefore the doctor is forced to limit oneself to generally clinical surveys, ultrasound, diverting on all procedures for no more than two hours.

After operation…

The time spent in the hospital depends on the type of operation produced. With open cholecystectomy, the seams are removed in about a week, and the duration of hospitalization is about two weeks. In the case of laparoscopy, the patient is written out after 2-4 days. Disability is restored in the first case for one to two months, in the second - up to 20 days after the operation. Hospital sheet is issued for the entire period of hospitalization and three days after discharge, further - at the discretion of the doctor's clinic.

The next day, the drainage is removed after the operation, if so was installed. This procedure is painless. Before removing the seams, they are treated daily by solutions of antiseptics.

The first 4-6 hours after removing the bubble should be refrained from making food and water, do not get out of bed. After this time, you can try to get up, but carefully, because after anesthesia, dizziness and fainting are possible.

With pain after surgery, it may hardly face every patient, but intensity is different in different approaches of treatment. Of course, to expect painless healing of a large wound after an open operation, and pain in this situation is the natural component of the postoperative state. Analgesics are appointed to eliminate it. After laparoscopic cholecystectomy, the soreness is less and completely tolerant, and most patients do not need painkillers.

A day after the operation, it is allowed to get up, walk around the ward, take food and water.Of particular importance is the power mode after the removal of the gallbladder. In the first few days, you can eat porridge, lightweight soups, fermented milk products, bananas, vegetable purees, low-fat boiled meat. Coffee, strong tea, alcohol, confectionery, fried and sharp foods are strictly prohibited.

Since after cholecystectomy, the important organ accumulating and timely allocating bile, he will have to adapt to the changed digestive conditions. Diet after removing the gallbladder corresponds to the table number 5 (hepatic). It is impossible to use fried and fatty products, smoked and many spices, requiring enhanced selection of digestive secrets, are prohibited canned food, marinades, eggs, alcohol, coffee, sweets, oily creams and butter.

First month after surgery It is necessary to adhere to 5-6 one-time nutrition, taking food in small portions, water needs to drink up to one and a half liters per day. It is allowed to eat white bread, boiled meat and fish, porridge, kissels, fermented dairy products stewed or cooked for a couple of vegetables.

In general, life after removing the gallbladder does not have significant limitations, 2-3 weeks after treatment, you can return to the usual way of life and work. The diet is shown in the first month, then the diet gradually expands. In principle, it will be possible everything, but do not get involved in products requiring increased berevel (fatty, fried dishes).

In the first month after the operation, it will be necessary to somewhat limit and physical activity, not to lift more than 2-3 kg and do not exercise, requiring the stress of the abdominal muscles. During this period, a scar is formed, with which limitations are connected.

Video: Rehabilitation after cholecystectomy

Possible complications

Typically, cholecystectomy proceeds quite safely, but some complications are possible, especially in senior patients, in the presence of severe concomitant pathology, with complex forms of damage to biliary tract.

Among the consequences allocate:

• Binding postoperative seam;
• Bleeding and abdominal abscesses (very rarely);
• Abstraction of bile;
• Damage to bile ducts during the operation;
• Allergic reactions;
• Thromboembolic complications;
• The aggravation of other chronic pathology.

The absenteeism of open interventions is often becoming a sleeping process, especially with common inflammation forms, acute cholecystitis and cholangitis.

Today, laparoscopic operations are not at all innovation for our society. In case of surgical treatment, the laparoscopy of the gallbladder takes 50-90% of all such cases. The article is closer to get acquainted with the concept of such an operation, as it is carried out than it is useful for human health.

What it is?

Laparoscopy is a highly efficient, safe and little traumatic method of surgical intervention in the internal organs. For this reason, the treatment of bile-name illness has long been a regular daily operation for a long time.

What is such treatment? In everyday life, it is understood to carry out operational therapy, during which a person remove a cut-off gallbladder along with the concretions formed in it using an important device - laparoscope.

Today, there are practically no operations so that the body can be preserved and remove only numerous biliary concrections. If the stones are single, then other ways are applied to their removal, such as:

• Dissolving using drugs;
• Crushing with laser equipment;
• Shock wave litholripsy.

During such methods of treatment, dissolved stones out of the body naturally.

It should be better to understand what laparoscopic treatment of the gallbladder should first get acquainted with the fact that this therapy differs from Laparotomy. Read the basic principles.

Laparoscopy

This type of surgical treatment is performed using auxiliary tools:

• Apparatus - laparoscope;
• Manipulators in the form of trocars.

What is laparoscope? This is a kind of device, where the flashlight is built into to illuminate the place of work and the camcorder. Camera Surgeon introduces to the abdominal space to the patient, making a pre-small incision (1cm) in it.

During the operation, all its manipulations are visible on the screen, thanks to the camcorder. It helps the doctor to follow their actions. Plus here is that there is no direct contact with a removable patient, but only visual contact.

The surgeon manages the necessary tools to operation by means of trocars. This is nothing more than hollow tubes, which are also introduced through punctures in the abdominal space. They are necessary to deliver the necessary tool to the remote control. On the tubes there are devices - manipulators, with their help the doctor can be moved to the tool inside the abdomen.

In short, the entire process of laparoscopic operation The doctor conducts, managing only three tubes:

• The first tube introduces a camcorder to issue a picture on the screen;
• Two other tubes are needed to work through them by a surgical instrument.

All stages of both operational interventions and their essence are completely identical.

Lapotomy

This is the most ordinary extension operation that the surgeon carries out, making a large and deep cut in the abdominal cavity (anterior part) with a scalpel. Through an incision, the doctor introduces tools and removes the patient's patient.

Laparotomy means the following: "Lapy" is a stomach, and "Tomia", it means to cut.

Indications and contraindications to laparoscopy

In medical practice, it is quite often possible to meet the diseases of the gallbladder. There are many reasons for this, for example:

• Unfavorable environmental data;
• Frequent stressful states;
• A man in abundance is eating fatty food, and even poor quality.

All this, in turn, leads to the development of various pathologies, and as a result of this, the gallway disease is developing. If the presence of this ailment does not affect the functionality of the human body, conservative treatment may be appointed.

Consider which indications may be to carry out laparoscopy, and in what cases this type of treatment is not shown to the patient.

Preparation for the operation

Before prompt intervention, which will be carried out according to the plan, the patient should be passed to the laboratory necessary assays:

• Blood - general and biochemical analysis, for the presence of jaundice of various types, AIDS, blood type, rhesus;
• Urinary liquid;
• Coagulogram;
• Electrocardiogram;
• Women hand over a vaginal smear.

If the results of the studies are quite normal, then the patient can be operated. If unacceptable deviations were found, it will be necessary to undergo therapeutic therapy to normalize the state.

Opinion expert

Shoshorin Yuri.

Doctor Therapist, Site Expert

On the eve of operational intervention, every meal should be stopped from 18:00, and the liquid stop drinking from 22:00. Late in the evening, duty medical staff Patient puts the belly to purify the intestine. Today it is practiced to take a strong laxative, but not everyone is shown.

How is the operation going

Before the start of the laparoscopic procedure to remove the gallbladder, he is introduced anesthesia to relieve painful sensations and sensitivity of tissues. In addition, anesthesia leads to a relaxed state of muscle tissue of the abdominal press.

After the introduction of anesthesia, the anesthesiologist patient in the patient inserts the probe through the mouth to remove the gastric gases and the remaining liquid. This will help prevent a random vomit reflex so that asphyxia is not rushing. The probe is removed after the operation.

As soon as the probe is installed, a mask for artificial lung ventilation is installed on the bottom of the patient's face. Through it, a person breathes during surgery. With laparoscopy, ventilation is simply necessary, since the gas smoke serves in the abdominal space. He presses on the diaphragm, pressing the lungs.

After all these preparatory procedures, the nurse processes the antiseptic the desired zone, and then the surgeon with assistants proceeds to the surgical procedure. It makes 3 knives - one near the navel and two on the sides of the right hypochondrium. Carbon dioxide for disrupting the internal organs so that they do not interfere with the surgical process.

A laparoscope, video camera with illumination and other important trocacars are introduced through the cuts. Inside the abdominal space, the surgeon is manipulated on the necessary parties, as a result of which the gallbladder is unsuitable for normal functioning. Removal occurs through a cosmetic incision made near Pup.

At the end of the surgical process, the blood vessels coagulate coagulate, and an antiseptic solution is introduced into the abdominal cavity. With it, disinfection is carried out, after it is sucking. Troacaras are removed, and the doctor is sewn.

With the help of a laparoscopic access method can also be carried out with a hollyistic ectomy. With this procedure, a patient introduces general anesthesia, namely, it is mandatory to artificial ventilation of the lungs by connecting to the device.

A different anesthesia is called "Gas Impact". Anesthesia is supplied to the patient with the help of a device through a special tube, which he breathes during operational intervention.

The elimination of such anesthesia is the presence of bronchial asthma in the patient. In this case, endotracheal anesthesia is replaced by common intravenous anesthesia.

Effects

After a laparoscopic operation, as after any operational intervention, unpleasant consequences may arise, which deliver strong discomfort. The main trouble is the ejection of bile, falling directly into the 12th pans. This process in medicine is called "subsequent cholecystectomic syndrome".

At the same time, the diagnosis of the patient may be observed such symptoms:

• Vomit reflex and nausea;
• In some cases, an increase in temperature is observed;
• Soreness and rumbling in the stomach;
• Stomach disorder and meteorism;
• Bitterness with belching, heartburn;
• Jaundice.

Opinion expert

Shoshorin Yuri.

Doctor Therapist, Site Expert

Unfortunately, in some patients, even after a laparoscopic operation, these symptoms may appear during subsequent life. It is almost impossible to get rid of them from them.

Possible complications

Any unforeseen situations or complications may occur both in surgical intervention and after the operation.

With the laparoscopy of the gallbladder, the following complications may occur:

• At the abdominal wall, the doctor may damage the blood vessels;
• A puncture or damage to the laparoscope of the stomach, gallbladder and other nearby internal organs may occur;
• Bleeding can begin from the liver bed or the artery of the gallbladder.

A more difficult complication is eliminated already with another operation - laparotomy.

Due to the removal of the organ and nearby tissues in the patient, some complications may also be observed.

• If, after removing the gallbladder, his cult was poorly sewn, bile cavity could get into the abdominal cavity;
• Peritonitis;
• There was a fabric around the navel.

In very extreme cases, after laparoscopy, 5-7% of patients may have hernia. Most often it happens in people with a large body weight. Or this complication arises from those patients who had an operation in an emergency order, and not scheduled in advance.

Advantages and disadvantages

Consider how the laparoscopic method of removing the gallbladder is posted.

1. Laparoscopy is a closed technique, and due to this, during the operation, the interaction of internal organs and tissues is completely eliminated. There is also no risk of infection with infections.
2. To carry out this operation, it is required to make a small detection diameter. This in turn reduces the traumatic process of the operation.
3. After laparoscopy, scars are not formed, so cosmetic stomach will not suffer.
4. Short postoperative period, not more than 3 days.
5. Those who have no opportunity to skip the work may begin to begin to it in a week.

With all his advantages, such an operational intervention has a number of shortcomings. Read them.

1. If the patient has chronic diseases of the cardiovascular or respiratory system, then the laparoscopy is not shown. Since the operation in the abdominal cavity is introduced carbon dioxide, there is a risk of squeezing the lungs or hearts. This may lead to the fact that pressure will increase in the venous system, and there may be complications in the work of the heart. Or there will be strong pressure on the diaphragm, which makes it difficult to breathe.
2. Severally limited diagnostic manipulations and opportunities during the operation.
3. Laparoscopy is impossible to conduct if the patient has a situation too launched. In these cases, unexpected pathologies may occur in the bustling bubble, and additional adjustment of operational intervention will be required.

If there are at least one of these items, traditional laparotomy is carried out.

List of allowed and prohibited products

Permitted products are subjected to heat treatment - boiled, steamed or baked in the oven.

Ailments associated with a disorder in the work of the gallbladder cannot always be a conservative treatment. Launched cases require urgent surgery capable of facilitating the general condition of the patient. One of the most common and safe varieties of such operations is recognized as a gallbladder laparoscopy, which is of particular interest in the past few years.

Brief characteristic of medical manipulation

The laparoscopy of the gallbladder is called a standard operation, during which the patient is removed by a gallbubble with a special device - laparoscope. This type of surgical intervention has several advantages over laparotomy - open surgical procedure:

• a small probability of damage to other organs during the laparoscopy of the gallbladder;
• relatively short period of rehabilitation;
• lack of strong pain after surgery;
• fast restoration of the patient's ability to work;
• uncomplicated preparation stages;
• availability of 3-5 small minor scars;
• low risk of developing complications, etc.

It is worth noting that under this operation can also be implied and the usual seizure of stones from the gallbladder cavity: in this case, the body will not be deleted.

Since laparoscopy is a safer form of procedure, wearing a special bandage in the postoperative period is not required. Such a measure is often prescribed to patients of a large complex, which has a weakness of the abdominal muscles.

How long does the operation last?

Surgical intervention can be carried out for 35-120 minutes. The duration is determined by the qualifications of a specialist and the individual characteristics of the operated person. In most cases, doctors perform their work in 1 hour.

If, during laparoscopy, a doctor has significant difficulties with an elevation of the body, it can go to laparotomy (open manipulation)

Testimony and contraindications to conduct

The operation is assigned primarily to patients who are diagnosed:

• polyps on the bustling bubble;
• cholesterosis (cholesterol deposits in the organ);
• cholelithiasis;
• non-carbon or calculous cholecystitis;
• the narrowing of the paths involved in the removal of bile.

However, the list of contraindications is significantly wider, its composition includes:

• late time of pregnancy;
• the extreme stage of obesity;
• myocardial infarction;
• peritonitis (inflammatory process of the abdominal region);
• malignant education in the bustling bubble;
• intrahranny organ location;
• myrizzy syndrome;
• cirrhosis of the liver;
• previously transferred laparotomy of the organs of the abdominal region, etc.

Preparation

At first, the patient must pass the biochemical and general analysis of blood and urine, to determine the reserves factor and blood group, pass the coagulogram and ECG. An inspection on hepatitis, syphilis and HIV is also appointed.

In the case of chronic ailments, it is worth visiting the corresponding doctors that determine the nature of the flow of disease and their possible effect on the course of the operation. If the results of the study are satisfactory, the person is allowed to laparoscopy.

After 22:00 pm, on the eve of an important day, the patient is prohibited to eat and drink. A few hours before the operation, the intestine is cleared: a man is prescribed a laxative and enema. Additional measures are discussed with the attending physician.

How is the operation?

Laparoscopy is carried out according to a specific plan:

• the patient lying on the operating table is introduced into general anesthesia;
• using the probe from the stomach, various gases and liquids are removed;
• the device of artificial ventilation of the lungs is connected;
• the abdominal cavity operated is filled with carbon dioxide;
• next, surgeons make several small cuts through which special tools and trocar are introduced;
• a special camcorder transmits information about the bustling bubble and other organs on the monitor;
• the gall bubble is gentially cut off from the hepatic lodge and anatomical battles, and then removed from the cavity;
• an attentive inspection of all organs of the abdominal region and washing with an antiseptic;
• the seams are superimposed.

Features of postoperative nutrition

Since only 8-11 days after the laparoscopic operation, the liver is fully imposed on the function of the remote authority, it is necessary to take care of the observance of a special diet, which contributes to the rapid restoration of the internal balance.

1st day: With good health, the patient can afford non-carbonated clean water with small sips. 2nd day: a person is allowed to eat low-fat yogurt. Day 3: The diet includes unsweetened kissel, kefir with a small percentage of fatty and faint tea without sugar. 4th day: if the general condition of the patient is satisfactory, the consumption of bravery and freshly squeezed natural juices is allowed.

Day 5: The above-mentioned products join a small piece of boiled fish and liquid vegetable soups. 6-7th day: a person is allowed to eat low-fat cottage cheese, stale bread, chicken meat in crushed and puree from fruits. 8-9th day: Advanced dishes appear in the menu, for example, puree, low-fat soups with rice or pasta, bonds and cutlets cooked for a pair.

It should be borne in mind that food is better to take small portions: the time interval between the techniques should be 2-2.5 hours. It is also necessary to exclude nicotine, alcohol, fried food and fast food.

After the laparoscopy, a person must be gradually introduced into its diet of at least 2 liters of liquid (pure water, kissels, herbs and tea brands) to maintain the kidneys in good condition

Possible consequences

Like any operational intervention, laparoscopy in rare cases may cause complications. These include damage to the internal organs, subcutaneous emphysema (accumulation of gas elements under the skin), inflammation in the scope of the seams, peritonitis, omphalitis, bleeding. When a patient is found in a patient such anxiety, doctors take appropriate countermeasures to eliminate side effect.

Thank you

The site provides reference information solely to familiarize yourself. Diagnosis and treatment of diseases must be under the supervision of a specialist. All drugs have contraindications. Consultation of a specialist is obligatory!

Gallbladder laparoscopy - definition, general characteristics, types of operations

That is, the "gallbladder laparoscopy" is, first of all, a surgical operation, during which either a complete removal of the entire organ, or the deserted stones available in it. A distinctive feature of the operation is access, with which it is made. This access is carried out using a special apparatus - laparoscopeand therefore called laparoscopic. Thus, the laparoscopy of the gallbladder is a surgical operation carried out using a laparoscope.

To clearly understand and imagine what the differences between the usual and laparoscopic surgical surgical operation are, it is necessary to present the course and essence of both techniques in general.

So, the usual surgery on the abdominal organs, including the bustling bubble, is carried out using the cut of the anterior abdominal wall, through which the doctor sees the organ with the eye and can produce various manipulations to the tools in his hands. That is, it is pretty easy to imagine a regular operation to remove the gallbladder - the doctor cuts the belly, cuts the bubble and sews the wound. After such a conventional operation on the skin always remains a scar in the form of a scar, corresponding to the lines of the cut. This scar will never give it to the owner to forget about the operation. Since the operation is performed using a cut of the front abdominal wall tissues, then such access to the internal organs is traditionally called laparotomic .

The term "laparotomy" is formed from two words - it is "lap-", which is translated as belly, and "Tomiya", meaning to cut. That is, the general translation of the term "laparotomy" sounds like cutting the stomach. Since, as a result of the cutting of the abdomen, the doctor is able to produce manipulation on a bustling bubble and other abdominal organs, the process of such cutting the anterior abdominal wall is called laparotomic access. In this case, the access is understood as a technique that allows the doctor to perform any actions on the internal bodies.

Laparoscopic operation on the abdominal organs and small pelvis, including a gallbladder, is made using special tools - laparoscope and trocharov-manipulators. Laparoscope is a camcorder with a lighting device (flashlight), which is introduced into the abdominal cavity through a puncture on the front abdominal wall. Then the image from the camcorder enters the screen on which the doctor sees internal organs. It is focusing on this image, it will conduct an operation. That is, with laparoscopy, the doctor sees the organs not through the cut of the belly, but through the camcorder entered into the abdominal cavity. The puncture through which the laparoscope is injected is from 1.5 to 2 cm long, so there is a small and almost imperceptible scar in its place.

In addition to Laparoscope, two more special hollow tubes are introduced into the abdominal cavity, called trocaram or manipulatorswhich are designed to manage surgical instruments. On the hollow holes inside the tubes, the tools are delivered to the abdominal cavity to the organ that will operate. After that, with the help of special devices on trocars, the tools begin to move and perform the necessary actions, for example, cut the spikes, impose clamps, catch blood vessels, etc. Tool management using trocars can be convened to control with a car, aircraft or other fixture.

Thus, the laparoscopic operation is the introduction of three tubes into the abdominal cavity through small pinches with a length of 1.5 - 2 cm, one of which is intended to obtain an image, and the other two - for the production of surgical manipulation itself.

Methods, course and essence of operations, which are produced using laparoscopy and laparotomy, are exactly the same. This means that the removal of the gallbladder will be carried out according to the same rules and stages both with the help of laparoscopy and during laparotomy.

That is, in addition to the classical laparotomic access, laparoscopic can be used to produce the same operations. In this case, the operation is called laparoscopic, or simply laparoscopy. After the words "laparoscopy" and "laparoscopic" typically add the name of the operation produced, for example, removal, after which the organ indicates on which intervention was made. For example, the correct name of the removal of the gallbladder during the laparoscopy will sound like this: "Laparoscopic removal of a gallbladder." However, in practice, the name of the operation (removal of a part or the entire organ, cutting stones, etc.) is passed, as a result of which only an indication of the laparoscopic access and the name of the organ on which intervention was performed.

Laparoscopic access can be produced two types of interventions on the bustling bubble:
1. Removing the gallbladder.
2. Removal of gallbladder stones.

Currently operation to remove stones from the gallbladder almost never produced For two main reasons. First, if there are many stones, then the entire body should be removed, which is already too pathologically changed and therefore will never function normally. In this case, the removal of only stones and leaving the gallbladder is unnecessary, since the body will constantly fall into and provoke other diseases.

And if there are few stones, or they are small, then you can use other methods for removing them (for example, litholithic therapy with ursodeoxycholic acid preparations, such as Ursosan, URSOFALK, etc., or crushing with ultrasound stones, due to which they decrease in size and independently Go out from the bubble in the intestine, from where it is removed from the body with food lumps and cartoons). In the case of small stones, litholithic therapy with medicines or ultrasound is also effective and avoids operation.

In other words, it is currently a situation that when a person needs an operation on the stones in the bustling bubble, it is advisable to remove the entire organ completely, and not to deliver stones. That is why surgeons most often resort to laparoscopic removal of the gallbladder, and not stones from it.

Benefits of laparoscopy in front of laparotomy

• Small damage to the fabrics of the front abdominal wall, since four punctures are used to carry out the operation, and not a cut;
• Minor pains after surgery doubting during the day;
• A few hours after the end of the operation, a person can walk and perform simple actions;
• Short stay in the hospital (1 - 4 days);
• Fast rehabilitation and disability;
• Low risk of postoperative hernia;
• Untime or practically invisible scars.

Anesthesia for the laparoscopy of the gallbladder

Laparoscopic removal of gallbladder - operation of the operation

After the introduction of a person in anesthesia, a anesthesiologist introduces a probe into the stomach to remove fluids and gases available in it. This probe is necessary in order to eliminate random vomiting and enter the contents of the stomach into the respiratory tract with the subsequent asphycia. The gastric probe remains in the esophagus until the end of the operation. After installing the probe, the mouth and nose are closed with a mask attached to the artificial ventilation of the lungs, with which a person will breathe throughout the operation. Artificial ventilation of the lungs at laparoscopy is absolutely necessary, since the gas used during the operation and injected into the abdominal cavity, presses on a diaphragm, which, in turn, strongly clamps lungs, as a result of which they cannot breathe independently.

Only after the introduction of a person in the anesthesia, removal of gases and liquid from the stomach, as well as the successful addition of artificial ventilation of the lungs, the surgeon and its assistants are embodiment of a laparoscopic operation to remove the gallbladder. To do this, a semicircular incision is made in the folds of the navel, through which the trocar with the camera and the flashlight is entered. However, before the introduction of the chamber and flashlight in the stomach, sterile gas is pumped, most often carbon dioxide, which is necessary for organized organs and increasing the volume of the abdominal cavity. Thanks to the gas bubble, the doctor gets the opportunity to freely operate with trocars in the abdominal cavity, minimally assigger neighboring organs.

Then, on the line of right hypochondrium, another 2 - 3 trocars are introduced, which the surgeon will manipulate tools and remove the gallbladder. The points of punctures on the skin of the abdomen, through which trocars are introduced for laparoscopic removal of the gallbladder, depicted in Figure 1.

Picture 1 - Points in which puncture is performed and trocaciers are introduced for laparoscopic removal of the gallbladder.

Then the surgeon primarily examines the location and type of gallbladder. If the bubble is closed with spikes due to a chronic inflammatory process, then the doctor will first dissect them, released the organ. Then the degree of its tension and fullness is determined. If the gallbladder is very tense very much, then the doctor first cuts its wall and sucks a small amount of fluid. Only after that the clamp is superimposed on the bubble, and a choledoch is distinguished from the tissues, which connects it with a duodenum. The cholester is cut, after which it is isolated from tissue bubble artery. Clamps impose on the vessel, cut it between them and carefully sew the clearance of the arteries.

Only after the liberation of the gallbladder from the artery and choledoch, the doctor starts its release from the hepatic bed. The bubble is separated slowly and gradually, in the course of migrating the electric shock of all bleeding vessels. When the bubble is separated from the surrounding tissues, it is removed through a special small cosmetic puncture in the navel.

After that, the doctor with a laparoscope carefully examines the abdominal cavity for bleeding vessels, bile and other pathologically modified structures. The vessels coagulate, and all the modified fabrics are removed, after which the antiseptic solution is introduced into the abdominal cavity, which produces flushes, at the end of which it is sucked.

On this laparoscopic operation to remove the gallbladder ends, the doctor removes all the trocars and sews or simply sticks the punctures on the skin. However, a drainage tube is sometimes introduced into one of the punctures, which is left for 1 to 2 days, so that the remnants of the antiseptic washing fluid can freely extort from the abdominal cavity. But if during the operation almost no bile, and the bubble was not very inflamed, then the drainage may not leave.

It should be remembered that the laparoscopic operation can be translated into a laparotomic if the bubble is too low with the surrounding tissues and cannot be removed using existing tools. In principle, if any increasing difficulties occur, the doctor removes trocars and makes the usual expanded laparotomic operation.

Laparoscopy of gallbladder stones - operation

After introducing the gas and trocarians into the abdominal cavity, the doctor, if necessary, cuts off spikes between the bubble bubble and surrounding organs and tissues, if any. Then the wall of the gallbladder is cut into the body cavity, the tip of the suction is entered, with which all content is displayed out. After that, the wall of the gallbladder is embeded, washed with the abdominal cavity with solutions of antiseptics, the trocars are removed and the seams are applied to the skin points.

Laparoscopic removal of gallbladder stones can also be translated into laparotomy at any time if the surgeon has any difficulty.

How many laparoscopy lasts the gallbladder?

Where to make an operation?

Laparoscopy of the gallbladder - Contraindications and testimony for surgery

• Chronic calculous and noncain cholecystitis;
• Polyps and cholesterosis of the gallbladder;
• Acute cholecystitis (in the first 2 - 3 days from the beginning of the disease);
• Asymptomatic cholecystolitiasis (stones in the bustling bubble).

• Abscess in the area of \u200b\u200bthe gallbladder;
• Severe diseases of the cardiovascular or respiratory system in the decompensation stage;
• The third trimester of pregnancy (from 27 weeks before delivery);
• Unclear arrangement of organs in the abdominal cavity;
• Operations on the abdominal organs made in the past laparotomic access;
• Intraheptero location of the gallbladder;
• Acute pancreatitis;
• Mechanical jaundice, resulting in blockage of biliary tract;
• Suspicion of the presence of a malignant tumor in the bustling bubble;
• Strong scarmers in the hepatic ligament or neck of the gallbladder;
• Blood coagulation disorders;
• Fistulas between biliary tracts and intestines;
• Acute gangrenous or perforated cholecystitis;
• "Porcelain" cholecystitis;
• The presence of a pacemaker.

Preparation for the laparoscopy of the gallbladder

• General analysis of blood and urine;
• Biochemical analysis of blood with a definition of bilirubin concentration, general protein, glucose, alkaline phosphatase;
• Coagulogram (APTTV, PH, MNA, TV, Fibrinogen);
• Smear on the flora from the vagina for women;
• Blood on HIV, syphilis, hepatitis B and C;

In addition, in the process of preparation for the laparoscopy of the gallbladder, it is necessary to control the flow of existing chronic diseases of the respiratory, digestive and endocrine system and to take agreed with the surgeon, which will operate, drugs.

On the day, the operation should complete the meals in 18-00, and drinking - at 22-00. From ten o'clock in the evening, on the eve of the operation, a person can neither eat or drink up to the beginning of surgical intervention. To purify the intestine per day before the operation should be taken laxative and put the enema. In the morning, immediately before the operation should also be supplied to the enema. No other preparation of laparoscopic removal of the gallbladder does not require. However, if in any individual case, the doctor will find it necessary to fulfill any additional preparatory manipulations, he will tell about it separately.

Gallbladder laparoscopy - postoperative period

On the second day after the operation, you can start to eat lightweight, soft food, for example, fastening broth, fruit, degreased cottage cheese, yogurt, boiled low-fat chopped meat, etc. Food should be taken often (5 - 7 times a day), but in small portions. Through the second day after the operation, you need to drink a lot. On the third day after surgery, there can be ordinary food, avoiding products causing strong gas formation (bean, black bread, etc.) and biliary (garlic, onions, sharp, salty, spicy). In principle, from 3 to 4 days after the operation, you can feed according to Diet No. 5, which will be described in detail in the relevant section.

Within 1 - 2 days after the operation, the person can disturb pain in the area of \u200b\u200bpunctures on the skin, in the right hypochondrium, as well as above the clavicle. These pain is due to traumatic tissue damage and will be fully held 1 to 4 days. If the pain does not subside, but, on the contrary, it is strengthened, then you should immediately consult a doctor, because it may be a symptom of complications.

During the entire postoperative period, which lasts 7 - 10 days, should not be lifted and carry out any work related to physical activity. Also during this period you need to wear soft linen, which will not irritate painful punctures on the skin. The postoperative period ends at 7 to 10 days, when in the conditions of the polyclinic remove the seams from the punctures on the stomach.

Hospital with gallbladder laparoscopy

In the development of any complications, the hospital is extended, but in this case the periods of disability are determined individually.

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

And the normal well-being and the ability to perform the usual work, if it is not related to physical exertion, it appears after 10 - 15 days after the operation. From this period, for the best rehabilitation, it is strictly followed by the following rules:

• Within one month or at least 2 weeks after the operation, penalties should be observed;
• Eating properly, avoiding constipation;
• Any sports training start no earlier than a month after the operation, starting with the minimum load;
• Within a month after surgery, do not engage in severe physical labor;
• During the first 3 months after the operation, do not lift more than 3 kg, and from 3 to 6 months - more than 5 kg;
• Within 3 - 4 months after surgery, comply with Diet No. 5.

Pain bubble laparoscopy

After removing the seams by 7-10 days after the operation, the pain no longer worries, but can manifest themselves with any active actions, or a strong voltage of the anterior abdominal wall (outline when attempting for defecation, lifting weight, etc.). Such moments should be avoided. In a remote period, after surgery (in a month or more), pain does not happen, and if such appear, this indicates the development of any other disease.

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

For 3 - 4 days after surgery, a person can eat puree from vegetables, low-fat curd, as well as boiled meat and fish of non-fat varieties. Such a diet should be maintained within 3 - 4 days, after which go to diet No. 5.

So, diet number 5 implies frequent and fractional nutrition (small portions of 5 - 6 times a day). All dishes should be shredded and warm, not hot or cold, and cooking products are necessary with cooking, extinguishing or baking. It is unacceptable fry. The following dishes and products should be excluded from the diet;

• Fatty products (fatty varieties of fish and meat, fat, high fatty dairy products, etc.);
• Roast;
• Canned meat, fish, vegetables;
• Smoked;
• Marinades and salting;
• Sharp seasonings (mustard, horseradish, ketchup chile, garlic, ginger, etc.);
• Any offal (liver, kidneys, brain, stomach, etc.);
• Mushrooms in any form;
• Raw vegetables;
• Raw green peas;
• Rye bread;
• Fresh white bread;
• Baking and confectionery (pies, pancakes, cakes, cakes, etc.);
• Alcohol;
• Cocoa and black coffee.

• Non-fat varieties of meat (indyusten, rabbit, chicken, veal, etc.) and fish (pike perch, perch, pike, etc.) in boiled, vapor or baked form;
• Kashi semi-liquid from any croup;
• Soups on water or boujondo, fastened with vegetables, crops or pasta;
• Steam or stew vegetables;
• Low-aluminous or skimmed dairy products (kefir, milk, prostrochy, cheese, etc.);
• Nonxal berries and fruits in fresh form or in compotets, moussas and jelly;
• Yesterday white bread;