Today, laparoscopic operations are not at all new to our society. In surgical treatment, laparoscopy of the gallbladder accounts for 50-90% of all such cases. In the article, we will take a closer look at the very concept of such an operation, how it is carried out, and how it is beneficial for human health.

What is it?

Laparoscopy is a highly effective, safe and low-traumatic method of surgical intervention on internal organs. For this reason, treating gallstone disease with this method has long become a common daily operation.

What is this treatment? In everyday life, this means surgical therapy, during which the severed gallbladder is removed from a person along with the stones formed in it, using an important device - a laparoscope.

Today, practically no operations are carried out so that the organ can be preserved and only numerous gallstones can be removed. If the stones are single, then other methods of removing them are used, such as:

• Dissolution using medications;
• Crushing using laser equipment;
• Shock wave litholripsia.

During these treatments, the dissolved stones are eliminated from the body naturally.

To better understand what laparoscopic treatment of the gallbladder is, you should first become familiar with how this therapy differs from laparotomy. Let's get acquainted with the basic principles.

Laparoscopy

This type of surgical treatment is performed using auxiliary instruments:

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

What is a laparoscope? This is a kind of device with a built-in flashlight for illuminating the work site and a video camera. The surgeon inserts the camera into the patient’s abdominal space, having previously made a small incision (1 cm) in it.

During the operation, all his manipulations are visible on the screen thanks to a video camera. This helps the doctor monitor his actions. The advantage here is that there is no direct contact with the diseased organ being removed, but only visual contact.

The surgeon controls the instruments necessary for the operation using trocars. These are nothing more than hollow tubes, which are also inserted through punctures into the abdominal space. They are necessary to deliver the required instrument to the organ to be removed. The tubes have manipulator devices, with their help the doctor is able to move the instrument inside the abdomen.

In a word, the doctor carries out the entire process of laparoscopic surgery using only three tubes:

• A video camera is inserted into the first tube to display the image on the screen;
• The other two tubes are needed to work through them with a surgical instrument.

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

Laparotomy

This is the most common abdominal operation, which the surgeon performs by making a large and deep incision in the abdominal cavity (its front part) using a scalpel. Through the incision, the doctor inserts instruments and removes the patient's diseased organ.

Laparotomy means the following: “lapar” means the stomach, and “tomy” means cutting.

Indications and contraindications for laparoscopy

In medical practice, gallbladder diseases can be encountered quite often. There are many reasons for this, for example:

• Unfavorable environmental data;
• Frequent stressful conditions;
• A person consumes fatty foods in abundance, and even of poor quality.

All this, in turn, leads to the development of various pathologies, and as a result, gallstone disease develops. If the presence of this disease does not in any way affect the functionality of the human body, then conservative treatment can be prescribed.

Let's consider what indications for laparoscopy may be, and in which cases this type of treatment is not indicated for the patient.

Indications	Contraindications
An inflammatory process is observed in the gallbladder, during which stones are formed.	Intervention is not performed if pus formation is detected in the area of ​​the cut-off bladder.
Chronic cholecystitis without stone formation.	Severe pathologies of the respiratory or cardiovascular system.
A polypous growth of size was found in the gallbladder<10мм.	Third trimester of pregnancy.
An excessive amount of cholesterol is deposited on the walls of the bladder space.	The presence of previously performed laparoscopic interventions on organs located in the abdominal space.
Cholecystitis in the acute stage, where the attack lasts more than 1-3 days.	The gallbladder has an intrahepatic location.
Multiple presence of stones in the gallbladder.	The patient has pancreatitis in an acute stage.
The presence of various pathologies leading to the development of adverse side effects	Obstructive jaundice resulting from poor patency of the bile ducts.
	Poor blood clotting ability.
	Presence of a pacemaker.
	Near the bubble there is a flaw or hole of unknown origin.

Preparing for surgery

Before surgery, which will be carried out according to plan, the patient should submit the necessary tests to the laboratory:

• Blood - general and biochemical analysis, for the presence of various types of jaundice, AIDS, blood type, Rh;
• Urine fluid;
• Coagulogram;
• Electrocardiogram;
• Women are given a vaginal smear.

If the test results are completely normal, then the patient can be operated on. If unacceptable deviations are detected, you will first have to undergo medical therapy to normalize the condition.

Expert opinion

Shoshorin Yuri

General practitioner, site expert

The day before surgery, you should stop eating any food from 18:00, and stop drinking liquids from 22:00. Late in the evening, the medical staff on duty gives the patient an enema to cleanse the intestines. Today it is practiced to take a strong laxative, but it is not indicated for everyone.

How is the operation performed?

Before the laparoscopic procedure to remove the gallbladder begins, anesthesia is administered to relieve pain and tissue sensitivity. In addition, anesthesia causes the abdominal muscle tissue to relax.

After anesthesia is administered, the anesthesiologist inserts a tube through the patient's mouth to remove gases and remaining fluid from the stomach. This will help prevent an accidental gag reflex to prevent asphyxia. The probe is removed after the operation.

As soon as the probe is installed, a mask is placed on the lower part of the patient's face for artificial ventilation of the lungs. A person breathes through it during surgery. During laparoscopy, ventilation is simply necessary, since gas smoke is supplied into the abdominal space. It presses on the diaphragm, pressing against the lungs.

After all these preparatory procedures, the nurse treats the desired area with an antiseptic, and then the surgeon and assistants begin the surgical procedure. 3 incisions are made - one near the navel and two on the sides of the right hypochondrium. Carbon dioxide is pumped in to straighten the internal organs so that they do not interfere with the surgical process.

A laparoscope, illuminated video camera and other important trocars are inserted through the incisions. Inside the abdominal space, the surgeon manipulates them in the right directions, as a result of which he removes the gallbladder that is unsuitable for normal functioning. Removal occurs through a cosmetic incision made near the navel.

At the end of the surgical process, the blood vessels are coagulated, and an antiseptic solution is injected into the abdominal cavity. With its help, disinfection is carried out, after which it is sucked out. The trocars are removed, and the doctor sutures the incisions.

Using the laparoscopic approach, cholecystectomy can also be performed. During this procedure, the patient is given general anesthesia, and artificial ventilation of the lungs is mandatory by connecting to a machine.

Another name for anesthesia is “gas exposure.” Anesthesia is given to the patient using a machine through a special tube through which he breathes during surgery.

The exception to administering such anesthesia is if the patient has bronchial asthma. In this case, endotracheal anesthesia is replaced with general intravenous anesthesia.

Consequences

After laparoscopic surgery, as after any surgical intervention, unpleasant consequences may occur that cause severe discomfort. The main problem is the release of bile that goes directly into the duodenum. This process in medicine is called “subsequent cholecystectomy syndrome.”

With this diagnosis, the patient may experience the following symptoms:

• Gag reflex and nausea;
• In some cases, there is an increase in temperature;
• Pain and rumbling in the abdomen;
• Stomach upset and flatulence;
• Bitterness when belching, heartburn;
• Jaundice.

Expert opinion

Shoshorin Yuri

General practitioner, site expert

Unfortunately, some patients, even after laparoscopic surgery, may experience these symptoms throughout their later lives. It is almost impossible to completely get rid of them.

Possible complications

Any unforeseen situations or complications may arise both during surgery and after the operation.

The following complications may occur during laparoscopy of the gallbladder:

• On the abdominal wall, the doctor can damage blood vessels;
• The stomach, gallbladder and other nearby internal organs may be punctured or damaged by the laparoscope;
• Bleeding may begin from the liver bed or gallbladder artery.

Complications of a more complex nature are eliminated with another operation - laparotomy.

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

• If, after removing the gallbladder, its stump was poorly sutured, bile could enter the abdominal cavity;
• Peritonitis;
• The tissue around the navel could become inflamed.

In very extreme cases, 5-7% of patients may develop a hernia after laparoscopy. Most often this happens in people with large body weight. Or this complication occurs in those patients who underwent emergency surgery and were not planned in advance.

Advantages and Disadvantages

Let's consider what advantages the laparoscopic method of gallbladder removal has.

1. Laparoscopy is a closed technique, and thanks to this, the interaction of internal organs and tissues is completely eliminated during the operation. There is also no risk of contracting infections.
2. This operation requires small incisions to be made. This in turn reduces the traumatic process of the operation.
3. After laparoscopy, no scars are formed, so the abdomen will not be cosmetically damaged.
4. Short postoperative period, no more than 3 days.
5. Those who cannot miss work can start it in a week.

With all its advantages, such surgical intervention also has a number of disadvantages. Let's get to know them.

1. If the patient has chronic diseases of the cardiovascular or respiratory system, then laparoscopy is not indicated for him. Since carbon dioxide is injected into the abdominal cavity during surgery, there is a risk of compression of the lungs or heart. This can lead to increased pressure in the venous system, and there may be complications in the functioning of the heart. Or there will be strong pressure on the diaphragm, making breathing difficult.
2. Diagnostic manipulations and possibilities during the operation are somewhat limited.
3. Laparoscopy cannot be performed if the patient’s situation is too advanced. In these cases, unexpected pathologies may occur in the gallbladder, and additional surgical adjustments will be required.

If at least one of these points is present, a traditional laparotomy is performed.

List of permitted and prohibited products

You can eat	It is forbidden to eat
You can include lean meat in your diet, such as veal, chicken, as well as turkey and rabbit meat.	Exclude meat and dairy products with high fat content.
Sea fish or river predators, such as hake, pollock, perch or pike.	Fried foods should not be consumed.
Porridge is cooked from cereals until semi-liquid.	Smoked products are prohibited. Any offal.
Boil low-fat infusions and make soups with them; you can also add vegetables, pasta or cereals.	Spicy dishes, pickles and marinades.
Vegetables can either be stewed, boiled, or steamed.	Rye bread or fresh baked goods, any baked goods.
It is allowed to eat white bread, but yesterday's bread, not fresh.	Black coffee, chocolate, cocoa.
Boil compotes, prepare jelly only from non-acidic varieties of fruits or berries.	Alcoholic drinks.
Honey.	Mushrooms in any form are not recommended.
Low calorie dairy products.	Raw vegetables.

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

The human body is a reasonable and fairly balanced mechanism.

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What is the name of surgery to remove the gallbladder?

Gallbladder removal

The operation to remove the gallbladder is one of the most common surgical interventions in the human abdominal cavity. The reasons for its implementation are usually cholelithiasis, chronic cholecystitis, acute cholecystitis. Today, surgeons in their practice use two methods of removing the gallbladder: laparoscopy and open cholecystectomy.

Preparing for gallbladder removal

Preoperative preparation must be carried out carefully both by the attending physician and by the patient himself. First of all, you need to undergo a comprehensive examination and tests. This is necessary to adequately analyze the nature of the stones in the gallbladder and its ducts and choose the most appropriate removal method. Sometimes it happens that laparoscopy is prescribed, but during the operation a large incision has to be made. Therefore, it is not always obvious which procedure should be prepared for.

The patient should undergo a number of examinations:

• Ultrasound - allows you to analyze and evaluate the condition of the gallbladder and other organs: pancreas, liver, etc. The doctor looks at the presence, size and location of stones. This method has some disadvantages. Thus, it is not always possible to clearly see the presence of stones in the final part of the bile duct.
• MRI - allows you to provide more reliable information about stones and other problems: inflammatory processes, cicatricial narrowings, etc.
• CT scan is used in unclear situations. Allows you to get a clear picture of the peri-vesical tissues, the development of adhesive processes and the general condition of the organs.
• Examinations of the respiratory and cardiovascular system: ECG, X-ray of the lungs.
• Laboratory research:
  1. clinical blood test (especially ESR) and urine;
  2. a set of biochemical tests, for example, bilirubin, total protein, urea, total cholesterol, glucose, creatinine, etc.; tests for HIV, syphilis, hepatitis, Rh factor, blood type;
  3. coagulogram;
  4. conclusion of a therapist and dentist.

In addition to all tests and procedures, the patient may be asked to take a laxative for several days before surgery to cleanse the intestines. You should not eat anything the night before surgery. It is advisable not to drink or eat anything for 6 hours (except for a sip of water with medicine). If the patient is taking certain medications, the doctor should be informed. Since some medications and nutritional supplements are contraindicated. They can affect the blood clotting process.

Be sure to maintain personal hygiene. The night before surgery, shower with antibacterial soap. There is no complete certainty about what kind of surgery is ahead, so the hospital should take some things necessary in case you have to stay in the ward for some time. Usually, after laparoscopy, the patient returns home soon, without requiring observation and strict bed rest in the hospital.

Gallbladder removal surgery

There are 2 methods of surgery - laparoscopy and cholecystectomy, the clear difference of which is demonstrated in the illustration below:
Removal of the gallbladder by laparoscopy is performed under general anesthesia. The surgeon makes small incisions in the abdominal cavity: 2 by 5 millimeters, and 2 by 10 millimeters. Through one incision, a tube with a camera is inserted, with which you can see what is happening in the body and clearly coordinate the surgeon’s manipulations. Special laparoscopic instruments - trocars - are inserted into the remaining incisions, which push the tissue apart. For safety and better visibility, gas (carbon dioxide) is injected into the patient through one of the tubes to inflate the abdomen. The gallbladder is removed.

Next comes the cholangiography procedure. This is a special x-ray that allows you to check the bile duct for various abnormalities. After this, all incisions are sutured. The laparoscopy procedure takes a total of 1-2 hours and costs from 14,000 rubles to 90,000 rubles.

Laparoscopy video

Sometimes a situation arises when traditional cholecystectomy is indispensable. For example, due to fairly large stones, severe inflammation of the bladder, infection, scars after operations.

In an open cholecystectomy, the surgeon makes a 15 centimeter long incision on the right side, just below the ribs and chest. Tissues and muscles are retracted back with special instruments for better access to the gallbladder and liver. The liver is slightly displaced. Cystic ducts, arteries, and vessels are cut out from the gallbladder, and the organ itself is removed. The doctor checks the common bile duct for the presence of stones. If there is a risk of inflammation or infection, the surgeon may leave the drainage tube in place for a few days. The seam is sutured.

Educational film about cholecystectomy

This operation also lasts 1-2 hours and costs from 13,000 rubles to 92,000 rubles.

Possible complications

During the postoperative period, the patient may feel some discomfort caused by possible complications:

• Abdominal pain. May hit the shoulder. Occurs due to the formation of gas in the abdominal cavity. The doctor will usually prescribe pain medication and recommend getting out of bed and walking.
• Sore throat. Arises from the breathing tube. Rinsing or a piece of ice will help.
• Pain at the incision site. It usually lasts 1-2 weeks, decreasing every day.
• Digestive problems: heartburn, nausea and vomiting. If necessary, the doctor may prescribe certain medications. The diet should be strictly followed.
• Loose stools. This is normal. May last up to 8 weeks.
• Redness of the skin, hernia, bruises and hematomas near the wound.
• Fluid leaking from the incision.
• Fever. May indicate the occurrence of an abscess.
• Recurrence of gallstones. Removing the gallbladder does not change the body's susceptibility to forming new stones.

Diet after gallbladder removal

One of the important aspects of normal life after removal of the gallbladder is strictly maintaining a diet. In the first 1.5-2 months, the patient is prescribed a gentle diet No. 5a. Steamed or boiled, grated food is allowed. Soups only with vegetable broth and cereals. Yesterday's wheat bread and crackers are allowed. Only lean meat - chicken, beef. The fish is also of fresh varieties - hake, pollock, cod, pike perch, pike. For breakfast, you can cook a steamed egg white omelette or a boiled egg (soft-boiled). Low-fat dairy products are also allowed. Fruits and berries can only be ripe and sweet in processed form.

If the patient feels well, after 2 months you can switch to diet No. 5. This is already a complete meal, but prepared using a special technology. You can steam, boil, stew or bake.

For breakfast, an omelet or cottage cheese casserole is recommended. For lunch, you can cook soup in vegetable broth or in second meat broth, not fatty. Borscht, cabbage soup, soup with meatballs. For the second course, any porridge with beef stroganoff and meatballs is suitable. Stuffed cabbage rolls, pilaf, stew, meat pies, dumplings, pasta - all this can be safely included in the diet.

For sweets, it is better to give preference to jam, marshmallows, marmalade, and sweet fruits.

Sample menu for the day:

Breakfast: cottage cheese casserole: 300 g cottage cheese, 2 tbsp. l. semolina, 1 tbsp. l. sour cream, 2 tbsp. sugar, raisins. Bake for 1 hour at 100 degrees. Lunch: Vegetable soup, stew: 200 g beef, 2 carrots, 4 medium potatoes, 1 zucchini, 1 tomato. Place in a saucepan and simmer over low heat for 1 hour. Dinner: porridge with steamed fish. Wash the fish, clean it, add a little salt. Place in a steamer and cook for 20-25 minutes.

It is strictly forbidden to use:

• alcohol;
• fried;
• spicy and salty dishes;
• spices, garlic, onions, mushrooms, radishes, radishes, sour, smoked, pickles, canned food;
• candies, soda, cakes;
• coarse fiber, peas, beans;
• cold foods (ice cream, jellied meat, aspic).

Medicines and herbs

When the gallbladder is removed for replacement therapy, you need to take Lyobil, Allohol, Cholenzym. Also stimulants of bile production - Osalmid, Cyclovalon. And non-toxic acid 300-500 mg before bed. For example, Hepatosan, Ursofalk, Ursosan.

kakmed.com

Cholecystectomy (removal of the gallbladder): indications, methods, rehabilitation

Removal of the gallbladder is considered one of the most common operations. It is 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, the indications for surgical treatment are:

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

cholelithiasis

Gallstone disease 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 poses a danger 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

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 is asymptomatic for a long time and can be detected by chance, and it becomes an indication for cholecystectomy when it causes symptoms of gallbladder damage 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.

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

Functional disorders of biliary excretion usually serve 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 to cholecystectomy surgery, which can be general or 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.

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 include diseases of internal organs in the stage of decompensation, peritonitis, long-term pregnancy, and 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

The operation to remove the gallbladder can be performed either classically, openly, or 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.

left: laparoscopic cholecystectomy, right: open surgery

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

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.

stages of gallbladder removal

The course of the intervention includes the same stages as other types of cholecystectomy: creating an access, ligating and crossing 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 the 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.

For the first month after surgery, you need to stick to 5-6 meals a day, eating in small portions, and drinking 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, removal of a bladder from a 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.

operaciya.info

Removal of the gallbladder: how is the operation performed and what to do after?

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

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

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

Gallbladder removal methods

Today, to remove gallstones, doctors use different methods to get rid of gallstones.

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

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

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

The operation is carried out using special tools. During the operation, the doctor contacts the organ only through instruments, due to which the risk of inflammation and infections after the operation is minimal.

Laser stone crushing is often used to remove gallstones. To reach the gall bladder with a laser, doctors make a puncture in the peritoneum.

The doctor uses the laser directly on the stones themselves. Laser stone removal takes about 20 minutes.

Laser stone breaking has some contraindications. Thus, laser exposure is contraindicated for people over 60 years of age, patients weighing 120 kg or more, and in severe general condition of the patient.

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

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

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

In what cases is the gallbladder removed?

Removing the gallbladder has been a source of medical debate for many years.

• the patient constantly has pain in the right side, there are infectious processes in the organ that do not go away after complex therapy;
• inflammatory enlargement of the organ;
• persistent jaundice;
• indications for surgery - cholangitis, which cannot be treated, especially against the background of blockage of the bile ducts;
• early changes in the liver, in which the functions of the organ are disrupted - a frequent indication for removal of the organ;
• The question of surgery is also raised in case of secondary pancreatitis.

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

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

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

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

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

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

CT scans are prescribed in cases where the doctor needs to examine the peri-vesical tissues and the condition of other peritoneal organs.

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

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

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

Removal of the organ occurs in stages

The liquid is stored in the bladder all the time until the food processing process occurs. After the organ is removed, the body gets used to working without a bladder for some time.

Most often, in this case, the body stores unused bile in the ducts. Even a doctor cannot say with certainty how long it takes before this process is established.

How is the operation performed?

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

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

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

If laparoscopy was chosen to remove the gallbladder, the doctor makes several incisions in the peritoneum through which a device with a camera and special instruments are inserted.

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

Why is laparoscopy so popular lately:

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

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

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

As a result, the pressure on the diaphragm and in the veins increases, making breathing and heart function a little more difficult. For patients with problems with the heart and respiratory system, this is a serious disadvantage.

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

It is not advisable to perform laparoscopy in the following situations:

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

Despite the growing popularity of laparoscopy, the open method is not losing ground. Open cholecystectomy is prescribed in cases where there are reasons to refuse laparoscopy.

In addition, in 3–5% of cases, laparoscopy is completed with open surgery, as unforeseen circumstances arise.

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

Recovery and complications after surgery

A person with gallstone disease is interested in how long recovery after surgery takes. After the operation to remove the gallbladder has taken place, the patient is taken to the ward, where anesthesia takes place for about an hour and the patient wakes up.

In some cases, after anesthesia, nausea and vomiting may occur, which is stopped with special medications.

Pain after removal of the gallbladder may occur several hours after the operation; the affected side must be numbed.

The first day after the operation the patient cannot eat anything, and from the second day they begin to gradually introduce food. How much and what a patient can eat is decided only by the attending physician.

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

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

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

Often fever and pain appear after eating fried or fatty foods, which is why it is so important to monitor the diet of a patient with gall bladder removed.

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

In addition, the doctor may prescribe traditional medicines: decoctions and infusions of herbs and other plant components that improve digestion.

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

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

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

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

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

Dysfunction of the sphincter of Oddi - substances included in the biliary mucosa are capable of increasing the tone of the sphincter, and if the organ is removed, then this tone is noticeably reduced.

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

The right side may hurt after eating and at night, in addition, the pain may radiate to the shoulder blade and arm, or encircle the area.

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

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

If not detected in a timely manner, the condition may worsen noticeably, which can lead to an abscess and even peritonitis.

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

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

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

• Drug treatment after removal of the gallbladder should help the patient adapt to a new way of processing food. As part of treatment, doctors prescribe hepatoprotectors;
• The patient’s nutrition should be gentle, fractional, dietary, the food intake regime should be constant. The doctor decides how long to follow a dietary regimen individually;
• Gymnastics for the abdominal wall will help improve your general condition and avoid negative consequences. How much gymnastics you need to do is decided by your attending physician.

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

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

protrakt.ru

Gallbladder removal surgery

Irina05/07/2013Surgery to remove the gallbladder

Dear readers, we continue the topic of the gallbladder. We talked about where the gallbladder is located, what its functions are, and how to perform an ultrasound of the gallbladder. Today we will talk about surgery to remove the gallbladder. It's called cholecystectomy. Removal of the gallbladder may be necessary if stones form in it or in the bile duct that comes out of it.

Indications for surgery to remove the gallbladder are the following situations:

• the presence of stones in the gall bladder with signs of acute or chronic inflammation (acute calculous cholecystitis and chronic calculous cholecystitis);
• stones in the bile ducts (choledocholithiasis);
• gallbladder gangrene

If the patient is admitted to the hospital as an emergency, then all preoperative preparation takes place directly in the hospital, under the supervision of the attending physician - surgeon.

Preparing for surgery to remove the gallbladder.

Preparation for surgery takes place as planned in a clinic setting. The patient undergoes a mandatory examination by a surgeon and is prescribed the necessary laboratory and instrumental examinations. As a rule, this is a clinical blood test, a general urine test, a biochemical blood test, and, if necessary, blood clotting (hemocoagulogram) is studied. An electrocardiogram is taken, an ultrasound of the abdominal cavity is performed, and a chest x-ray is prescribed according to indications. An examination by a therapist who assesses the body’s compensatory capabilities for concomitant diseases is necessary.

So, a fully examined person is admitted to the surgical department. First of all, the patient talks with his attending physician - the surgeon who will perform the surgery. The doctor collects a life history, anamnesis of the disease, and conducts a general examination of the patient. Based on the examination and examination data, he determines the tactics for managing his new patient. Let us briefly dwell on the key points that are taken into account by the doctor when choosing a cholecystectomy technique.

Surgery to remove the gallbladder. Modern techniques.

Nowadays, there are several types of such surgical interventions.

1. Laparoscopic cholecystectomy.
2. Mini access cholecystectomy.
3. Open cholecystectomy.
4. Transvaginal (or transgastric) cholecystectomy.

Let's talk in more detail about the features of these methods.

Removal of the gallbladder. Laparoscopy.

Laparoscopic cholecystectomy is the most gentle way to remove the gallbladder. The method is based on the introduction of a video camera (laparoscope) into the abdominal cavity, which allows you to see the surgical area on the monitor screen. Working with special instruments also inserted into the abdominal cavity, surgeons under such video-endoscopic control can perform surgery only by making several punctures in the abdominal wall.

The advantages of this operation are low trauma, minimal pain in the postoperative period, and a quick rehabilitation period, which allows you to quickly return to everyday life and work.

It is believed that laparoscopic cholecystectomy is the method of choice for cholelithiasis. But in 1-5% of cases, due to the presence of anatomical abnormalities of the biliary tract, severe inflammatory or adhesive process, it is not possible to remove the gallbladder laparoscopically. In this case, the surgeon plans to perform a mini-access operation or a traditional (open) cholecystectomy.

Mini-access cholecystectomy also reduces trauma to the abdominal wall; it is performed from a 3-7 cm long incision in the right hypochondrium or from a small incision in the midline of the abdomen.

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Removal of the gallbladder. Abdominal surgery.

Open (traditional) cholecystectomy is most often performed in patients with acute inflammation of the gallbladder (acute cholecystitis), complicated by widespread peritonitis, or with complex forms of bile duct pathology.

Nowadays, another promising method of surgical intervention to remove the gallbladder has begun to be developed - transvaginal or transgastric cholecystectomy. Access to the gallbladder is made using flexible endoscopes either through the vagina or through the mouth. The advantage of this technique is that with this version of cholecystectomy, no scars remain on the anterior abdominal wall.

Well, the surgeon has decided on the surgical technique and the patient goes into the ward. It’s the turn of the anesthesiologist-resuscitator. He comes to talk in the afternoon, after completing scheduled work in the operating room. The conversation with him will be long, he will learn in great detail all the information about past diseases, operations, allergic reactions and medications currently taken.

After a frank conversation, the anesthesiologist-resuscitator develops the most appropriate and safe anesthesia tactics that can adequately protect the patient from surgical stress. Most often, the operation is performed under general anesthesia (anesthesia), but combination anesthesia options are possible. The doctor will clearly explain the reason for choosing this anesthesia option and give the necessary preoperative recommendations.

So, we figured out that the operation to remove the gallbladder is performed strictly according to indications, taking into account the individual characteristics of the patient.

If you have had such an operation, do not despair. Life doesn't end there. Evgeniy Snegir and I published the book “Diet after gallbladder removal in questions and answers.”

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Surgery to remove the gallbladder is the main treatment method for diseases of the biliary system. Despite the development of methods of conservative therapy, only surgical intervention can completely eliminate organ pathologies. There are several types of surgery. Which one will be chosen depends on the patient’s condition and the technical base of the clinic.

What is cholecystectomy

The gallbladder (GB) is a pear-shaped organ located under the liver. It is designed to accumulate bile and send it into the duodenum. Poor nutrition, unhealthy lifestyle and metabolic disorders lead to gastrointestinal diseases. The organ and ducts can become inflamed and clogged with stones. In such cases, surgery to remove the gallbladder is prescribed.

Regardless of the method of removal, all operations are called cholecystectomy. To indicate the type of intervention, a qualifying word is added - laparoscopic, abdominal, mini-access, single-port.

Although the organ is not vital, the intervention is performed by surgeons with extensive clinical experience. Improper removal of the gallbladder can lead to serious consequences: bleeding, damage to the liver and nearby organs, and effusion of bile.

When is surgery needed?

Indications for cholecystectomy are pathologies of the gallbladder and its ducts that are not amenable to drug treatment. Among them:

1. (ZhKB). Often becomes the reason for surgery. Accompanied by the formation of stones that block the ducts, provoke biliary colic, and threaten perforation of the gallbladder and peritonitis.
2. – one of the manifestations of cholelithiasis. Characterized by pain in the right hypochondrium, bitter taste, nausea, biliary colic.
3. – inflammation of the walls of the gallbladder, which can spread to neighboring organs. It is caused by cholelithiasis, a local circulatory disorder. For this reason, cholecystectomy is often performed in older adults.
4. . Manifested by the deposition of fats in the wall of the gallbladder. It can be detected by chance; in such cases, cholecystectomy is prescribed after a routine examination.
5. . This is the formation of benign tumors - polyps. Indications for removal are tumors that grow rapidly and exceed 10 mm. Such formations tend to become malignant.

Polyposis

However, there are cases when the gallbladder is not removed. Absolute contraindications are acute heart attack and stroke, hemophilia, pregnancy in the first and second trimester, peritonitis.

Cholecystectomy is prescribed with caution for jaundice, cirrhosis, pancreatitis, gastric and duodenal ulcers. Intervention is undesirable if acute cholecystitis is diagnosed, lasting from 3 days, or the patient has undergone surgery in the next six months. Whether the gallbladder with these conditions will be removed is considered individually.

Obesity of the III and IV degrees, adhesions and compactions in the neck of the organ are contraindications for laparoscopic cholecystectomy (LCE). Laparotomy is chosen.

Types and features of operations to remove the gallbladder

There are 2 types of cholecystectomy - emergency and planned. The first is carried out for patients with acute conditions on the day of hospitalization. The second is prescribed in the standard manner, giving 10-14 days to prepare for removal of the gallbladder.

The operation is classified according to the method of execution. There are the following types of cholecystectomy: laparotomy, mini-access, laparoscopic intervention - classic and single-port. How long the removal operation lasts depends on the technique, anatomical features, and complications. The duration varies from 40 minutes to 6 hours.

Open abdominal surgery – laparotomy

A classic cholecystectomy is done through an incision in the middle of the abdomen or under the costal arch. It is prescribed when it is impossible to perform the intervention in another way: if there is a suspicion of oncology, adhesions, obesity from the third degree, the risk of damage to the walls of the gallbladder, nearby organs and vessels.

This intervention is called laparotomy. Abdominal gall surgery was previously used everywhere. Today it has been replaced by modern methods, and the cavity method is resorted to if others cannot be used.

The advantage of laparotomy is hassle-free access. The doctor can examine and examine the organs.

How long the abdominal surgery to remove the gallbladder lasts depends on the patient’s physique, whether there is inflammation or stones, complications.

On average, it takes 4 hours to cut out an organ. Even if difficulties arise, the maximum time the intervention will last is 6 hours.

Laparoscopic cholecystectomy

The operation to remove the gallbladder using a laparoscope is the most common. It is used in 90% of cases.

Laparoscopic cholecystectomy is performed using an endoscope. It consists of:

• laparoscope - an optical tube with lenses, video cameras and lighting;
• insufflator - delivers sterile gas into the abdominal cavity;
• trocar - tubes with stylets intended for piercing tissue;
• aspirator - for washing the cavity and pumping out liquid;
• endoscopic instruments - scissors, staplers, clamps, etc.

Removal of the gallbladder is performed through 1-1.5 cm punctures in the abdomen. 4-5 incisions are made into which the instruments are inserted. The doctor does not have direct visual access; he is guided by the image on the monitor.

During laparoscopy, the gallbladder is removed through a puncture in the navel area, and sutures are applied at the end. The operation lasts up to 2 hours, usually 40-60 minutes.

Laparoscopic gallbladder removal has pros and cons. The benefits include:

• minimally invasive and, as a result, rapid rehabilitation and restoration of performance;
• blood loss up to 30-40 ml;
• reduced pain after intervention;
• rare cases of postoperative complications.

Disadvantages include limited access and the inability to intervene in cases of adhesions, obesity, inflammation, and fistulas. If complications arise during laparoscopy, the gallbladder will be removed in the classical way - abdominal.

Single-port laparoscopy – SILS

An improved method of endoscopic intervention is single puncture surgery. The abbreviation for this method of gallbladder removal is SILS, from English singl incision laparoscopic surgery. This is a type of laparoscopy operation in which only one 2-centimeter puncture is made in the navel area.

A 3-hole flexible SILS port is inserted into the incision. All equipment is introduced into them. The main requirement is the flexibility of the tools. The hard ones will intersect with each other, and gallstone laparoscopy will be complicated.

The advantages of the technique are that it is less invasive. It allows:

• perform cholecystectomy on patients regardless of age and anatomical features;
• perform several interventions simultaneously from one incision;
• reduce pain and recovery time. The puncture heals in 2-4 days, no scars remain, and patients are discharged after a day.

The disadvantage of single-port laparoscopy is the duration. The operation time to remove the gallbladder is 1.5-2 hours.

Mini access cholecystectomy

This method is a variation of classic laparotomy. The difference is the smaller incision. If with a cavity intervention its length is 20 cm, then with a mini-access it is 3-7 cm. The surgeon has the same access as with the open method, but there is less tissue injury and rehabilitation is easier.

The duration of the operation to remove the gallbladder using a mini-access takes 2 – 3 hours.

Video: laparoscopic cholecystectomy, operation progress

Is the operation dangerous: possible complications

Possible with any surgical intervention, cholecystectomy is no exception. Standard postoperative deterioration is considered to be:

• suppuration and suture dehiscence - due to the patient’s fault or due to poor antiseptic treatment;
• pain in the abdominal area, during laparoscopic intervention - radiating to the area of ​​the collarbones and sternum due to the injection of gas;
• Digestive problems – since the gallbladder was removed, diarrhea, constipation, nausea, indigestion are noted for 2 weeks.

In case of complicated cholecystectomy or due to the fault of the surgeon, removal of the gallbladder can be dangerous for a person. Such cases include:

• vascular damage with subsequent bleeding;
• injuries of the bile ducts or bladder with the release of secretions into the abdominal cavity - threatens the development of pancreatitis;
• perforation of the intestines, liver, and other organs;
• metastasis of a tumor in the abdominal cavity - occurs if the operation was performed against the background of liver or gallbladder cancer.

The risk of complications during laparoscopy is 0.5-1%.

If surgery was performed using an endoscope and one of these complications occurs, the laparoscope is removed and laparotomy is performed, since damage can only be repaired through open access. Therefore, surgery to remove the gallbladder takes longer.

A consequence characteristic only of laparoscopic removal surgery is subcutaneous emphysema. It occurs when the surgeon inserts a trocar not into the abdominal cavity, but under the skin, and pumps gas into this area. More common in obese patients. The complication is not dangerous: the air is removed through the puncture or it resolves on its own.

How to prepare for surgery

Before cholecystectomy, preliminary measures are taken. Initially, the patient undergoes an examination 1-1.5 weeks before cholecystectomy. The patient submits:

• general and biochemical blood tests;
• coagulogram;
• blood test for hepatitis, HIV, syphilis;
• vaginal smear - for women;
• electrocardiogram, fluorography and ultrasound examination of the digestive organs.

According to indications, colonoscopy, cholangiopancreatography, fibrogastroscopy and other necessary tests are prescribed. The operation is allowed if the indicators are within normal limits. Otherwise, the patient’s condition is first stabilized and then sent to the surgical department.

The scheme is suitable for planned removal of the gallbladder. In emergency cases, surgeons have only two hours to prepare.

2 weeks before surgery, the surgeon and anesthesiologist talk with the patient. They talk about possible complications, the course of the operation, how the gallbladder is removed, and explain how to prepare for cholecystectomy.

• diet. 2 weeks before cholecystectomy, eat easily digestible food that does not provoke bile formation;
• performing therapeutic exercises prescribed by a doctor;
• eating easily digestible food on the eve of surgery;
• refusal to eat in the evening after 18.00 and from drinking after 22.00;
• on the eve of gall bladder surgery and in the morning - taking laxatives together with enemas.

In the morning, the patient washes, puts on clean clothes and shaves the hair on his stomach. Before the operating room, remove jewelry, glasses, and contact lenses.

How is surgery to remove a gallbladder performed?

For any type of surgery to remove the gallbladder, general anesthesia is performed. The subsequent surgical procedure varies. Stages of cavity cholecystectomy:

• an incision in the midline of the abdomen or under the costal arch;
• identification and ligation of the artery supplying blood to the gallbladder;
• cutting off the gallbladder and removing it;
• processing of the organ box;
• installation of drains as necessary;
• suturing wounds.

Laparotomy is a complex operation to remove the gallbladder. Laparoscopy is easier to perform, but it has its nuances.

Before laparoscopy of the gallbladder, the patient is placed on his back. There are 2 possible positions: the doctor stands between the legs of the person being operated on or is located on the left. Then proceeds directly to laparoscopic cholecystectomy, the course of the operation is as follows:

• 4 punctures are made: 1st - above or below the navel, 2nd - under the sternum, 3rd - 4-5 cm under the costal arch, 4th - in the navel area;
• Carbon dioxide is pumped into the abdominal cavity to expand the organs and provide visibility and access to the gallbladder;
• a laparoscope, aspirator and endoscopic instruments are introduced;
• apply clamps and cut off the gallbladder from the bile duct connecting the organ to the duodenum;
• the artery is cut and its lumen is sutured;
• separate the bubble, cauterizing the bleeding wounds with an electrocoagulator as it is excised;
• the gallbladder is removed through an incision in the navel;
• wash the operated area with an antiseptic, pump out the liquid and sew up the punctures.

These are the main points. Your doctor will tell you more about how to remove the gallbladder by laparoscopy or laparotomy.

The technique for performing other types of cholecystectomy is similar. So, SILS laparoscopy of the gallbladder is done as standard, only through one puncture. And the mini-access intervention is similar to the classic abdominal one, with the exception of the length of the incision.

After surgery

The recovery period depends on the method of surgery - open or laparoscopic. In the first case, the main rehabilitation will take 3 weeks, in the second – 7 days. They return to work after 1-2 months or 20 days, respectively.

How long you will have to stay in the hospital after removing the gallbladder is also related to the surgical method: with laparoscopy you are discharged on the third to fifth day, with laparotomy - after 1.5-2 weeks.

Regardless of the method, the patient must follow general recommendations:

• You cannot turn over in bed, get up or walk for 6-7 hours. Then you need to carefully walk along the ward or hospital corridor so that blood clots do not form;
• it is forbidden to eat and drink on the first day;
• do not wet the seams;
• Do not lift weights over 3 kg for 4 weeks, and more than 5 kg in subsequent weeks;
• Sexual activity is excluded for 2-8 weeks.

From the second day they use decoctions of herbs, rose hips, and low-fat kefir. On the third day, they eat light broth, soft fruits, purees, smoothies. Then the diet is expanded with ground lean meat, soups, cereals, and fermented milk products. This diet is followed for 2 weeks.

For the next six months, fried, smoked, spices, canned food, strong tea, alcohol, sweets, fresh bread, and pastries are prohibited. They eat fractionally - in small portions 5-7 times a day. Food temperature is moderate, room temperature.

Pain after surgery is relieved with analgesics. Antibiotics are indicated to prevent infection, hepatoprotectors, choleretic drugs and enzymes to normalize digestion. Additionally, vitamins and physiotherapeutic procedures are prescribed.

Video: rehabilitation after cholecystectomy

Removing the gallbladder is not a dangerous intervention, although complications are possible and restrictions are imposed during the recovery period. Patients quickly return to their previous lives. The rehabilitation period depends on the method of surgical intervention. It goes away faster after laparoscopy or SILS. But they have a high cost: on average 50 thousand and 92 thousand rubles, respectively. Laparotomy will cost less: the price for a classic one is about 39 thousand rubles, for cholecystectomy with a mini access - 33 thousand rubles.

Operation in progress

Let's continue the topic of cholelithiasis (GSD), or rather the surgical treatment of this pathology. Those people who decide not to remove gallstones may not read this article. Better read this one. For those who agreed to the operation, a completely reasonable question arises. How and what method of operation should I choose? Well, let's figure it out.

First, let's define what laparotomy and laparoscopy are.

Laparotomy

Laparotomy is a surgical operation of opening the abdominal cavity (from the Greek Lapara - belly, tome - incision, dissection). The incision for cholelithiasis is usually made from the xiphoid process to the navel in the midline. There is a way to remove the gallbladder from a mini access. This is when an incision is made in the projection of the gallbladder (from 3 to 5 cm long) and the bladder, using special instruments, is removed through this incision.

Laparoscopy

Laparoscopy is a surgical operation on internal organs, which is performed through small (usually 0.5-1.5 cm) incisions on the anterior abdominal wall. There can be from 2 to 4 such cuts. The main instrument, the laparoscope, is inserted into the abdominal cavity through one of the incisions. This is a telescopic tube attached to a video camera. And the surgeon performs all manipulations under the control of a video camera. The image is displayed on the monitor. The doctor performs the operation with a special instrument.

So, let's look at the advantages and disadvantages of each surgical treatment method.

Advantages of laparotomy

Scar after laparotomy

• This is a “large” incision and opening of the abdominal cavity, which visually and, most importantly, palpation (with hands) allows you to assess the condition of the organ, the ability to accurately and gently apply force to the tissues.
• Hands serve as an important tool in diagnosing various diseases, especially tumors, and hands allow for delicate operations and manipulations, such as complex sutures.
• In many cases, laparotomy can be performed faster than laparoscopy, which plays an important role when performing operations on patients with severe concomitant pathology and some patients with emergency pathology.
• the absence of increased gas pressure in the abdominal cavity, which complicates the functioning of the cardiovascular and respiratory systems.

Disadvantages of laparotomy

• It is highly traumatic (a large amount of tissue is dissected) and after the operation a visible scar is formed (although everything is individual here).
• Open method of operation, i.e. when the abdominal cavity communicates with the surrounding atmosphere of the operating room, instruments, and the hands of the surgeon, which increases the overall contamination of the surgical field.
• The patient's hospital stay is from 10 to 15 days.
• There is pain in the postoperative period due to extensive tissue trauma.

Benefits of laparoscopy

Places of mini-incisions for laparoscopic cholecystectomy

• Very low morbidity.
• Short periods of hospital stay, from 3 to 10 days (according to different clinics).
• As a rule, there is no pain and quick recovery after surgery.
• No large postoperative scars.
• The surgeon sees a much larger image on the monitor than with his eyes (you can magnify up to 40 times, i.e. almost like under a microscope).

Disadvantages of laparoscopy

• The surgeon is limited in his range of motion at the surgical site and dexterity is lost.
• Depth perception is distorted.
• Hands are not used to interact with tissue, so the force being applied cannot be accurately judged, which may result in injury.
• Some of the instruments for laparoscopy The surgeon needs to get used to the method of operation, because the instrument moves in the opposite direction to the surgeon's hands.
• Increasing intra-abdominal pressure due to carbon dioxide insufflation.

If the surgeon has extensive experience in performing laparoscopic operations, then there is no difference in the choice of surgical treatment method. The most important thing is that the doctor is fluent in both surgical techniques.

Nowadays laparoscopy is in fashion and often young surgeons who are fluent in the technique of laparoscopic operations do not know how to perform a banal laparotomy.

It is up to you to decide which method of operation to choose.

Below is a short video showing laparoscopic removal of the gallbladder.

Video comment:

1. Visible smoke is electrocoagulation of tissues. With this we “kill 2 birds with one stone” - we dissect the tissue and perform hemostasis (stop bleeding).

2. Metal brackets are clips. In the video there are a lot of them on the cystic duct, and just above one is on the cystic artery.

In accessible language about complications of acute appendicitis

Y-shaped phlegmon of the hand or why is a general blood test taken from the fourth finger?

zapdoc.ru

Laparoscopic examination of the gallbladder

Medical research methods are becoming more informative and less traumatic every year. They allow you to exclude a wide range of diseases. Laparoscopy of the gallbladder is one of the research methods, which is considered the “gold standard” for diseases of the hepatopancreatoduodenal zone (the area of ​​the liver, pancreas, and gallbladder). In addition to providing diagnostic capabilities, the laparoscopic method can be used to remove stones from the gallbladder (another name for the operation is cholecystectomy).

Laparoscopy and laparotomy

Pros of research

Laparoscopy of the gallbladder involves examination using small incisions on the anterior abdominal wall. Their length does not exceed 15 mm, and the total number is no more than 4. This ensures a relatively low traumatic operation. For example, a conventional laparotomy, which makes it possible to assess the condition of an organ, requires tissue dissection up to 200 mm in length.

Low trauma causes less blood loss. If laparoscopy on the gallbladder is accompanied by blood loss of up to 40 ml, then the volume of blood lost during a laparotomy incision reaches a much larger scale.

When compared with surgery under laparotomy, laparoscopy of the gallbladder is accompanied by a small number of complications. For example, adhesions and adhesive disease develop very rarely.

During laparoscopy, the pain syndrome is moderate. This fact allows it to be stopped using only non-steroidal anti-inflammatory drugs without the use of narcotic analgesics.

When examining the gallbladder using the endoscopic method, as well as when removing the gallbladder using laparoscopy, the patient's period of disability is shortened when compared with laparotomy. The hospitalization period is also shorter.

When is laparoscopy indicated?

The study, despite a number of advantages, is associated with risks and therefore has clearly defined indications. It is worth immediately noting that laparoscopy is applicable for two main purposes - diagnosis and treatment.

Laparoscopic cholecystectomy has clear indications

In what clinical situations should this study be prescribed?

• The first indication is diseases of the organs of the hepatobiliary zone, which are very difficult to determine or confirm using other methods. When the results of ultrasound, computed tomography, MRI, and X-ray do not clarify the clinical situation, it is advisable to supplement the diagnostic plan with laparoscopy.
• In cases where the doctor suspects a neoplasm of the gallbladder, he prescribes a laparoscopic examination. The disease is either confirmed or excluded. In the first case, you can at the same time assess whether the tumor has grown into neighboring tissues, as well as its stage, which is necessary to determine further management and treatment tactics.
• Another diagnostic indication that should be noted is ascites - the accumulation of free fluid in the abdominal cavity. Laparoscopy from a diagnostic intervention develops into a therapeutic one, since it is necessary to evacuate the accumulated exudate or transudate.

Therapeutic possibilities of laparoscopy

Cholecystectomy is an operation to remove the gallbladder. It is considered the most frequently performed procedure using laparoscopy. In what situations is such intervention indicated?

Cholecystectomy becomes the treatment of choice for chronic calculous cholecystitis. This is gallstone disease (GSD), complicated by the addition of an inflammatory process to the organ wall. Before the operation, you should take blood tests to assess biochemical parameters, perform an ultrasound of the internal organs, and an X-ray examination (a survey image, as well as a contrast technique).

Gallbladder cholesterosis is another important indication for therapeutic laparoscopy. The disease often occurs clinically in the same way as cholelithiasis. Before performing the operation, ultrasound and radiographic examinations are prescribed. Symptoms of the disease are nonspecific: dyspepsia, combined with paroxysmal pain in the right hypochondrium.

If there are polyps on the mucous membrane of the gallbladder, outgrowths form on its inner surface. They are benign in nature, but can cause clinical symptoms. Not every polyp needs to be removed. Cholecystectomy is performed if polyposis is combined with familial intestinal pathology, accompanied by the formation of polyps, or polyps cause pain. When polyposis is combined with cholelithiasis, suspected of being malignant (rapid increase in size), laparoscopic removal of the organ is also recommended.

Acute cholecystitis is an indication for emergency laparoscopy. First, they try to stabilize the situation conservatively through infusions. If the measures are ineffective, the gallbladder is removed; if the condition improves, cholecystectomy is postponed until it is carried out as planned. Preparation for surgery in the latter case is more adequate and of higher quality, which determines a better outcome of the intervention with minimal risk of complications.

Cholecystectomy is not the only type of surgical correction within the framework of laparoscopy. In order to remove one or more gallstones in chronic cholelithiasis without inflammation, choledochotomy is used. We are talking about excision of the bile duct.

Situations in which surgery is contraindicated

In some cases, laparoscopy is contraindicated

There are a number of diseases and many conditions when laparoscopy of the gallbladder cannot be performed. These include both diseases of the organ itself and problems of the cardiovascular system, dysfunction of the liver and kidneys.

• acute cerebrovascular accident or stroke;
• acute coronary syndrome;
• pregnancy;
• hemorrhagic diathesis with a high risk of intraoperative bleeding (during intervention);
• purulent peritonitis (in this case laparotomy and drainage are indicated);
• malignant neoplasm of the gallbladder (removal is not advisable, since the operation requires compliance with the rules of ablastics and antiblastics).

The above conditions should be considered absolute contraindications. Jaundice, the development of acute pancreatitis, gastric ulcer, and cirrhotic liver disease can be considered relative. In these situations, the doctor independently makes a decision about the possibility and advisability of conducting the study.

How to prepare?

Preparation for laparoscopy of the gallbladder is carried out the day before. In the evening, the last meal is possible no later than 19:00. After this, a cleansing enema is performed. You can take a laxative. The next morning before the study, this procedure is repeated until the wash water is clean.

On the morning of the laparoscopy, you should not take liquid or food. You should find out whether you can take the drugs either from your doctor or an anesthesiologist. It is recommended to take a shower in the morning. At this time, the hair from the anterior abdominal wall is shaved. Then remove all jewelry, lenses, dentures.

Immediately before anesthesia, the patient is given premedication. It is aimed at reducing anxiety, fear, and vegetative influences.

Methodology and interpretation of results

Laparoscopic cholecystectomy through four punctures of the abdominal wall

After anesthesia (anesthesia) has been administered, the actual operation begins. The surgeon makes 4 punctures no longer than 15 mm. With hepatomegaly (liver enlargement), an additional fifth puncture is possible.

After the abdominal cavity is filled with gas, you can look and evaluate the condition of the organs of the hepatobiliary zone.

The gallbladder should be normally pinkish in color, the serous membrane should be shiny. It may become cloudy or dull. This indicates purulent damage to the organ. Lumpy overlays are often found that are fused with the surrounding tissues. This is what malignant lesions look like.

If a pathology is detected, the doctor can expand the scope of the intervention. During the operation, laparoscopy is complemented by a laparotomy incision. The incisions are then sutured. Approximately one suture is required for each of 4-5 incisions.

You need to find out how much gallbladder laparoscopy costs directly from the clinics. Before conducting it, you should undergo a series of studies. Today, laparoscopic examination of the gallbladder is often prescribed by doctors. Patients themselves also speak positively about this method. Indeed, it is convenient due to its low trauma, low risk of complications and quick rehabilitation.

diagnostinfo.ru

What is laparoscopy of the gallbladder, important points and features of its implementation

Modern surgical techniques make it possible to abandon abdominal operations, which were used ten years ago. In particular, today almost every clinic performs laparoscopy of the gallbladder, although the beginning was made not so long ago - in 1987 by a surgeon in one of the French clinics. Current practicing surgeons have already sufficiently mastered the technique of laparoscopic operations, which can significantly increase the chances of recovery for patients.

What is laparoscopy

Laparoscopy is a low-traumatic surgical intervention in which the organ is accessed through several small incisions. The size of the incisions varies, but during gall bladder surgery, a team of surgeons needs only 1.5 cm to gain the necessary access to the organ. This is much less traumatic than making a wide incision in the middle of the peritoneum. Complications with this approach rarely occur, and rehabilitation lasts a matter of days. There are practically no contraindications to laparoscopy.

Laparoscopy for gallbladder disease is used for several purposes:

1. to diagnose the disease, if without an external examination of the gallbladder it is not possible to accurately diagnose;
2. for direct treatment of pathology (for example, to remove the gallbladder for calculous cholecystitis).

In some cases, it is possible to combine two types of intervention into one. If, upon suspicion of calculous cholecystitis, this particular diagnosis is made, and the condition of the organ does not allow delaying the operation, then the removal of the gallbladder is carried out during diagnostic laparoscopy, transferring it to the surgical stage.

Cholecystectomy is the most popular operation in surgical practice. This is the so-called “gold standard” in the radical treatment of cholecystitis, since the method is quite effective and low-traumatic for the patient, lasting up to one hour. If previously patients had complications after abdominal surgery, experienced severe anesthesia for the body, and wore a bandage in the postoperative period, then laparoscopic intervention can significantly eliminate these problems. Rehabilitation of the patient in the postoperative period occurs as quickly as possible.

Benefits of laparoscopy

Despite the fact that at first laparoscopy was perceived with skepticism by many surgeons, now its advantages are not only declared out loud, but also confirmed by long-term results of the operations performed. Let's name the main advantages of laparoscopy of the gallbladder over the previously used abdominal surgery:

1. least traumatic compared to the previous method - you can make only four small incisions within one centimeter in size, the operation requires anesthesia;
2. low blood loss (about forty milliliters), which is due to less damage to blood vessels;
3. short rehabilitation - the patient can be sent home after a couple of days, and in some cases the next day, when the anesthesia wears off;
4. there is no need to wear a bandage in the postoperative period;
5. You can return to work and a normal lifestyle a week after the operation, when all functions are restored;
6. pain after the operation is practically not felt, and if it is present, the pain can be relieved with conventional analgesics;
7. postoperative complications such as hernias and adhesions do not appear after laparotomy.

How is the operation performed?

Important!

A healthy liver is the key to your longevity. This organ performs a huge number of vital functions. If the first symptoms of a gastrointestinal tract or liver disease have been noticed, namely: yellowing of the sclera of the eyes, nausea, rare or frequent bowel movements, you simply must take action.

Laparoscopy of the gallbladder is performed using three main instruments: a laparoscope, an insufflator and a trocar. Additionally, each surgical intervention uses an irrigator and a set of endoscopic instruments.

Diagnostic and laboratory tests

Before the operation is performed, the patient is prescribed a series of diagnostic tests. Based on the test results, you can not only confirm the diagnosis, but also find out the general health of the patient during this period, his readiness for surgery to remove the gallbladder, and anticipate possible complications. Among the studies that the patient needs to do are the following tests:

Immediately a few days before the operation, the patient undergoes a study of the gallbladder and liver. For this purpose, ultrasound examination, targeted blood biochemistry, cholangiopancreatography and other procedures can be performed at the discretion of the attending physician.

Preparation for laparotomy

Before the operation, the patient is introduced to the plan, the desired result and possible complications. Despite the fact that there are practically no complications after laparotomy, the content of the preoperative conversation has not changed for many years. The patient is informed what kind of anesthesia he will receive, and how anesthesia during laparoscopy can affect his health, what complications there may be, and how long the recovery will take.

If the patient agrees to the operation, preparations are made for laparoscopy of the gallbladder:

• the patient before the operation can only eat light food, the last time at seven in the evening, and on the day of the laparotomy the patient is prohibited from eating and drinking;
• the day before the operation, a laxative is given and a cleansing enema is performed;
• if necessary, the patient can be given sedatives;
• Temperature is measured at night.

Carrying out the operation

Before laparoscopy, the patient is given endotracheal anesthesia, during which the patient does not feel pain, and the respiratory function is controlled by a special device.

At the very beginning of the operation, the necessary incisions are made: one below the navel, the second under the sternum, the third below the costal arch, and the fourth at the level of the imaginary connection of the line from the navel and the armpit. If the liver is enlarged, a fifth puncture may be needed: how many incisions are decided by the doctor during the intervention. The necessary instruments are inserted into the incisions and the laparoscopic operation begins.

After the gallbladder is removed, the incisions are closed with one suture per puncture. The anesthesia is stopped, the patient awakens, and postoperative recovery begins.

Contraindications for surgery

Despite the apparent ease of laparotomy and mild anesthesia, laparoscopic surgery, like any other intervention, has contraindications. In particular, contraindications will be:

1. recent heart disease, for example, myocardial infarction, after which the patient may not tolerate anesthesia;
2. a recent stroke is also a contraindication to surgery;
3. problems with blood clotting;
4. high temperature for no apparent reason;
5. obesity of the third and fourth degree;
6. pregnancy in the second half of the term;
7. cancerous organ damage;
8. changes in the gallbladder that interfere with manipulations on it.

Under some circumstances, the surgeon may insist on surgery, although laparoscopy requires treatment of pathologies of the abdominal organs. However, the operation is performed for inflammation of the bile duct, obstruction of the bile ducts and the development of jaundice, acute pancreatitis, cirrhosis of the liver, changes in the size of the bile duct due to the appearance of benign seals, cholecystitis in the acute stage, and gastric ulcer.

Postoperative recovery of the patient

If the operation is successful, the patient is allowed to get out of bed and take some liquid food on the same day. Already on the second day after laparoscopy of the gallbladder, you can eat food of normal consistency according to table No. 5. Patients do not wear a bandage.

Ninety percent of operated patients with a successfully removed gallbladder go home on the second day, if anesthesia during this period did not cause health complications. Doctors explain how to deal with wound dressings and give nutritional recommendations. A week after the operation, the patient comes to have the stitches removed.

After the sutures are removed, patients can return to work, following a diet and limiting physical activity in the first two weeks after laparoscopy to prevent adhesions from appearing. Rehabilitation in such cases does not last long and is completed successfully; sick leave is given for a week.

As a rule, complications do not arise after laparoscopy, but in some cases patients may experience:

1. bleeding from damaged vessels;
2. damage to the ducts;
3. low-grade fever for several days after surgery;
4. inflammation at the puncture site;
5. damage to internal organs, such as the liver;
6. puncture of the intestine with a trocar;
7. subcutaneous emphysema.

Note that such complications are exceptions to the rule, and they occur only in half a percent of all cases. Basically, the postoperative period proceeds without problems. If all precautions are taken, the operation is successful and the patient extends his sick leave as an outpatient.

Who said that curing the liver is difficult?

• You are tormented by a feeling of heaviness and a dull pain in your right side...
• And bad breath haunts me...
• Your liver is causing digestive problems...
• In addition, the medications recommended by doctors are for some reason ineffective in your case...

There is an effective cure for liver disease. Read Elena Malysheva's article about liver treatment...

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Laparoscopy

A method of modern endosurgery, in which high-precision optical instruments - laparoscopes - are introduced into the abdominal cavity through punctures in the outer wall. With their help, internal organs are examined. Laparoscopes can also be used to perform surgical interventions in cavities. Today, about 90% of gynecological and 60% of general surgical interventions are performed using this technique.

Laparoscopy is a relatively new method of modern surgery. The patient's abdomen or pelvic cavity is filled with gas, special instruments are inserted into the body through small incisions, and the doctor works with them, monitoring his actions on a monitor. The introduction of this technique into surgical practice has made many operations easily portable and quick. Thus, with the help of laparoscopy, removal of the gallbladder has become much easier. With timely surgery, patients are free from complications and pain associated with the presence of stones. Laparoscopy of an ovarian cyst has the least traumatic effect on the tissue and allows you to save the organ, which is very important for women who are planning a pregnancy. Removal of the appendix performed using laparoscopy quickly improves the patient's condition and reduces the period of his disability.

Operation laparoscopy

What is laparoscopy

Laparoscopy is a method of surgical intervention in which all manipulations are carried out through several incisions on the body into which instruments and a video camera are inserted. The most modern method - through a single port - involves introducing all the necessary devices through one hole. It requires a highly qualified surgeon, because working in a confined space is truly a jewel.

The doctor's work begins by filling the abdominal cavity with a special gas (usually carbon dioxide) to create the necessary operating space. Then the main device, the laparoscope, is introduced. It is equipped with a lens system and is connected to a camera, where an image of the operated area is transmitted. An optical cable with a light source is connected to the laparoscope. The remaining instruments are selected depending on what kind of work the surgeon will perform: these can be devices for coagulation and excision, drying cavities, and connecting tissues.

Today, laparoscopic operations are very widespread: removal of hernias, appendix, gallbladder - surgeons prefer to do all this using the laparoscopic method. Laparoscopy is widely used in gynecology - it is used to remove fibroids, treat endometriosis, and eliminate obstruction of the fallopian tubes. Laparoscopy of an ovarian cyst successfully replaces traumatic abdominal surgery.

When is laparoscopy used?

The laparoscopy operation is actively used by surgeons due to the fact that it has many advantages compared to classical laparotomy. When should you give it preference?

• In the diagnosis of “acute abdomen,” when the doctor finds it difficult to determine the cause of the pain based on nonspecific symptoms. Laparoscopy of the abdominal and pelvic organs allows you to quickly identify why your stomach hurts and perform the necessary manipulations (for example, remove a cyst or appendix).
• If diagnostics in gynecology is required for infertility, when pregnancy does not occur for more than a year. Simultaneously with the examination of the pelvic organs, the surgeon can cauterize the detected foci of endometriosis, cut adhesions on the tubes, and remove fibroids.
• When diagnosing an ectopic pregnancy and surgery to remove it. Unlike classical surgical treatment, laparoscopy for ectopic pregnancy most often allows a woman to save her fallopian tube.
• To achieve a contraceptive effect (sterilization). In this case, the surgeon cuts or places clips on the fallopian tubes to prevent fertilization of the eggs. Since pregnancy after laparoscopy with dissection of the fallopian tubes is possible only as a result of in vitro fertilization, sterilization is performed for women who do not want to give birth again (mainly after 35 years and with at least two children), or if there are medical indications prohibiting pregnancy.
• For the treatment of gynecological diseases: endometriosis, fibroids, uterine prolapse or prolapse, all kinds of formations on the ovaries - all this is successfully treated laparoscopically. Thus, ovarian laparoscopy allows a woman to get rid of organic cysts that are harmful to health and can interfere with pregnancy.
• Laparoscopy is used to diagnose and treat inflammation in the pelvis (pelviperitonitis).
• In the treatment of diseases of the gastrointestinal tract: hernias, appendicitis, removal of part of the intestine.
• For the treatment of cholelithiasis. Removing the gallbladder using laparoscopy is an operation that is quite easily tolerated by the patient, and allows you to prevent the development of such a serious complication when a stone blocks the pancreatic duct, causing pancreatic necrosis, or blocks the common bile duct, interfering with the circulation of bile.
• Diagnosis and treatment of acute injuries of the abdomen and pelvis: laparoscopy allows you to examine the abdominal and pelvic cavity, see and stop bleeding, and, if necessary, remove an organ (spleen, bladder, gall bladder).

Sutures after laparoscopy

Sutures after laparoscopy are placed on the places where trocars (instruments) were inserted. As a rule, these are three holes, and when operating through a single port, there is only one wound. The absence of large incisions allows the patient to quickly recover after surgery: as a rule, painkillers are prescribed for 2-3 days, and the patient can get up in the evening or the morning after the operation.

To prevent local infection, the sutures after laparoscopy are treated with an antiseptic daily during the entire healing period, and a gauze bandage is applied on top. If the tissues are sutured with self-absorbing threads, suture removal is not required. Otherwise, they are removed approximately a week after surgery in the dressing room of a hospital or on an outpatient basis.

During the first 15 days, the patient is recommended to refuse baths in favor of a shower, while it is necessary to wet the sutures as little as possible, and immediately after hygiene procedures, additionally lubricate them with an antiseptic solution (iodine, brilliant green, potassium permanganate). If the patient complains of pain in the area of ​​the holes, has a fever, headache or nausea, you need to contact a surgeon to check the condition of the wounds and exclude the possibility of purulent complications.

Benefits of laparoscopy

The advantages of laparoscopy are obvious even to non-doctors:

• The absence of large traumatic incisions speeds up the process of wound healing and rehabilitation of the patient.
• After laparoscopy, pain is much less pronounced than after abdominal surgery, and this allows you to reduce the period of using anesthetics.
• Early mobilization of the patient due to the fact that the pain after laparoscopy is mild, allows you to quickly restore passage through the intestines (mobility), and also serves as the prevention of thrombotic complications.
• The development of laparoscopic technologies makes it possible to perform organ-preserving operations. If previously, during an ectopic pregnancy, a woman was guaranteed to lose one fallopian tube, and if the situation repeats, both, but now the doctor can save the tubes by removing only the egg. Organic ovarian cysts were removed with tissue excision, which impaired their function. After laparoscopy, the ovaries continue to function normally and give patients the opportunity to plan a pregnancy and live a normal life.
• From an aesthetic point of view, the absence of large stitches is important for patients. Laparoscopy of the ovaries through three holes leaves small scars near the navel, on the side and in the lower abdomen. And if the operation is performed through a single access, the hole hidden in the navel area is completely invisible. After laparoscopy of the gallbladder, the scars are located near the navel, on the side and in the upper abdomen.
• For a doctor, laparoscopic surgery is convenient because video equipment allows you to clearly see the surgical field (up to 40 times magnification) from different sides.
• Recording actions on video in controversial cases can serve as evidence of the correctness (or incorrectness) of the doctor’s manipulations during the operation.

Disadvantages of laparoscopy

Despite the obvious advantages of laparoscopy, it has certain disadvantages:

• A narrower scope of use compared to the traditionally performed laparotomy (for example, laparoscopy of the gallbladder is usually not performed in the acute stage, but it is with this that many patients are admitted to the hospital).
• Features of video surveillance distort the doctor's sense of depth, which can lead to injury.
• The lack of direct contact of the surgeon's hands with the tissue being operated also increases the likelihood of injury, because when working with “remote” instruments it is difficult to assess the applied force and perform very delicate manipulations. In addition, the lack of tactile contact is bad from a diagnostic point of view, because during a conventional operation the surgeon can determine the nature of the disease and palpate the tumor by touch.
• Equipment for carrying out operations is much more expensive compared to traditional ones. Therefore, despite the fact that laparoscopic surgery has a significant economic effect in the long term (the patient’s recovery period is reduced, pain quickly disappears during laparoscopy and there is no need to “keep” the patient on painkillers and involve staff in care), many hospitals cannot afford such equipment .
• Training doctors in laparoscopy is a long, expensive process, because acquiring the skill of “remote” manipulations with control of one’s actions only on a monitor is quite difficult. Moreover, those doctors who have experience in laparotomy should be trained, because laparoscopic intervention at any time in the presence of complications can turn into open abdominal surgery.
• Laparoscopy can cause specific complications associated with the injection of gas into the pelvic or abdominal cavity - impaired respiratory function, cardiac activity, pain. Another disadvantage is that working by touch can lead to damage to large vessels, internal organs and tissues.

When is laparoscopy prohibited?

Despite all the obvious advantages of laparoscopy, there are situations when it is absolutely forbidden to do it:

• If the patient is between life and death in a state of clinical death, coma or agony.
• When a patient has developed severe sepsis or purulent peritonitis, there is reliable evidence of intestinal obstruction.
• In the presence of significant disorders in the cardiovascular system and respiratory organs.
• Acute and chronic renal failure
• Acute and chronic liver failure

In addition, laparoscopy is not advisable:

• In case of severe disorders of hemostasis (blood coagulation system).
• If the patient suffers from severe obesity.
• If the patient is of advanced age and has cardiovascular diseases.
• During acute infections.
• Late in pregnancy.
• In case of exacerbation of gastric or duodenal ulcer.
• If the patient experiences sudden changes in blood pressure and heart rate.
• In the case where the patient has recently undergone extensive abdominal surgery and the healing stage has not yet been completed.
• Diffuse peritonitis
• Severe adhesive disease in the abdominal cavity or pelvis

In these cases, the decision on whether the patient can be operated on laparoscopically is made by a council consisting of surgeons, anesthesiologists, and specialized specialists.

Types of laparoscopy

Diagnostic laparoscopy

Diagnostic laparoscopy is routinely used only when a complete examination of the patient without surgical intervention has been carried out.

Laparoscopic intervention can be performed for the purpose of diagnosis:

• To determine the causes of an “acute abdomen” in a patient - when a person literally “bends over” from pain, but there are no obvious reasons, or there is no time to find out, the most reliable way is to examine the organs of the abdominal and pelvic region.
• For examination, identification of damaged organs and the source of bleeding into the abdominal cavity after injuries.
• In gynecology, fallopian tube laparoscopy is performed to clarify the diagnosis of ectopic pregnancy and to diagnose infertility. If a woman experiences acute abdominal pain, vomiting and nausea, cold sweat, and ultrasound shows neoplasms in the ovaries or fluid in the abdominal cavity, ovarian laparoscopy will accurately determine whether apoplexy (tissue rupture), torsion or rupture of the cyst has occurred.
• To examine the gastrointestinal tract and determine the perforation of the ulcer, intestinal bleeding, obstruction, and the presence of a tumor. The disadvantage of diagnostic laparoscopy when looking for a tumor or source of bleeding is that they can be located inside organs, and the surgeon sees only the outer surfaces. To more accurately determine the diagnosis in this case, a combination of laparoscopy with endoscopic, ultrasound and radiological methods (MSCT, CT) is used in a special hybrid operating room equipped with the necessary equipment.

Operative laparoscopy

The laparoscopy operation can be performed separately from the diagnosis, or follow it. The division into diagnostic and operative laparoscopy is very arbitrary. So, if a patient complains of severe abdominal pain after an injury, diagnostic procedures are combined with suturing the source of bleeding and suturing or removing damaged organs. And when a woman comes to the surgeon’s table with delayed menstruation, pain and the absence of a fertilized egg in the uterine cavity according to ultrasound results, laparoscopy of the fallopian tubes makes it possible to see an ectopic pregnancy, remove the egg and sutured the tube.

Operative laparoscopy can be planned or emergency, but both may be preceded by a diagnostic study, which is carried out at the very beginning.

What types of operations are usually performed routinely?

• Laparoscopy of the uterus, when ultrasound reveals fibroids, or there is a suspicion of endometriosis, or the patient complains of periodic bleeding not related to the cycle, and diagnostic curettage has identified changes in the endometrium.
• Laparoscopy of the tubes is done if, based on the results of an X-ray examination, there is evidence of their obstruction, and this interferes with pregnancy.
• Laparoscopy of an ovarian cyst, if it is proven that it is not functional, and the only treatment option is surgery. Surgical laparoscopy of an ovarian cyst is needed when the formation is very large (regardless of its origin), conservative treatment does not help, and there is a risk of rupture.
• Removal of the gallbladder in remission (out of exacerbation).
• Hernia repair for hernias of various localizations (if they are not strangulated).

Emergency operations include:

• All types of urgent gynecological interventions: laparoscopy of ovarian, uterine, tube cysts, when the woman’s health condition is severe and only emergency surgical treatment can help. This happens in the case of ovarian rupture, cysts, heavy bleeding, or suspected ectopic pregnancy.
• Treatment of appendicitis - as a rule, the appendix becomes inflamed suddenly and needs to be removed urgently.
• Treatment of strangulated hernias.
• Stopping bleeding, treating or removing internal organs after injuries.
• Treatment of inflammation of the abdominal cavity of any origin.

As a rule, all emergency operations are “two-in-one” operations (diagnosis + treatment), because there is no time left for a thorough examination by other methods.

Preparation for laparoscopy

Preparation for laparoscopic surgery is no different from preparation for laparotomy. Firstly, a general examination of the patient is necessary to find out whether he is allowed to have surgery and under what conditions it should be performed:

• Laboratory blood tests (general, biochemistry, coagulation, glucose, hepatitis, HIV, RW, blood group and Rh factor, sexually transmitted infections).
• General urine analysis.
• Examination of stool for the presence of helminths.
• Fluorography.
• ECG, ECHO-KG.
• Ultrasound and additional examinations of organs, due to diseases of which laparoscopy is prescribed.
• Before undergoing gynecological operations, women should undergo a smear test for purity and oncocytology.

In addition, you need a consultation with a therapist and a specialist in whose direction the operation is planned, and in the case of concomitant diseases (diabetes, heart disease, asthma, etc.) - a consultation and opinion of the relevant doctors.

Gynecological operations are carried out mainly in the first phase of the cycle, immediately after the end of menstruation. Sometimes, to diagnose infertility, intervention is prescribed for the period after ovulation.

Any operations cannot be performed during acute respiratory diseases.

A week before the intervention, it is better to start following a diet that excludes increased gas formation - you need to exclude beans, peas, black bread, cabbage, milk, etc.

In consultation with the doctor, it is necessary to stop or, on the contrary, introduce certain medications - for example, if hemostasis is impaired and there is a high risk of thrombosis, the patient is prescribed direct anticoagulants until the day of surgery.

Eating and drinking are prohibited 8-10 hours before the intervention. As a rule, all planned operations are performed in the morning, so the patient should not have dinner the day before, and should limit himself to light food for lunch. To cleanse the gastrointestinal tract, cleansing enemas are additionally prescribed - in the evening and in the morning before surgery. All these measures are needed in case the intestines are affected during manipulations - food residues in it, once in the abdominal cavity, can cause a serious complication (peritonitis).

To prevent thrombotic complications, immediately before surgery, the patient must wear special elastic stockings or apply bandages and remain in them until the doctor allows them to be removed (usually after 14-15 days).

Hygiene procedures include showering and shaving hair in the lower abdomen, genitals and navel area. Shaving is done only in the hospital immediately before surgery.

If the patient cannot cope with anxiety, he is prescribed sedatives (mild herbal drugs - a few days before, more serious ones such as phenazepam - on the day before the operation).

Laparoscopy in gynecology

Pregnancy after laparoscopy

Laparoscopy in gynecology is used for low-traumatic treatment of reproductive diseases. For example, when a woman wants but cannot get pregnant and conservative treatment does not give results. Fortunately, modern medicine can help her. How does this work?

• When pregnancy cannot develop due to fibroids filling the uterine cavity, laparoscopic removal of the myomatous node will come to the rescue.
• If the lumen of the fallopian tubes is blocked for various reasons, laparoscopic plastic surgery will restore their patency.
• Endometriosis (adenomyosis) is often the cause of infertility. Treatment consists of cauterizing the lesions, and then taking hormonal drugs to prevent relapses.
• The cause of infertility may be a dysfunction of the ovaries, an indirect sign of which is the appearance of cysts. In 70% of cases, cysts are functional in nature; they appear on certain days of the cycle, and then decrease and disappear. But sometimes regression is disrupted due to hormonal imbalance, and the tumor continues to grow, reaching significant sizes - up to 10 cm or more. In addition, a cyst can be a congenital or acquired pathology: a dermoid formation remains in a woman from the time of intrauterine development, and an endometrioid formation is formed when endometrial cells end up in the ovary and grow pathologically in it. Another type of cyst is cystadenoma (true), which has a tendency to degenerate into a malignant tumor. All these tumors should be removed. Unfortunately, cysts can form again after laparoscopy, but a combination of surgery and conservative treatment reduces the likelihood of their occurrence.
• If the cause is polycystic disease, resection or cauterization of ovarian tissue will help. In this case, the ovaries after laparoscopy work in a healthier mode - new healthy tissue grows in the operated areas, due to a decrease in the production of androgens, the number of cysts decreases, and the follicles gain the ability to burst to release the egg.

As a rule, laparoscopic operations are low-traumatic, and the woman quickly recovers. Therefore, planning a pregnancy is allowed just a month after laparoscopy of a cyst and other ovarian diseases has been performed. Well, when the cause of infertility is polycystic disease or endometriosis, the expectant mother is prescribed hormonal treatment for up to six months, after which she can begin planning a pregnancy.

The period of pregnancy after laparoscopy may be limited (for example, with polycystic disease, due to persistent hormonal imbalance, the ovaries quickly become overgrown with cysts again), and therefore you need to follow the instructions of the attending physician and follow his instructions in order to benefit from the results of treatment.

Laparoscopy for diseases of the fallopian tubes

Diseases of the fallopian tubes and the use of laparoscopy

Laparoscopy in gynecology is successfully used to treat fallopian tube pathology. These diseases can cause severe discomfort and prevent pregnancy.

With the help of fallopian tube laparoscopy, the doctor copes with ectopic pregnancy: the operation allows for a sparing operation and leaves a chance to save the organ.

Laparoscopy of the tubes makes it possible to check their patency: if they are impassable, plastic surgery, dissection and coagulation of adhesions are required.

Surgery helps with pio- and hydrosalpinx, when fluid or pus accumulates in the lumen of the tube. Modern technologies for surgical treatment in some cases make it possible to save the tube, and if it is impossible to leave it, removal will be carried out as carefully as possible.

Another reason why tubal laparoscopy is performed is contraception. To achieve the desired effect, you can apply clips (less reliably) or cut the tube (in this case, the likelihood of pregnancy is reduced to zero).

How is tubal laparoscopy performed?

Tubal laparoscopy is performed according to the standard procedure, even if it is performed urgently if an ectopic pregnancy is suspected.

Often the operation is combined with laparoscopy of the cyst and uterus, especially if the goal is to diagnose the causes of infertility.

Under general anesthesia, a hole is made in the patient's abdominal wall, and then carbon dioxide is pumped through it and a laparoscope is inserted. The other two holes in the sides are needed for inserting instruments. After this, the organs in the surgical field are examined, and then the surgeon acts in accordance with the circumstances: if an ectopic pregnancy is detected, part of the tube with the embryo is excised and removed, in the case of adhesions, the adhesions are cauterized and dissected, etc.

Laparoscopy ends with inspection of the space, removal of gas, installation of drainage (except in cases where the operation was diagnostic, or areas of endometriosis were cauterized), and suturing the wounds.

Recovery after surgery

Rehabilitation after laparoscopy is usually quick. Within two hours after waking up from anesthesia, the woman is allowed to drink, sit down in the evening of the day the operation is performed, and get up and eat in the morning. Pain after laparoscopy is not intense and goes away quickly - after a few days, patients usually refuse pain relief.

But the treatment of tubal diseases does not end with surgery. It involves a whole range of procedures following surgery - physiotherapy, medication, spa treatment. All this should be prescribed by a gynecologist.

Complications after tubal laparoscopy

What complications can occur after tubal laparoscopy? As a rule, the troubles are standard:

• Infection of sutures and tissues, suppuration.
• Emphysema is a pathological accumulation of gas at the insertion sites and muscles.
• Injuries to blood vessels and neighboring organs.
• Thrombosis.

A specific complication may include the development of salpingitis (inflammation of the tubes) and salpingo-oophoritis (inflammation of the tubes and ovaries) if a woman has a chronic infection - tuberculosis, chlamydia, ureaplasmosis, etc.

Laparoscopy for diseases of the uterus

Uterine diseases and laparoscopy

Laparoscopy in gynecology can be used to diagnose and treat diseases of the uterus:

• Myomas (with superficial small nodes). If the nodes are located in hard-to-reach places, preference should be given to laparotomy to reduce the risk of bleeding, or to use a technique for temporarily stopping the blood supply to the uterus.
• Endometriosis (adenomyosis).
• Polyp.
• Prolapse or prolapse of the uterus.
• Malignant growth of the endometrium and uterine tumors.

Laparoscopy of the uterus makes it possible to carry out treatment almost bloodlessly and without complications, and, if necessary, remove the diseased organ.

How is the operation performed?

Laparoscopy for diseases of the uterus can be diagnostic, therapeutic, or pursue two goals simultaneously. In all cases, the sequence of the operation is the same: first, an incision is made in the navel area and a needle is inserted to inject gas, the abdominal cavity is filled with carbon dioxide, after which the needle is removed, and a trocar with a video camera is inserted into the same hole. Two other punctures are made on the sides of the torso, and the necessary instruments are inserted through them.

The doctor’s tactics depend on what problem was discovered in the patient as a result of preliminary examinations or directly on the table. For example, if a woman is operated on for adenomyosis, the surgeon removes the adenomyosis node and sutures the wound surface. To reduce blood loss and ensure high-quality tissue fusion, special sutures and methods of fixing the walls of the uterus during suturing can be used.

It is important to know whether a woman wants to have children: if the operation is performed to treat fibroids and a pregnancy is planned after laparoscopy, it is better to avoid removing all myomatous nodes, and remove only those that, due to their size and shape, can interfere with the normal development of the embryo.

At the end of the operation, the doctor once again examines the pelvic cavity, removes blood and fluid, checks how firmly the terminals are on the vessels or stump, and how the sutures are placed. Then the gas is pumped out, the instruments are removed, and sutures are applied to the soft tissues and skin where the trocars enter.

Complications of diseases of the uterus

Laparoscopy of the uterus, as a rule, does not have any specific complications when compared with other operations. The only peculiarities include the likelihood of more severe bleeding, since large blood vessels approach the uterus. Other complications of the postoperative period are as follows:

• Infection and suppuration of postoperative sutures.
• Emphysema (accumulation of gas at the sites where trocars are inserted and in the muscles).
• Damage to blood vessels and neighboring organs.
• Spikes.
• Constipation, urination problems.
• Thrombosis.

Laparoscopy for ovarian diseases

Ovarian cyst and laparoscopy

Ovarian cysts in women can be functional (related to the hormonal cycle) and pathological. The latter include endometrioid, dermoid, and cystadenomas. All of them require surgical treatment. Sometimes it is necessary to remove a functional cyst if it is actively growing, becomes larger than 8 cm, and there is a risk of its rupture or twisting of the stem.

The inconveniences that the neoplasm creates for a woman - pain in the lower abdomen and during sexual intercourse, changes in the cycle, urination problems - can be eliminated by laparoscopic surgery. It allows you to remove the tumor as carefully as possible, without affecting healthy tissue, and send it for histological examination. To avoid complications, the surgeon tries to enucleate the cyst completely and remove it without violating its integrity.

A pathological cyst after laparoscopy, performed in compliance with all requirements and with subsequent conservative treatment, as a rule, no longer appears.

Laparoscopy for polycystic ovary syndrome

Polycystic disease (polycystic ovary syndrome, PCOS) is an endocrine disease that causes infertility. With PCOS, many cysts form in the enlarged ovaries. The reason for this phenomenon is excessive secretion of androgens, as a result of which ovulation does not occur, and small follicles turn into cysts. Treatment for PCOS can be conservative or surgical. Usually they start with conservative treatment, and if there is no effect, the patient is offered surgery. It is carried out in different ways:

• Cauterization is a shallow circular (1 cm) incision on the surface of the ovary, in place of which healthy tissue grows, and then normal follicles mature.
• Removal of the dense membrane from the surface of the ovaries using a special electrode. The ovaries begin to function normally after laparoscopy because the follicles can grow, mature and burst normally, allowing the egg to be released.
• Removal of cysts using electric current.
• Wedge resection is the removal of part of the ovaries in such a way as to capture more cysts and less healthy tissue. The remaining tissue produces less androgens. Resection is used for severe PCOS.
• Endothermocoagulation is the burning of holes on the surface of the ovary. As a result, the ovaries produce less androgens after laparoscopy.

You should know that surgical treatment of PCOS has a short-term effect. Cysts do not form after laparoscopy for some time, but if hormonal imbalances persist, after some time they begin to grow again. Therefore, a woman is recommended to plan pregnancy as soon as possible after laparoscopy.

Other indications (adhesions, ovarian apoplexy, etc.)

In addition to cysts, laparoscopic operations on the ovaries can be performed in other cases:

• Ovarian torsion is a rare condition that occurs in young women. The cause of torsion is an anatomical deviation in the structure (pathological length of the tubes, absence or underdevelopment of the uterine ligament), cysts and tumors. Timely diagnosis and treatment helps to avoid tissue necrosis and subsequent infertility.
• Adhesions sometimes cause a lot of discomfort and cause chronic pelvic pain. They may be the result of long-term chronic inflammation or surgery.
• Apoplexy (rupture) of the ovaries is a sudden violation of the integrity of the tissue during ovulation, especially after physical activity, discontinuation of contraceptives, or heavy lifting. Rupture can also occur in the presence of cysts. The main method of treatment is surgical, when the doctor removes the cyst, stops the bleeding, and sutures the tissue. In rare cases, it is necessary to remove the ovary if the bleeding cannot be stopped during surgery. Usually, the ovaries after laparoscopy, performed in a timely manner due to apoplexy, continue to function normally, allowing women to plan a pregnancy.

Complications of ovarian diseases

Laparoscopy of a cyst or other ovarian formations sometimes occurs with complications. All of them are non-specific and can also occur during other types of operations:

• Hernias (protrusion of part of the intestine in an unusual place).
• Emphysema (accumulation of gas both inside the muscles and under the skin).
• Damage to blood vessels.
• Damage to internal organs.
• Adhesive process.
• Constipation, urination problems.
• Thrombosis.

Laparoscopy of the gallbladder

How is gallbladder removal surgery performed?

Removing the gallbladder using laparoscopy (laparoscopic cholecystectomy) is the most common operation in the world. If previously a person, experiencing pain in the right hypochondrium and knowing about the presence of stones, decided on surgical treatment when there was nowhere to go, today patients prefer to have the gallbladder removed as planned, without waiting for complications. Another reason for removal is the presence of polyps with a high risk of degeneration into a tumor.

How is the operation performed? The patient is secured with belts and then the table is moved to a position convenient for viewing: the patient lies on his back, the head end of the operating table is raised by 20-25 degrees, and the table itself is tilted to the left. After installing a catheter for infusion of drugs and administering anesthesia, the surgeon cuts the skin near the navel and pierces the abdominal wall with a Veres needle, through which 4-5 liters of carbon dioxide are supplied into the abdominal cavity. After this, the needle is removed, a special instrument (trocar) is inserted into the resulting puncture, and through it a laparoscope with a video camera and a light source is inserted. Then, under video control, a trocar is inserted for the surgeon into the upper abdomen (in the area of ​​the stomach), and 1-2 into the right side (for assistant manipulation).

The abdominal cavity is examined from the inside for the presence of other pathologies, after which work begins on cutting off the gallbladder. First, the gallbladder is isolated, clips are applied to the cystic duct and cystic artery, which are then divided. Finally, the bladder is separated from the liver and removed from the abdominal cavity.

The bladder is placed in a sterile container inside the abdomen and then removed from an access point in the upper abdomen. It happens that the size of the stones does not allow them to be pulled out through the hole made, and then surgeons either widen it or first crush the stones before removing the bubble.

At the end of the procedure for removing the bladder and stones, a drain is placed in the abdomen in the liver area to ensure the outflow of effusion. The carbon dioxide is then removed, the instruments are removed, and the skin wounds are sutured.

Contraindications for surgery

In addition to general contraindications regarding the condition of the lungs, heart, and nervous system, laparoscopy of the gallbladder cannot be performed if the patient has:

• Obstructive jaundice, in which the flow of bile from the liver is impaired due to blockage by a stone or the presence of a tumor.
• Acute inflammation of the pancreas.
• Inflammation of the common bile duct coming from the liver.
• Acute inflammation of the gallbladder, if more than 3 days have passed since the first symptoms appeared, swelling around the organ.
• Atrophy of the gallbladder or severe hardening of its walls.
• The presence of fistulas, inflammation, bedsores in the area of ​​the bladder neck.
• Abscess or fistulas in the area of ​​the gallbladder and intestines.
• Pronounced adhesions in the area of ​​the gallbladder, common duct and liver.
• When cancer of the bladder or ducts is suspected.

In all the described cases, the gallbladder must be removed using laparotomy. If the operation began laparoscopically, but difficulties arose during it, surgeons proceed to open abdominal surgery.

Rehabilitation after laparoscopy of the gallbladder

The rehabilitation period after laparoscopy of the gallbladder, as a rule, proceeds calmly and much easier than after an extensive laparotomy. The patient is put on a postoperative bandage and “raised to his feet” in the evening of the day of surgery or the next morning, and from then on he can and should move independently. Patients can be given water a few hours after recovery from anesthesia, and fed the next day.

Those who have had their gallbladder removed due to the presence of stones in it must follow diet No. 5 for at least the first 6 months after surgery, and it is better to do this for life. Do not forget that the reservoir where the stones were stored has been removed, but metabolic disorders and altered (promoting stone formation) properties of bile have not gone away. This means that stones can appear in the intrahepatic ducts and the common bile duct. To prevent this, you need to be observed by a gastroenterologist and periodically take lipotropic drugs, follow a diet and diet.

Return to a full life and work activity after laparoscopic cholecystectomy is possible after 14-15 days. To avoid straining the abdominal muscles, weights weighing more than 4 kg should not be lifted for 2 months from the date of surgery. You can do feasible physical exercise in the form of walking after discharge from the hospital, but it is better to avoid serious exercises related to the abs for six months.

Pain after laparoscopy

Pain after laparoscopy usually does not last long and is easily tolerated by the patient. They are associated with tissue damage at the sites of insertion of trocars (instruments) and manipulations inside the abdominal cavity. As a rule, the pain is most intense within a few hours after the end of the operation, but quickly passes after taking analgesics. After a day, the strength of the discomfort decreases, and the patient requires less and less painkillers (some people even refuse them completely).

On the first day after laparoscopy, mild pain may be in the shoulder and chest area. This is due to the injection of carbon dioxide into the abdominal cavity and distension of the abdomen during the operation, which causes spasm of the diaphragm and compression of organs. The discomfort goes away after a few days.

Another possible cause of pain after laparoscopy is the release of gas outside the abdominal cavity. If it has penetrated into the subcutaneous space, the administration of analgesics helps, and the discomfort quickly passes. The entry of gas into the space between the abdominal muscles causes severe pain, shortness of breath, a feeling of lack of air, and it is difficult for the patient to turn his head and swallow. This condition is life-threatening and therefore requires urgent treatment: the patient is placed in a reclining position with the head of the body raised, and needles are inserted into the muscles in a special way to release the gas.

It may hurt after laparoscopy due to complications that have arisen - suppuration of the trocar insertion sites, damage to internal organs that was not noticed during the operation. In all the described cases, you need to urgently seek medical help, and not wait for relief at home.

Diet after laparoscopy

The diet after laparoscopy is prescribed depending on the disease for which the person was operated on.

If it is not related to the gastrointestinal tract (for example, ovarian laparoscopy was performed), it is enough to follow the principles of a healthy diet. Food should be moderate or low in calories, contain little animal fat, and contain a lot of dietary fiber. You need to eat fractionally, 5-6 times a day, in small portions. The amount of fluid consumed is 1.5-2 liters per day. The first full meal usually occurs the day after the operation, and before that, 2-3 hours after emerging from anesthesia, the patient is allowed to drink.

Removal of the gallbladder performed during laparoscopy requires the prescription of diet No. 5, and it must be followed not only in the postoperative period, but also beyond. Food should be low-fat, non-spicy, pickled and smoked foods, carbonated drinks are prohibited, chocolate should be limited. Preference is given to food that promotes the breakdown of animal fats, is low in calories and rich in protein. After laparoscopy of the gallbladder, you need to give up fried foods and switch to stewing, baking or boiling foods.

If the operation was performed on other organs of the gastrointestinal tract, starting from the third day the patient is prescribed diet No. 2 according to Pevzner. It must be strictly observed during the first month, and then you can agree on an increase in the diet with a gastroenterologist. Diet No. 2 involves mechanical sparing of the gastrointestinal tract and a decrease in secretory function. Therefore, preference is given to baked, boiled or stewed food in a warm form; cold and hot foods should be excluded. Dishes should have a soft or pureed consistency, without a crust.

Complications of laparoscopy

Damage to the gastrointestinal tract

One of the most common complications during laparoscopic surgery is damage to the gastrointestinal tract, since most operations are performed in the abdominal cavity. What complications are possible?

Puncture of organs (spleen, stomach, intestinal loops) usually occurs with multiple adhesions, when the anatomical location of all organs is somewhat changed (for example, the intestinal loops are not located in a standard manner, but are “pulled” to each other). The puncture usually does not have serious consequences, it does not require special treatment.

Cutting damage to intestinal loops and colon occurs both due to careless handling of instruments and during the procedure of dissecting multiple adhesions and areas of fusion of the intestine with other internal organs. Sometimes cut and puncture injuries to organs are caused due to the fact that the operation was performed incorrectly (a urinary catheter or nasogastric tube was not installed). If such a complication occurs, the surgeon must proceed to abdominal surgery to check the nature and extent of the damage and repair it.

Tissue damage due to coagulation can cause bleeding or perforation of hollow organs. The most common case of damage is when, during laparoscopy, removal of the appendix is ​​accompanied by coagulation of the mesentery, or sterilization of the stump with a special instrument. Since it is difficult to assess the degree of burn or perforation using only a video monitor, laparotomy is usually used to eliminate the complication.

Removing the gallbladder by laparoscopy can damage the bile ducts. Depending on the severity of the complication, there may be either a slight leakage of bile or unpleasant consequences in the form of the formation of extensive scars, which subsequently impede the outflow of bile. Therefore, if, during laparoscopic removal of the gallbladder, the surgeon sees a violation of the integrity of the ducts and the appearance of bile, you need to proceed to laparotomy surgery and suture the damage.

Gas embolism

During a laparoscopy operation, a situation may arise when the needle enters a large blood vessel, and the injected carbon dioxide enters its lumen. This complication is called gas embolism, it is extremely dangerous and can lead to the death of the patient. To avoid it, the surgical technique involves the use of rapidly absorbable (resorbable) gases such as nitrous oxide or carbon dioxide, which, if they enter a vein or artery, will disintegrate in a short time.

Damage to blood vessels

Laparoscopic operations may be accompanied by damage to blood vessels. Depending on which vessel is damaged and how much, the severity of the complication and the prognosis depend.

A needle entering the epigastric vessel leads to the formation of a hematoma of the anterior abdominal wall. It can be suspected after a laparoscope is inserted into the retroperitoneal space, and on the screen the surgeon sees the filling of the cavity with blood or bulging of the peritoneum. If damage to the vessel is detected, but there is no accumulation of blood yet, to prevent hematoma, the doctor places sutures through the thickness of the peritoneum perpendicular to the vessel.

If the vessels of the rectus abdominis muscles are affected, cavitary bleeding or an external hematoma around the hole made by the trocar may be visualized on the monitor. To eliminate blood loss, sutures are required on the damaged vessel above and below the inserted trocar.

Damage to the vessels of the anterior abdominal wall with bleeding is detected after laparoscopy, when gas is pumped out of the abdominal cavity and instruments are removed. Depending on the severity of bleeding, in this case, either laparotomy surgery or conservative treatment is necessary.

If the largest vessels are affected, an urgent laparotomy is necessary, the purpose of which is to stop severe bleeding. A delay of even a few tens of seconds is fraught with death.

Extraperitoneal gas insufflation

The gas that is used to fill the abdominal cavity before surgery is needed for a better view of the organs. A complication during its use is called extraperitoneal insufflation. As the name suggests, in this case the gas enters outside the peritoneum (“extra”). Depending on its location, pain and unpleasant symptoms of different types occur.

When gas enters the subcutaneous space or the thickness of the peritoneal tissue, subcutaneous or preperitoneal emphysema is formed. As a rule, it does not affect cardiac and respiratory activity and goes away on its own, but it may interfere with a good view of the organs during surgery. A complication can be suspected if after laparoscopy the pain is more pronounced than usual and bothers the patient. They can be removed using conventional analgesics.

A rare complication is mediastinal emphysema (gas entering the mediastinum). In this case, during or after laparoscopy, the patient experiences difficulty breathing and increasing shortness of breath, pain, and impaired swallowing function. The patient should be brought to a reclining position as quickly as possible, fixing the operating table or bed at an angle of 45º. To remove gas from tissues, special needles are used, inserting them 1-1.5 cm deep. In addition, medications are prescribed to maintain cardiovascular activity.

The most dangerous case is when the trocar (instrument) needle gets into the lumen of a large blood vessel, causing a gas bubble to escape into its cavity and gas embolism.

Rehabilitation after laparoscopy

As after any operation, after laparoscopy the patient requires rehabilitation. But, unlike recovery after traditional surgery, returning to normal life is much faster and easier.

Thus, the patient requires bed rest only on the day of the operation, and even then it is associated mainly with the need to recover after anesthesia. You can sit up and turn over in bed in the evening, and in the morning you can get up and walk.

Restrictions on food intake are also explained by the fact that the body needs to recover from anesthesia (except in cases where the operation was performed on the gastrointestinal tract). But you can drink little by little after a few hours, and in case of surgery on the digestive tract - after a day. The patient's diet should consist of healthy low-calorie foods with reduced fat and protein content. You need to eat plenty of foods containing dietary fiber to prevent constipation and prevent bloating. You should limit spicy, smoked, salty foods, and exclude alcohol. You need to eat little and often, drink about one and a half liters of liquid per day. After laparoscopy of the gallbladder and gastrointestinal tract, the patient is prescribed a special therapeutic diet, which must be followed not only in the postoperative period, but also beyond.

Self-absorbable material can be used to apply sutures after laparoscopy, and then their removal is not required.

If the sutures are made with material that requires removal, this is done on an outpatient basis 5-7 days after surgery. Until the wounds and sutures after laparoscopy have completely healed, it is not recommended to take baths; it is better to limit yourself to washing in the shower, and after it you need to treat the skin with iodine or a solution of potassium manganese.

Physical labor is possible starting from the 4th week after surgery. Of course, you should not immediately strive for sporting feats, but the patient is quite capable of the usual rhythm of life with everyday stress and physical therapy.

After laparoscopy of ovarian cysts and other gynecological interventions, women may observe discharge similar to menstrual discharge within a few days. This is a normal reaction of the body to surgery. It also happens that menstruation is restored only after a few months, and this is also nothing to worry about, but it is necessary to be observed by a gynecologist so as not to miss possible complications. After laparoscopy of the ovaries, uterus and tubes, you should abstain from intimate life for 3-4 weeks. And if the patient is bothered by severe pain in the lower abdomen, fever, redness at the surgical puncture sites, nausea, vomiting and headache, you should immediately consult a doctor.

Laparoscopy has firmly entered the arsenal of modern surgery. Conducting low-traumatic, high-precision operations has become the norm. Just a few decades ago, torsion of an ovarian cyst in a young woman threatened her with lifelong infertility. Today, ovarian laparoscopy allows you to cure the disease without any consequences. Gynecological operations, treatment of gastrointestinal diseases, diagnosis and even removal of tumors - all this is now done with high quality and less traumatic. And the rapid recovery after laparoscopy, minimal pain and comfort are increasingly attracting patients.

Today, removal of the gallbladder remains the main method of treating cholecystitis and cholelithiasis. The operation is performed in several ways and differs in the operational access to the affected organ. Laparoscopic cholecystectomy, performed using special equipment, is recognized as the “gold standard”. If there are contraindications, resection is performed traditionally (through a large incision in the abdominal wall) or using a mini-access.

What is cholecystectomy

The bladder serves as a repository for bile, which removes excess cholesterol, toxins and bilirubin from the body. It is the most important component in the digestive chain. The quality of breakdown and absorption of nutrients depends on the coherence of the gallbladder.

Violation of the functionality of the cavity organ leads to the development of pathological processes. At a certain stage, taking medications and diet helps. But in most cases, immediate use of radical measures to remove the cavitary organ is required.

The operation is called cholecystectomy and is prescribed both planned and for emergency indications. A planned procedure with preoperative preparation of the patient is preferable. But there are situations in which even a slight delay threatens the development of serious complications.

Why is the operation performed?

Various methods are used to treat stones in the organ. This is a diet, litholytic therapy or extracorporeal crushing of stones with ultrasound. Each of them has its own disadvantages and is not a guarantee of a cure.

Drugs for dissolving stones are toxic, require long-term use and are poorly tolerated by most patients. Extracorporeal lithotripsy breaks large stones into small fragments, but there is a danger of blocking the bile duct with a large stone and the appearance of obstructive jaundice, as well as other complications.

Evacuation of gallstones does not exclude the recurrence of stones. This means that after conservative treatment, pathological changes in the organ and the presence of factors that previously contributed to stone formation remain.

Indications for use

Surgery to remove the gallbladder is required if the organ stops functioning and becomes a source of pathological processes. The doctor may prescribe a laparoscopic or open cholecystectomy if the patient:

• the presence of stones in the main cystic duct;
• acute cholecystitis;
• obstruction (blocking) of the biliary tract;
• attacks of hepatic colic;
• cholelithiasis with minor manifestations or absence of signs of the disease;
• deposition of calcium salts in the tissues of the gallbladder;
• cholesterosis – saturation of the walls of an organ with cholesterol against the background of cholelithiasis;
• the formation of polyps on the mucous membrane of the organ;
• the appearance of secondary (bile) pancreatitis;
• neoplasms of various origins.

All these pathologies pose a danger to the patient’s life. If the cholecystectomy operation was performed on time, this contributes to the patient’s recovery and prevents the development of such serious complications as:

• abscess;
• obstructive jaundice;
• inflammation of the bile ducts;
• impaired motility of the duodenum (duodenostasis);
• renal and liver failure.

With the development of gangrenous cholecystitis, the appearance of a through defect in the wall of the gallbladder (perforation), this means that urgent surgery is required.

Contraindications

In what cases is cholecystectomy not performed:

• cardiac and respiratory failure in the stage of decompensation;
• destruction of the gallbladder;
• severe chronic diseases;
• low blood clotting rates;
• oncology;
• acute infectious pathologies;
• extensive peritonitis;
• accumulation of lymphoid fluid or blood in the anterior abdominal wall;
• 1st and 3rd trimester of pregnancy;
• congenital gallbladder defects;
• severe inflammation in the cervical area of ​​the gallbladder.

When indications for cholecystectomy appear in elderly patients, laparoscopy or laparotomy is performed regardless of age.

The operation may be canceled due to the risk of postoperative complications if:

• concomitant somatic diseases;
• blockage of the cystic duct;
• pus in the bladder cavity;
• the presence of previous operations in the abdominal cavity.

Surgery to remove the gallbladder is postponed if:

• the person is over 70 years old and suffers from a chronic disease that is severe;
• cholangitis - inflammatory processes in the bile ducts;
• the formation of many adhesions in the abdominal cavity;
• obstructive jaundice;
• cirrhosis;
• scleroatrophic gallbladder;
• ulcerative damage to the walls of the duodenum;
• obesity stage 3-4;
• chronic pancreatitis due to the proliferation of tumor tissue.

Acute cholecystitis in the first three days is treated with laparoscopic cholecystectomy; if time is lost, then the operation is contraindicated.

Types of surgery

Depending on the indications, the operation can be performed in different ways. In surgery, there is a classification based on the method of access to the damaged organ during surgery.

Types of cholecystectomy and their description:

1. Laparotomy is an open excision of the gallbladder. To do this, make a large incision (15-20 cm) on the front wall of the abdomen.
2. Laparoscopy – the operation is performed through 3 neat mini-punctures using endoscopic equipment.
3. Mini-access cholecystectomy is a minimally invasive procedure with minor tissue trauma. For resection, a vertical incision of 3-7 in the area of ​​the right hypochondrium is sufficient.

What type of operation is applicable in a particular case is determined by the doctor after receiving the results of a complete examination of the patient. If there are no contraindications, preference is given to laparoscopic cholecystectomy; it has the best characteristics.

Preparing for surgery

Planned surgical treatment involves preoperative diagnostics. This allows for an assessment of the general functional state, the presence of infection, allergies, inflammation and other contraindications. The success of surgery depends a lot on the quality of preparation.

List of examination methods before resection of the gallbladder:

• general and biochemical examination of blood and urine;
• reaction to RW;
• analysis for the presence of hepatitis B and C;
• hemostasiogram;
• description of the electrocardiogram;
• determination of blood group and Rh factor;
• Ultrasound of the biliary system and abdominal organs;
• fluorography;
• FGS or colonoscopy (if indicated).

Additionally, you may need to consult a cardiologist, allergist, gastroenterologist and endocrinologist. Detailed diagnostics will help determine the optimal type of anesthesia and predict the body’s reaction to LCE surgery.

3 days before a planned cholecystectomy, it is recommended to switch to a gentle diet, preferably not to eat vegetables, fruits, or baked goods. The night before, you can have dinner with yogurt, kefir or porridge, and also cleanse the intestines with an enema. Eating and drinking are prohibited 8 hours before surgery.

Cavitary cholecystectomy

Laparotomy is a surgical procedure that is performed through a large trepanation window. Performed after unsuccessful laparoscopy or for special indications:

• inflammation of the peritoneum (peritonitis);
• gangrenous cholecystitis;
• cancer or malignancy of benign formations;
• the presence of a large number of stones (more than 2/3 of the volume);
• abscess;
• dropsy of the abdomen (accumulation of lymphoid tissue);
• bladder injuries.

Laparotomy can be a continuation of LCE if:

• the hepatic duct is damaged;
• internal bleeding began;
• fistulas formed.

During installation, internal organs may be damaged by the inserted trocars, which can also be corrected with open surgery.

Stages of laparotomy

The open access surgical technique includes the following steps:

1. An incision (15-30 cm) is made in the middle of the abdomen or under the right rib.
2. The gallbladder is freed from the surrounding fatty tissue.
3. Blood vessels and bile ducts are blocked.
4. The bladder is cut off from the liver and removed.
5. The bed at the site of the removed organ is sutured with a self-absorbing surgical thread or cauterized with a surgical laser.
6. The surgical wound is gradually sutured in layers.

Open (cavitary) cholecystectomy is performed under general anesthesia and can last up to 2 hours. This technique is rarely used due to extensive trauma to abdominal tissue, a large cosmetic defect at the incision site and the risk of adhesions. An additional disadvantage is the long recovery.

Laparoscopic surgery

The most common method of surgical treatment is endoscopic cholecystectomy. This is a minimally invasive procedure to remove the gallbladder with minimal damage to the anterior abdominal wall.

The affected organ is removed through one of 3-4 incisions, the size of which does not exceed 10 mm. Subsequently, the puncture sites grow together with the formation of barely noticeable scars. The duration of laparoscopic surgery varies between 30-90 minutes and depends on the weight of the patient, the duration of anesthesia and the presence of stones in the ducts.

Advantages and Disadvantages

Advantages of video laparoscopic endoscopy:

• The laparoscope allows you to clearly “see” the operation site;
• no pain in the postoperative period;
• least traumatic compared to other techniques;
• short period of hospital stay (1-4 days);
• low risk of formation of adhesions and hernia formations;
• rapid restoration of working capacity.

Like any other medical procedure, endoscopic surgery also has disadvantages:

• the likelihood of infection;
• bleeding;
• violation of the integrity of internal organs with medical instruments;
• inability to remove stones from the ducts.

If a complication is detected during the operation (infiltration, adhesions), treatment is continued through wide access using the traditional technique.

Progress of the operation

Surgical treatment is performed in sterile conditions under general anesthesia. Description of the stages of LCE:

1. As part of the preparation, a probe is placed in the stomach and a catheter is placed in the bladder. To prevent the formation of blood clots, anti-embolic stockings are worn on the legs.
2. Nitric oxide or carbon dioxide is injected into the abdominal cavity through a puncture below the navel to improve surgeons' access by elevating the abdomen.
3. Trocars with micro-instruments at the end are inserted at 3-4 points. The procedure is carried out under monitoring using a laparoscope.
4. The bubble is moved away from the tissue, the hepatic duct and artery are clamped with staples.
5. The organ is excised and removed through the umbilical incision. Damaged tissue areas are removed, vessels are stopped.
6. The cavities are washed with an antiseptic solution.
7. The instruments are removed and the incisions are closed with sutures.

At all stages of the operation, manipulations are controlled by visualization of what is happening on the monitor screen using a microscopic camera that transmits the image while located in the abdomen.

Operational risks

The likelihood of complications during cholecystectomy surgery is negligible. According to statistics, the situation is recorded in 1 out of 100 patients undergoing surgery. Sometimes there are cases of injury to internal organs by trocars. But the cause is most often anomalies in the location of organs. In rare cases, there is a risk of internal bleeding or disruption of the integrity of the gallbladder duct.

Postoperative period

Immediately after surgery, in the first 4 hours, bed rest is required. After laparoscopy, it is recommended to get up and start walking after 6-8 hours. The patient may complain of a nagging painful sensation at the insertion site of the instruments. There is no severe pain syndrome.

In most cases, the recovery period takes no more than 7-14 days. During this period, it is important to maintain a physical activity regime - avoid heavy physical activity for 1-2 months, which contributes to:

• prevention of congestion in the lungs;
• normalization of intestinal function;
• reducing the risk of adhesions.

When pain or dyspeptic disorders occur, the doctor prescribes medications that eliminate negative symptoms.

Diet

After laparoscopic or open cholecystectomy in adults, proper nutrition is of great importance. After removal of the gallbladder, bile enters the duodenum directly in small portions. Therefore, foods high in fat should be avoided.

On the first day you can drink only water, on day 2 - low-fat kefir and tea. In the future, the diet is compiled taking into account the permitted products:

Allowed	Forbidden
Vegetable broth soup with potatoes and carrots, pureed through a sieve Puree soup with the addition of lean beef, you can add a little cream	Rich broths from fatty meat, fish, mushrooms Okroshka Borsch, cabbage soup
Porridge of rice, oatmeal, buckwheat with milk. The cereal must be well cooked.	Millet, pearl barley, corn grits
Steamed meatballs Cereal cutlets Pudding	Fatty meat: pork, lamb
Small vermicelli, mashed potatoes	Canned smoked dishes
Boiled lean fish Steamed fish cutlets	Fried, salted fish
Low-fat cottage cheese without sugar, kefir	Spicy cheese, high fat dairy products
Stale bread Dry cookies	Freshly baked bread, pastries, creamy products
Boiled or steamed vegetables: carrots, cauliflower, zucchini, potatoes, pumpkin	Garlic, sorrel, white cabbage, cucumbers, turnips, spinach, mushrooms
Tea with added milk Kissel Rose hip decoction	Alcohol Carbonated drinks Kvass, strong coffee without milk

The diet after laparoscopic cholecystectomy should be divided (5-6 times a day), and the food should be warm. Fluid must be supplied to the body in sufficient quantities - at least 2 liters per day.

Possible complications

In most patients, organ resection is successful. Negative effects occur in 2 out of 10 adult patients. More often, complications are observed in elderly patients or with destructive types of pathology.

After removal of an organ, changes occur that can serve as an impetus for the development of secondary pathologies:

• the composition of bile secretion changes;
• the process of bile entering the duodenum is disrupted;
• disruption of the digestion process;
• excessive gas formation in the intestines;
• violation of peristalsis;
• the hepatic ducts dilate.

Such phenomena contribute to the emergence of complications that can arise at different stages of rehabilitation after cholecystectomy. List of possible consequences:

• gastroduodenal reflux;
• duodenitis;
• postoperative hernia;
• imbalance of microflora in the intestine;
• formation of adhesions;
• scars that reduce the lumen of the bile ducts;
• inflammation of the small or large intestine;
• gastritis;
• diarrhea;
• intestinal colic.

Complications may occur after laparoscopic cholecystectomy, which is an indication for changing treatment tactics.

Alarming symptoms:

• severe abdominal pain;
• increase in temperature;
• jaundice with characteristic staining of the skin;
• heaviness in the right hypochondrium.

Most patients recover completely after removal of the damaged organ. In a small number, signs of the disease may persist or worsen: bitterness in the mouth, poor digestion. This condition is called postcholecystectomy syndrome and occurs in adults:

• with chronic inflammation of the gastric mucosa;
• ulcerative lesion;
• hiatal hernia;
• colitis with a chronic course.

Prevention of the syndrome is the treatment of concomitant pathologies before surgery.

Conclusion

The prognosis is most favorable if the operation is performed without incisions. To do this, it is advisable not to neglect the pathology and to operate as planned. When laparoscopic cholecystectomy is performed in compliance with all standards, the patient recovers and feels well. Unpleasant sensations will not arise if you adhere to the rules of dietary nutrition and follow the doctor’s recommendations.

Video

Watch a video about life after gallbladder removal.