Main indications for gallbladder removal. Surgery to remove gallstones. Preparing for planned surgery

To date there is not one conservative method treatment that would 100% help get rid of stones in the bile ducts (choledocholithiasis). The most in an efficient way The treatment for cholecystitis is surgery to remove the gallbladder (cholecystectomy). In modern clinics, it is carried out in the most gentle way possible using laparoscopy after just 2-4 punctures on the body. A few hours after the procedure, the patient can already get up, and after a few days be discharged home.

Causes of gallstone disease

The gallbladder is a small organ shaped like a pouch. Its main function is the production of bile (an aggressive fluid necessary for normal digestion). Stagnation leads to the fact that individual components of bile precipitate, from which stones are subsequently formed. There are several reasons for this:

Eating disorders. Abuse of products with high content cholesterol, fatty or salty foods, long-term consumption of highly mineralized water leads to metabolic disorders and the formation of stones in the bile ducts.
Taking certain types of medications, especially hormonal contraceptives, increases the risk of developing calculous (inflammation of the bladder with stone formation) cholecystitis.
A sedentary lifestyle, obesity, and long-term adherence to low-calorie diets lead to digestive dysfunction and congestion in the biliary tract.
The anatomical features of the structure of the gallbladder (the presence of bends or kinks) prevent the normal removal of bile and can also provoke calculous cholecystitis.

Why are stones dangerous?

As long as the stones are in the cavity of the gallbladder, a person may not even be aware of their presence. As soon as the accumulations begin to move along the bile ducts, a person is overcome by attacks of biliary colic, lasting from several minutes to 8-10 hours, dyspeptic disorders appear (difficult and painful digestion, accompanied by pain in the epigastric region, a feeling of fullness of the stomach, nausea and vomiting, heaviness in the stomach). right hypochondrium).

Choledocholithiasis (stones in the bile duct) is dangerous due to possible development inflammation of the ducts, pancreatitis, obstructive jaundice. Often, large accumulations of stones during movement cause other dangerous complications:

perforation – rupture of the gallbladder or ducts;
peritonitis - inflammation of the peritoneum resulting from the effusion of bile into its cavity.

Long-term stagnation of bile can lead to the appearance of polyps on the walls of the organ and their malignancy (malignancy). Acute cholecystitis with the presence of stones is a reason for urgent hospitalization and surgical treatment, but even the asymptomatic course of the pathology does not exclude the possibility of surgery if the following indications are present:

risk of developing hemolytic anemia;
sedentary lifestyle life, to exclude bedsores in bedridden patients;
jaundice;
cholangitis - inflammation of the intrahepatic or bile ducts;
cholesterosis – metabolic disorder and accumulation of cholesterol on the walls of the gallbladder;
calcification – accumulation of calcium salts on the walls of an organ.

Indications for gallbladder removal

Initially, the stones formed in the bowels of the gallbladder are small in size: from 0.1 to 0.3 mm. They may come out on their own, with physical therapy or drug treatment. If these methods are ineffective, the size of the stones increases over time (some stones can reach 5 cm in diameter). They are no longer able to painlessly pass through the bile ducts, so doctors prefer to resort to removing the organ. Other indications for prescribing the procedure are:

the presence of sharp stones that increase the risk of perforation of the organ or its parts;
obstructive jaundice;
acute clinical symptoms – severe pain, increased body temperature, diarrhea, vomiting;
narrowing of the bile ducts;
anomalies anatomical structure organ;
patient's wishes.

Contraindications

There are general and local contraindications to cholecystectomy. If emergency surgical intervention is necessary due to a threat to human life, some of them are considered relative and may not be taken into account by the surgeon, since the benefits of treatment outweigh the possible risks. TO general contraindications include:

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

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

inflammation of the bile duct;
peptic ulcer duodenum or stomach;
cirrhosis;
gallbladder atrophy;
acute pancreatitis - inflammation of the pancreas;
jaundice;
adhesive disease;
calcification of organ walls;
large hernia;
pregnancy (1st and 2nd trimester);
abscess in the biliary tract;
acute gangrenous or perforated cholecystitis;
history of surgical intervention on the abdominal organs, performed via laparotomy.

Types of surgical intervention and their features

Cholecystectomy can be performed in the classic way(using a scalpel) or using minimally invasive techniques. The choice of method depends on the patient’s condition, the nature of the pathology, and the equipment of the medical center. Each method has its own advantages and disadvantages:

Cavity or open surgery to remove the gallbladder - midline laparotomy (an incision in the anterior abdominal wall) or oblique incisions under the costal arch. This type surgical intervention indicated for acute peritonitis, complex lesions of the biliary tract. During the procedure, the surgeon has good access to the affected organ, can examine its location in detail, assess the condition, and probe the bile ducts. The downside is the risk of complications and cosmetic skin defects (scars).
Laparoscopy – newest method surgery, due to which stones are removed through 2–4 small incisions (0.5–1.5 cm each) on the abdominal wall. The procedure is the “gold standard” of treatment chronic cholecystitis, acute inflammatory process. During laparoscopy, the surgeon has limited access and therefore cannot assess the condition of the internal organs. The advantages of the minimally invasive technique are:

minimum pain in the postoperative period;
rapid restoration of working capacity;
reducing the risk of developing postoperative complications;
reduction in the number of days spent in hospital;
minimum cosmetic defects on the skin.

Mini-access cholecystectomy is a method of single laparoendoscopic access through the navel or the area of the right hypochondrium. Such actions are carried out with a minimum number of stones and no complications. The pros and cons of cholecystectomy are completely the same as standard laparoscopy.

Preparing for surgery

Before any type of cholecystectomy is performed in the hospital, the patient is visited by a surgeon and an anesthesiologist. They tell you how the procedure will take place, about the anesthesia used, possible complications and take written consent for the treatment. It is advisable to begin preparing for the procedure before hospitalization in the gastroenterology department, checking with the doctor for recommendations on diet and lifestyle, and taking tests. This will help make the procedure easier.

Preoperative

To clarify possible contraindications and achieve better treatment results, it is important not only to properly prepare for the procedure, but also to undergo an examination. Preoperative diagnostics include:

General, biochemical blood and urine tests are completed within 7–10 days.
A clarifying test for blood group and Rh factor - 3-5 days before the procedure.
Testing for syphilis, hepatitis C and B, HIV - 3 months before cholecystectomy.
Coagulogram - tests to study the hemostasis system (blood clotting test). More often it is carried out in conjunction with general or biochemical tests.
Ultrasound of the gallbladder, biliary tract, abdominal organs - 2 weeks before the procedure.
Electrocardiography (ECG) – diagnosis of pathologies of the cardiovascular system. It is performed a few days or a week before cholecystectomy.
Fluorography or radiography of the chest organs - helps to identify pathologies of the heart, lungs, and diaphragm. It is given 3–5 days before cholecystectomy.

Only those people whose test results are within normal limits are allowed to undergo cholecystectomy. If diagnostic tests reveal abnormalities, you must first undergo a course of treatment aimed at normalizing the condition. Some patients, in addition to general tests, may need consultation with specialized specialists (cardiologist, gastroenterologist, endocrinologist) and clarification of the condition of the biliary tract using ultrasound or X-ray with contrast.

Since hospitalization

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

The day before cholecystectomy, the patient is prescribed a light meal. The last time you can eat is no later than 19.00. On the day of the procedure, you should refuse any food or water.
The night before, you need to take a shower, shave the hair from your stomach if necessary, and do a cleansing enema.
The day before the procedure, your doctor may prescribe mild laxatives.
If you are taking any medications, you should check with your doctor about the need to stop them.

Anesthesia

To perform cholecystectomy, general (endotracheal) anesthesia is used. At local anesthesia It is impossible to ensure complete control over breathing, relieve pain and tissue sensitivity, and relax muscles. Preparation for endotracheal anesthesia consists of several stages:

Before surgery, the patient is given sedatives (tranquilizers or drugs with anxiolytic effect). Thanks to the premedication stage, a person approaches surgery calmly and in a balanced state.
Before cholecystectomy, introductory anesthesia is administered. To do this, sedatives are injected intravenously to ensure sleep before the main stage of the procedure begins.
The third stage is to ensure muscle relaxation. To do this, muscle relaxants are administered intravenously - drugs that strain and promote relaxation of smooth muscles.
At the final stage, an endotracheal tube is inserted through the larynx and its end is connected to a ventilator.

The main advantages of endotracheal anesthesia are maximum safety for the patient and control over the depth of drug-induced sleep. The possibility of waking up during surgery is reduced to zero, as well as the possibility of malfunctions in the respiratory or cardiovascular system. After recovery from anesthesia, confusion, moderate dizziness, headache, and nausea may occur.

How does cholecystectomy occur?

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

Laparoscopy

Surgeries on the abdominal organs through punctures (laparoscopy) are not considered rare or innovative today. They are recognized as the “gold standard” of surgery and are used to treat 90% of diseases. Such procedures take place in short terms and involve minimal blood loss for the patient (up to 10 times less than with conventional surgery). Laparoscopy proceeds according to the following scheme:

The doctor completely disinfects the skin at the puncture site using special chemical reagents.
3–4 deep incisions about 1 cm in length are made on the anterior abdominal wall.
Then, using a special device (laparoflator), carbon dioxide is pumped under the abdominal wall. Its task is to lift the peritoneum, maximizing the viewing area of the surgical field.
Through other incisions, a light source and special laparoscopic devices are introduced. The optics are connected to a video camera, which transmits detailed information to the monitor. color image organ.
The doctor controls his actions by looking at the monitor. Using instruments, the arteries and cystic duct are cut off, then the organ itself is removed.
A drainage is placed at the site of the excised organ, all bleeding wounds are cauterized electric shock.
At this stage, laparoscopy is completed. The surgeon removes all devices, sutures or tapes the puncture sites.

Abdominal surgery

Open surgery is used extremely rarely today. The indications for prescribing such a procedure are: adhesion of the organ with nearby soft tissues, peritonitis, complex lesions of the biliary tract. Abdominal surgery is carried out according to the following scheme:

After introducing the patient into a state of medical sleep, the surgeon disinfects the surface tissues.
A small incision about 15 cm in length is then made on the right side.
Neighboring organs are forcibly pushed back to provide maximum access to the damaged area.
Special clips (clamps) are placed on the arteries and cystic ducts to prevent the outflow of fluid.
The damaged organ is separated and removed, and the organ bed is treated.
If necessary, drainage is applied and the incision is sutured.

Mini access cholecystectomy

The development of a single laparoendoscopic access method allowed surgeons to perform operations to excise internal organs, minimizing the number of surgical approaches. This method of surgical intervention has become very popular and is actively used in modern surgery clinics. The course of the mini-access operation consists of the same steps as standard laparoscopy. The only difference is that to remove the damaged organ, the doctor makes only one puncture 3–7 cm under the right costal arch or by inserting devices through the umbilical ring.

How long does the operation take?

Cholecystectomy is not considered a complex surgical procedure that would require lengthy manipulation or the involvement of multiple surgeons. The duration of the operation and the period of hospital stay depends on the chosen method surgical intervention:

On average, laparoscopy takes one to two hours. The hospital stay (if no complications arise during or after the operation) is 1–4 days.
The mini-access operation lasts from 30 minutes to one and a half hours. After surgery, the patient remains under medical supervision for another 1–2 days.
Open cholecystectomy takes from one and a half to two hours. After the operation, the person spends at least ten days in the hospital, provided that there are no complications during or after the procedure. Full rehabilitation takes up to three months. Surgical sutures are removed after 6–8 days.

Postoperative period

If a drain was installed during the operation, it is removed the next day after the procedure. Before the stitches are removed, the skin is bandaged and treated daily. antiseptic solutions. The first few hours (from 4 to 6) after cholecystectomy you need to refrain from eating, drinking, and getting out of bed is prohibited. After a day, short walks around the ward, meals and water are allowed.

If the procedure goes without complications, discomfort is minimized and is more often associated with recovery from anesthesia. Mild nausea, dizziness, and a feeling of euphoria are possible. Pain after cholecystectomy occurs when choosing an open surgical method. To eliminate this unpleasant symptom, analgesics are prescribed for a course of no more than 10 days. After laparoscopy, pain in the abdominal area is quite tolerable, so most patients do not need painkillers.

Since the operation involves excision of an important organ that is directly involved in the digestion process, the patient is assigned a special treatment table No. 5 (liver). The diet must be strictly followed during the first month of rehabilitation, then the diet can be gradually expanded. The first time after cholecystectomy should be limited physical activity, do not perform exercises that require tension in the abdominal muscles.

Rehabilitation and recovery

The return to the patient’s usual lifestyle after laparoscopy occurs quickly and without complications. On full recovery the body takes from 1 to 3 months. When choosing an open cavity excision method, the rehabilitation period is prolonged and lasts about six months. Feeling good and the patient’s ability to work returns two to three weeks after treatment. Starting from this period, you must adhere to the following rules:

For a month (at least three weeks) you must remain calm, observe bed rest, combining half an hour of exercise and 2-3 hours of rest.
Any sports training or increased physical activity is allowed no earlier than three months after open surgery and 30 days after laparoscopy. You should start with minimal loads, avoiding abdominal exercises.
During the first three months, do not lift more than three kilograms, starting from the fourth month - no more than 5 kg.
To speed up the healing of postoperative wounds, it is recommended to undergo a course of physiotherapeutic procedures and take vitamin preparations.

Diet therapy

On the eighth or ninth day, if the operation was successful, the patient is discharged from the hospital. At this stage of rehabilitation, it is important to establish proper nutrition at home, according to treatment table No. 5. You need to eat in fractions, giving preference dietary products. All daily food should be divided into 6-7 servings. Daily calorie content dishes: 1600–2900 kcal. It is advisable to eat at one time so that bile is produced only during meals. The last meal should be no later than two hours before bedtime.

To dilute the concentration of bile during this period, doctors recommend drinking a lot - up to two to two and a half liters of fluid per day. This can be rosehip decoction, non-acidic sterilized juices, still mineral water. For the first few weeks, all fresh fruits and vegetables are prohibited. After two months, the diet can be gradually expanded, focusing on protein foods. Preferred cooking dishes - boiling, steaming, stewing without fat. All food should be at a neutral temperature (about 30–40 degrees): not too hot or cold.

What can you eat if your gallbladder has been removed?

The diet needs to be structured so that it is easier for the body to cope with incoming food. You are allowed to eat no more than 50 grams of butter or 70 grams of vegetable oil per day; it is advisable to completely exclude all other animal fats. The general norm for bread is 200 grams; preference should be given to products made from whole grain flour with the addition of bran. The basis of the diet after surgery to remove the gallbladder should be following products:

low-fat varieties of meat or fish - turkey fillet, chicken, beef, pike perch, hake, perch;
semi-liquid porridge from any cereals - rice, buckwheat, semolina, oats;
vegetable soups or first courses with lean chicken broth, but without frying onions and carrots;
steamed, stewed or boiled vegetables (allowed after a month of rehabilitation);
low-fat dairy or fermented milk products - kefir, milk, yogurt, yogurt without dyes or food additives, cottage cheese;
non-acidic berries and fruits;
preserves, jam, mousses, soufflés, jelly, up to 25 grams of sugar per day.

List of prohibited products

To maintain the digestive system, you should completely exclude it from your diet. fried foods, pickled foods, spicy or smoked foods. The following are absolutely prohibited:

fatty meat - goose, lamb, duck, pork, lard;
fish - salmon, salmon, mackerel, flounder, sprat, sardines, halibut, catfish;
fatty fermented milk products;
meat broths;
ice cream, iced drinks, soda;
alcohol;
conservation;
mushrooms;
raw vegetables;
sour vegetable purees;
chocolate;
baked goods, confectionery, baked goods;
offal;
spicy seasonings or sauces;
cocoa, black coffee;
fresh wheat and rye bread;
sorrel, spinach, onion, garlic.

Consequences of cholecystectomy

After laparoscopic organ removal, some patients experience postcholecystectomy syndrome associated with the periodic occurrence of such discomfort such as nausea, heartburn, flatulence, diarrhea. All symptoms are successfully relieved by diet, taking digestive enzymes in tablets and antispasmodics (if necessary to eliminate pain).

It is impossible to reliably determine whether other consequences will arise after removal of the gallbladder with stones, but the patient will definitely be informed about possible problems and given recommendations on how to eliminate them. More often occur:

Digestive disorder. Normally, bile is produced in the liver, then enters the gallbladder, where it accumulates and becomes more concentrated. After removing the storage organ, the fluid directly enters the intestines, and its concentration is lower. If a person eats large portions, bile cannot immediately process all the food, which causes: a feeling of heaviness in the stomach, bloating, and nausea.
Risk of relapse. The absence of a gallbladder does not guarantee that new stones will not appear again after some time. The problem can be solved by following a diet, reducing cholesterol intake, active image life.
Bacterial overgrowth in the intestines. Concentrated bile not only digests food better, but also destroys some harmful bacteria and microbes living in the duodenum. The bactericidal effect of fluid coming directly from the liver is much weaker. Hence, many patients are concerned about frequent constipation, diarrhea, flatulence.
Allergy. After surgery, the digestive system undergoes a number of changes: the motor function of the gastrointestinal tract slows down, and the composition of the flora changes. These factors can serve as a trigger for the development allergic reactions for some food products, dust, pollen. To identify the irritant, allergy tests are performed.
Stagnation of bile. Eliminated using a safe procedure - duodenal intubation. A special tube is inserted through the esophagus, through which a solution is supplied that helps speed up bile excretion.

Possible complications

In most cases, surgical treatment is successful, allowing the patient to quickly recover and return to a normal lifestyle. Unforeseen situations or deterioration in health are more common with abdominal surgery, but complications after removal of the gallbladder using the laparoscopic method are not excluded. Possible consequences include:

Damage to internal organs internal bleeding if damaged blood vessels. More often it occurs at the site of insertion of the trocar (laparoscopic manipulator) and is stopped by suturing. Sometimes bleeding is possible from the liver, then they resort to the method of electrocoagulation.
Damage to the ducts. Leads to the fact that bile begins to accumulate in the abdominal cavity. If the damage was noticeable during laparoscopy, the surgeon continues the operation open method, otherwise repeated surgery will be necessary.
Suppuration postoperative suture. The complication occurs very rarely. To stop suppuration, antibiotics and antiseptic drugs are prescribed.
Subcutaneous emphysema (accumulation of carbon dioxide under the skin). Often occurs in obese patients due to the tube getting into the skin rather than into the abdominal cavity. The gas is removed after surgery using a needle.
Thromboembolic complications. Occur extremely rarely and lead to thrombosis pulmonary arteries or inferior vena cava. The patient is prescribed bed rest and anticoagulants - medications that reduce blood clotting.

Drug treatment for relapses

To maintain the functionality of the gastrointestinal tract and prevent bile stagnation, drug therapy is prescribed. Treatment after removal of the gallbladder involves the use of the following groups of medications:

Enzymes - help break down food, improve the functioning of the digestive system, stimulate the production of pancreatic juice. As part of such medicines There are pancreatic enzymes that break down proteins, fats and carbohydrates. Enzyme preparations well tolerated and side effects(constipation, nausea, diarrhea) occur extremely rarely. Popular tablets include:

Mezim (1 tablet with meals);
Festal (1-2 tablets before or after meals);
Liobil (1–3 tablets after meals);
Enterosan (1 capsule 15 minutes before meals);
Hepatosan (1-2 capsules 15 minutes before meals).

Choleretic agents – protect the liver from stagnation of liver secretions, normalize digestion and intestinal function. Most of these medications are herbal based and rarely cause side effects. To popular medicines choleretic drugs include:

Cholenzym (1 tablet 1–3 times a day);
Cyclovalon (0.1 gram 4 times a day);
Allochol (1-2 tablets 3-4 times a day);
Osalmid (1-2 tablets 3 times a day).

Litholytic medications (hepatoprotectors) - restore damaged liver cells, increase bile production, dilute and improve its composition. The following medications have proven themselves to be effective:

Ursofalk (patients weighing up to 60 kg, 2 capsules per day, over 60 kg - 3 drops);
Ursosan (10–15 mg of the drug per day).

How much does gallbladder surgery cost?

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

Video

The gallbladder is an organ located in the upper right part of the abdominal region. Performs the functions of deposition (accumulative process) and removal of bile fluid. Participates in digestive processes in the body.

Bile is produced in the liver. In pathological processes, the formation of concrements (stones) in gallbladder surgery is required to remove the organ. In women, cholelithiasis is registered more often than in men.

Modern medicine offers different ways to remove an organ. A procedure with minimal impact on internal organs is called laparoscopy. A person can lead a normal life after surgery, subject to some restrictions.

The gallbladder is susceptible to inflammatory processes and poor nutrition (obesity is a serious factor in organ diseases). Cholecystitis and cholelithiasis (GSD) worsen your health. There are symptoms of nausea, vomiting, acute pain in the area of the right hypochondrium, increased body temperature, abdominal cramps after lunch, and itchy skin.

The disease negatively affects the body. Diagnoses are an indication for removal of the gallbladder (gallbladder), because the functioning of the organ is limited. He does not participate in digestive process, actually doesn't work. As gallbladder disease progresses, the body gradually adapts to do without it. Other organs begin to be responsible for the function of bile secretion.

The procedure in which the damaged gallbladder is excised is called. Surgically The organ that is the focus of the inflammatory process and the carrier of infection is removed.

Prompt detection of the disease and timely removal of the gallbladder contributes to rapid rehabilitation period without complications. Stones are removed from the gallbladder surgically. Inflammatory processes left unattended put you at risk of disease progression neighboring organs. Inflammation of the pancreas (pancreatitis), gastritis, ulcerative colitis duodenum and stomach. The postoperative period in this case will take longer to restore the patient’s health.

Preparatory measures for the procedure to remove the gallbladder

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

Before the operation, you must undergo a full medical examination. The patient is sent for laboratory tests:

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

To the extent that the test results are within normal limits, the outcome of the procedure will be more favorable.

Preliminary consultation with a doctor is important. You must inform us if you are allergic to medications, individual intolerance components. The doctor must explain to the patient how the procedure for removing the organ will take place, how long it will take, explain where the bile goes and goes after the bladder is removed, and familiarize them with the possible consequences and what complications there are.

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

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

Description of gallbladder laparoscopy

The planned procedure is not complicated, low-traumatic. If the patient is in normal health and well-being, the procedure is quick and easy. Features of the procedure when removing an organ:

The person being operated on is placed on operating table on your back.
General anesthesia is used.
Treat the area where the puncture will be performed.
The procedure is performed with sterile medical devices and equipment (endoscopic instruments, aspirator, laparoscope, trocar, insufflator).
During laparoscopy to remove the gallbladder, 4 incisions (punctures) are made on the abdomen. If the surgical method of laparoscopy cannot be performed, then an emergency decision is made. abdominal surgery. In this case, an incision is made on the right side of the abdomen.
Using devices, the duct of the organ is blocked.
Then the gallbladder is removed laparoscopically (the best option is through the navel), and the remaining bile is removed.
A drainage is placed in place of the organ. It will drain fluid from the site where the organ was removed.
Using laparoscopy through a puncture.
After the organ has been removed, a suture is placed on each puncture; after healing, there is almost no scar left (healed incisions are not noticeable).

Abdominal surgery (laparotomy)

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

Laparoscopy can be done in Evpatoria.

Operation time

First, the preparation stage takes place. The test results and the condition of the gallbladder are assessed for surgery. Based on the severity of the disease and the anatomical features of the organ, the time of the operation is planned.

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

Reasons influencing the duration and progress of the surgical process:

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

The rehabilitation period depends on the quality of the operation.

Postoperative period

Once the operation is successful, the person is transferred to the intensive care unit. The patient comes out of anesthesia. For the first hours, the patient should lie down and be under the supervision of a doctor. It is forbidden to get out of bed and walk, eat, and drink on your own. The patient takes painkillers medicines. If pain in the abdomen appears and does not go away, but becomes more acute, the seam is bleeding, the wound is puffy, you should immediately tell the doctor.

Possible complications after laparoscopic cholecystectomy

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

Progression of chronic diseases;
The formation of an intra-abdominal hematoma is dangerous;
Peritonitis;
Blood clots appeared in the stool;
Development of a cyst in the bed of the gallbladder;
May burn in the abdomen;
A lump or compaction appears at the seam site;
Intestinal problems (stool disorders, flatulence);
Sore throat, cough;
Relapses of hepatic colic;
Formation of stones in the bile ducts.

To avoid negative consequences, you must follow the doctor’s recommendations and adhere to the diet. If you notice any warning signs, consult a doctor immediately.

Contraindications to laparoscopic cholecystectomy

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

Pregnancy. First and last trimester.
Attacks of acute cholecystitis.
Poor results of blood and urine tests. In this situation, first drug therapy, after improvement, they begin laparoscopy.
Large hernias.
Poor blood clotting.
The patient's serious condition. Having a cholecystectomy can worsen your health.
Recent abdominal surgery.
Mirizzi syndrome.
Infectious diseases at the time of the procedure.

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

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

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

Gallstone disease - what is it?

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

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

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

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

Is surgery necessary?

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

Indications for surgery

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

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

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

Types of operations

Typically, the process of education gallstones- it's not a quick thing. Of course, if you are unlucky and the ambulance takes you to surgical hospital With acute attack, which was diagnosed as cholecystitis of the gallbladder, then you have little choice. But in most cases, people who know about their problem discuss all the details in advance with the attending physician and determine the date of the planned surgical intervention.

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

open cholecystectomy - traditional method, which involves opening the abdominal cavity;
laparoscopic cholecystectomy - more modern technique, which is preferred today.

Open cholecystectomy

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

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

Laparoscopy of the gallbladder

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

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

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

Preparing for surgery

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

Postoperative period

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

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

Litholytic therapy

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

Criteria for litholytic therapy

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

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

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

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

General information

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

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

Localization of the gallbladder

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

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

Diseases

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

Acute cholecystitis

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

Choledocholithiasis

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

Gallstone disease

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

Gallbladder filled with stones

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

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

Polyps

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

Stages of polyp formation

Dyskinesia

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

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

Surgical techniques

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

Open cholecystectomy

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

Kocher access

Among the leading disadvantages are:

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

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

Minimally invasive open cholecystectomy

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

Advantages compared to traditional open cholecystectomy:

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

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

Laparoscopy

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

Advantages of laparoscopic surgery:

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

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

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

IN similar situations It would be most advisable to perform an open cholecystectomy.

Comparison of operational approaches

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

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

Progress of the operation

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

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

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

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

Postoperative period

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

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

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

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

Diet

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

Pharmacological treatment

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

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

Complications

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

All materials on the website are presented
for information, possible contraindications, consultation with a doctor is MANDATORY! Do not engage in self-diagnosis and self-medication!

The gallbladder is an important organ that plays an important role in the digestive process.

Liver cells - hepatocytes - secrete a special substance called bile. The gallbladder is a kind of reservoir for storing this substance.

When food arrives, the organ releases bile through the ducts into the intestines for the further digestion process.

Removal of the gallbladder is a common operation that is performed for pathological problems with this organ.

Reasons for the formation of pathologies

The main problem for which surgery to remove the gallbladder is stone formation. There are many factors.

It should be noted that if previously such a problem occurred in older age, now stones can appear even in children.

Often this is due to poor nutrition. Nowadays there is a large assortment on store shelves and these are not always high-quality and healthy products. Parents eat themselves and feed it to their children, and as a result, various problems occur.

Stone formation occurs when cholesterol levels rise in the body. Products with a high content of it: butter, fatty meat, eggs, kidneys, etc.

Also, problems are provoked when people do not have a specific routine. Or, if long fasting gives way to overeating. In this case, a person tries to saturate his body with fried, fatty or sweet foods.

As a result, as a consequence, a person who abuses junk food, obesity begins. It is very bad when fatty liver degeneration develops.

Besides poor nutrition, there are also other reasons for the formation of gallstones.

This could be taking medications. Especially if the dosage is exaggerated or the course is not followed. This also applies to hormonal contraceptives.

The appearance of the disease is also influenced by other pathological changes in the organ. Various kinks, bends and other anatomical changes can provoke the development of stone formation.

Sometimes, exactly complete removal the gallbladder is the only the right decision. It is important that the operation is carried out by a qualified specialist in order to prevent the possibility of various complications.

Indications for surgery

There are several ways to remove an organ. Depending on the course of the disease and the type of pathology, one or another method is used.

Indications for surgery are:

Gallstone disease. It is with this disease that cholecystectomy is most often required. Most often characterized by frequent attacks biliary colic. This greatly complicates the lives of patients, and they already agree to anything just to end their torment. In addition, the development and growth of stones in the gallbladder and its ducts leads to various complications. If treatment is not started in time, a person may develop peritonitis or rupture of the gallbladder. And this is fraught fatal. In humans, the disease may be accompanied by: severe symptoms, or their complete absence. In any case, the purpose of the operation is to prevent complications.
Polyposis. Periodic examination is necessary if polyps are detected in the organ. Indications for removal are: rapid growth(if the size exceeds 10 mm and the polyp stalk is thin), combination with cholelithiasis.
Cholesterosis with poor flow of bile. Its accompanying stone formation in the gallbladder is considered dangerous. Also, the operation must be performed in mandatory if deposits of calcium salts are detected on the walls of the organ. It may be accompanied by symptoms or occur in a quiet form, without showing any signs.
Spicy and chronic inflammation gallbladder. For example, this is cholecystitis. The disease is characterized severe inflammation walls of the gallbladder. It is especially dangerous when cholecystitis is accompanied by the presence of stones. In this case, the operation should be carried out as soon as possible.
Others functional disorders organ, if conservative treatment is impossible and there is a risk of complications.

Contraindications

If there are contraindications, the specialist chooses what poses the greatest risk to human health.

Therefore, only some caution is observed on the part of the doctor. All contraindications can be divided into local and general.

General contraindications:

Exchange disorders.
Terminal states.
Severe decompensated pathology of internal organs.

Laparoscopy is not advisable if:

Late pregnancy.
Pathological problems of internal organs at the stage of decompensation.
Pathology of hemostasis.
Peritonitis.

Local contraindications for laparoscopy:

Adhesive disease.
Acute cholecystitis.
Pregnancy 1st and 3rd trimester.
Formation of calcium salts on the walls of the gallbladder.
Large hernias.

In this case, the doctor and patient must consider all the risks and make an important decision. If laparoscopy is not possible, then abdominal surgery is performed.

What awaits the patient after surgery?

Any intervention causes various changes. Surgery to remove the gallbladder is no exception.

The patient can live quite well normal life without the presence of this organ. But at the same time, you will need to follow all the specialist’s recommendations, and also be sure to monitor your diet and give up bad habits.

Only in this case can a person count on a full and high-quality life.

But even with the most positive course of the postoperative period, transformation occurs inside the body.

Changes in the body after removal:

Bile was involved in digestion and helped fight accidentally ingested bacteria and harmful components. After removal of the organ, the intestinal microflora will change and the bacterial population will increase.
Now there is no place to store bile, which means it will go straight from the liver straight to the intestines.
The intracavitary pressure on the hepatic ducts will increase.

Provided that the person does not follow a diet and consume fatty foods, there is a lack of bile for digestion.

As a result, various disorders are observed in the intestines, food absorption slows down and worsens.

The patient begins to experience the following symptoms:

Nausea. In some cases, the body may even begin to reject food, which will manifest itself in the form of vomiting. Bile is present in the vomit.
Increased gas formation.
Signs of indigestion.
Heartburn.

In this situation, the patient experiences a lack of certain substances in the body:

Antioxidants.
Fatty acids.
Vitamins A, E, D, K.

The composition of bile also plays an important role. During the rehabilitation period, the patient is prescribed special treatment, which normalizes the state of bile juice.

If its effect is too caustic, serious damage to the intestinal mucosa is possible. As a result, there is a risk of cancer formation.

Feelings in the first days after cholecystectomy

Much will depend on the patient’s body and on the methods of performing the operation. With laparoscopy, a person recovers within 2 weeks.

When surgery was performed using the usual abdominal method, rehabilitation time is about 8 weeks.

In the first days after surgery, the patient may have the following symptoms:

Nausea. Its appearance is most often influenced by the effects of anesthesia.
Pain at the site of the incision or puncture. This is a natural manifestation, because a person has just lost a very important organ. Doctors prescribe various painkillers for pain.
After laparoscopy, there may be pain in the abdominal area, radiating to the shoulders. They should disappear in a few days.
General malaise.
Gas formation.
Diarrhea.

This is a natural process of adaptation. For some, the symptoms may expand, while for others it will be limited to a couple of signs.

The main thing is that the person does not panic and follows all the doctor’s recommendations without exception.

Standard abdominal surgery

This surgical intervention involves a midline laparotomy or oblique incisions under the costal arch.

This allows the specialist to gain good access to the organ and its ducts.

Open surgery has a number of disadvantages:

Large seam, which doesn't look the best.
Major surgical trauma.
There is a high probability of complications. Most often these are functional failures in the intestines and other internal organs.

The main indications for abdominal surgery are:

Acute inflammatory process with peritonitis.
Complex lesions of the bile ducts.

Operational stages:

An incision into the anterior wall of the peritoneum and a full examination of the work to be done.
Isolation and ligation of all ducts and arteries leading to the organ to prevent bleeding.
Removing the gallbladder.
Processing the location of the organ.
Applying drainage and suture to the incision site.

Laparoscopy

The most adequate treatment for many problems in the gallbladder. This method has many advantages compared to the cavity method.

Firstly, laparoscopy causes minor surgical trauma. Secondly, patients suffer from it pain syndrome during the rehabilitation period. Thirdly, laparoscopy has a short recovery period.

After such treatment, the doctor can discharge the patient from the hospital on day 3, provided there are no complications.

Indications for use:

Chronic form of cholecystitis.
Gallstone disease.
Acute inflammatory processes in the gallbladder.

Operational stages:

Laparoscopy involves inserting a series of instruments directly into the gallbladder. The entire procedure is performed using a computer monitor. The operation must be performed by a qualified specialist. At the first stage, punctures of the abdominal wall and insertion of instruments are performed.
To ensure a better overview, carbon dioxide is pumped into the abdomen.
Next comes clipping, cutting off ducts and arteries.
The removal of the organ itself.
Removal of instruments and suturing.

The speed of the operation is noted. Very often, laparoscopy takes no more than 1 hour, and only in some cases, if complications arise, it lasts up to 2 hours.

It should be noted that it is impossible to remove large stones through punctures. To do this, they are first crushed and only then removed from the gallbladder in small parts.

Sometimes it is necessary to install drainage under the liver. This is done to ensure the outflow of bile that has formed due to surgical trauma.

Mini access

Another way to remove the gallbladder. If laparoscopy is not possible due to some contraindications, the doctor decides to change the method of surgical intervention. One of these is the minimally invasive method.

Mini access is something between normal operation and laparoscopy. Operational stages include:

Providing access.
Ligation and cutting of arteries and ducts.
Removal of the gallbladder.

Unlike simple abdominal surgery, mini-access is characterized by a small incision area. The incision is made no more than 7 cm under the ribs on the right side.

This method of operation allows the surgeon to inspect the insides and extract the gallbladder as efficiently as possible.

Indications for minimally invasive surgery:

Availability large quantity adhesions.
Inflammatory tissue infiltration.

The patient is discharged from the hospital on the 5th day after surgery. Compared with abdominal surgery, the postoperative period is much easier and faster.

Preparing for surgery

How the removal itself and the rehabilitation period will go will depend on how the patient prepares for the operation.

Before the operation, diagnostic measures must be prescribed:

Coagulogram.
Blood test. They do both general and biochemical. It is also important to identify the presence of syphilis and hepatitis.
Urinalysis.
Fluorography of the lungs.
Ultrasound diagnostics of abdominal organs.
It is important to find out your blood type and Rh factor before surgery.
Fibrogastroscopy.
Colonoscopy.

It is also necessary to undergo examination and obtain advice from various specialists. Everyone should consult a physician. Some need to visit a gastroenterologist, endocrinologist, or cardiologist.

Before proceeding with the operation, specialists must identify all contraindications and clarify various important points.

You also need to bring your blood pressure back to normal and monitor your sugar levels if the patient is diabetic. Severe pathologies of internal organs should be compensated as much as possible.

You need to adapt to a special diet in advance. On the eve of the operation, food should be as light as possible.

Already in the evening before the operation, the patient is deprived of any food and water. Also in the evening and in the morning, a person is given a cleansing enema to eliminate any contents inside the intestines.

In case acute course and sudden hospitalization, procedures are carried out very quickly. All procedures take no more than 2 hours.

Postoperative period

How long a person will be in the hospital depends in most cases on the type of surgery. How the body will recover is directly related to compliance with the recommendations and the condition of the body itself.

During abdominal surgery, the sutures are removed no earlier than 7 days, and the patient is kept under control for about 2 weeks. With a good course and restoration of the body, the ability to work occurs within 1-2 months.

Laparoscopy is less traumatic and a person is discharged within 2-4 days. A person also recovers much faster. Full working capacity occurs after 20 days.

For the first 6 hours you should not consume food or water. It is also worth observing bed rest. On the first day, a person may experience nausea and dizziness.

This is a natural state, because the patient is recovering from anesthesia. Therefore, the first attempts to get out of bed should be careful.

Only after a day, the patient is allowed to walk around the room a little, drink and eat. The diet includes: bananas, cereals, vegetable purees, light soups, boiled lean meats, dairy products.

The following are prohibited: various sweets and baked goods, strong tea, coffee, fried and spicy foods, alcohol.

Diet is now an important companion for a person after cholecystectomy. Now the body is losing an important organ, and the load increases noticeably. To reduce exposure negative factors, experts advise sticking to diet No. 5.

Your doctor may also prescribe medications containing enzymes that improve digestion. These are Pancreatin, Mezim, Festal. The use of choleretic herbs will also be useful.