Faced with the prospect of surgery to remove the gallbladder, everyone will probably want to know what surgical methods exist, how it works and how long it takes, as well as what the preparation and rehabilitation period consists of.

Methods of performing surgery to remove the gallbladder

Today in medicine there are two options for performing such an operation:

• laparoscopic – surgery made through small incisions in abdominal wall through thin surgical instruments;
• traditional (cavitary or open) - removal is made through a 15-centimeter incision on the right side.

Preparation for surgery

The preparatory procedures are as follows:

1. 2-3 days before the scheduled operation, the doctor may prescribe it to cleanse the intestines.
2. If you are taking any additional medications, then your doctor should know about this; it is quite possible to discontinue medications that affect.
3. The last meal should be no less than 8-10 hours before surgery, it is also advisable not to consume liquids for 4 hours.

Laparoscopic surgery to remove the gallbladder

The laparoscopic method of surgery is used in most cases. This operation is performed under general anesthesia and lasts 1-2 hours. During the operation, 3-4 incisions measuring 5 and 10 mm are made in the abdominal wall. Through them they are introduced special tools and a micro video camera to monitor the process. Carbon dioxide is injected into the abdominal cavity to inflate the abdomen and provide room for manipulation. After this, the bubble is directly removed. After a control check of the bile ducts, the incision sites are sutured and the patient is sent to intensive care. Stay in the hospital after surgery – 24 hours. And the very next day you can return to your normal lifestyle, following the diet and other recommendations of your doctor.

Abdominal surgery to remove the gallbladder

Abdominal surgery to remove the gallbladder is currently performed only if there are indications:

• a large area of ​​inflammation or infection of the bladder;
• large volume of stones or their size;
• occurrence of unforeseen situations during laparoscopy;
• contraindications for laparoscopy.

Abdominal surgery, as well as laparoscopy, is performed under general anesthesia. At the very beginning, an incision is made with a scalpel on the right side, slightly below the ribs, measuring 15 cm. Then the neighboring organs are forced to move to access the operated area and the removal itself occurs. After this, a control examination of the bile ducts is also carried out for the possible presence of stones and the incision is sutured. A drainage tube may be inserted to drain the lymph. After 3-4 days it is removed. Painkillers will be used for the first few days so that you will not have to endure much pain from the incision. Hospitalization for strip operation lasts 10-14 days. The rehabilitation period is 2-3 months.

What do you need to know after gallbladder removal?

After gallbladder removal surgery, you should follow your doctor's recommendations. Let us recall some rules that will help you recover faster:

The gallbladder performs important role in the digestive processes. But in case of inflammatory pathologies, the course of which is not corrected by drug therapy, the organ is removed. A person can easily exist without a gallbladder. When determining intervention tactics, doctors are increasingly giving preference to laparoscopy as a minimally invasive and safe option.

Laparoscopy of the gallbladder as a type of low-traumatic surgical intervention was first performed in 1987 by the French surgeon Dubois. IN modern surgery the share of manipulations in the form of laparoscopy accounts for 50–90% due to their high efficiency and low likelihood of complications. Laparoscopy is the best option in therapy cholelithiasis and others pathological conditions gallbladder in advanced stages.

Advantages and disadvantages of the procedure

Laparoscopy of the gallbladder is understood as a type of surgical procedure during which the affected organ is completely excised, or pathological formations(stones) accumulated in the bladder cavity and ducts. The laparoscopic method has a number of significant advantages:

• low trauma for the patient - compared to open surgery, in which an incision is made across the entire wall of the peritoneal zone, during laparoscopy access to the gall bladder for subsequent excision is made through 4 punctures with a diameter of no more than 10 mm;
• small blood loss (40 ml), and the general blood flow and the functioning of neighboring organs of the peritoneal cavity are not affected;
• the rehabilitation period is reduced - the patient is ready for discharge after the intervention in 24–72 hours;
• The patient’s performance is restored after a week;
• pain after the intervention is mild or moderate, easily relieved with conventional painkillers;
• there is a low probability of developing complications in the form of adhesions, which is due to the lack of direct contact of the peritoneal organs with the doctor’s hands and napkins.

Despite the mass positive points, laparoscopy has a drawback - a lot of contraindications to the manipulation.

Types of intervention, indications

Laparoscopy of the gallbladder is performed in several variants - laparoscopic cholecystectomy, choledochotomy, anastomosis. Laparoscopic cholecystectomy is a common type of endoscopic intervention with excision of the gallbladder. The main indications for organizing intervention are:

1. chronic form of cholecystitis, complicated by the formation of stones in the organ cavity and ducts;
2. lipoidosis;
3. acute form of cholecystitis;
4. formation of multiple polyps on the walls of the gallbladder.

The indications for anastomosis are identical - cholelithiasis, in which the bladder is excised, and bile duct sutured to the duodenum. Anastomoses are also used in cases of stenosis of the bile ducts.

An important role in surgery is played by diagnostic laparoscopy gall. The intervention is carried out with diagnostic purpose, to clarify and confirm gallbladder diseases (for persistent cholecystitis unknown etiology), bile ducts and liver. Diagnostic laparoscopy is used to detect the presence of cancerous tumors in the organs of the biliary tract, the stage and degree of tumor germination. Sometimes this method is used to determine the cause of ascites.

Contraindications

All contraindications to laparoscopic excision of the bile duct are divided into absolute - surgery strictly prohibited; and relative - when the manipulation can be performed, but with some risk for the patient.

Laparoscopic excision of the gallbladder is not performed if:

• severe pathologies cardiovascular system (acute heart attack) because of high probability fatal outcome the patient during the intervention;
• stroke with acute disorder cerebral circulation - such patients are prohibited from being given anesthesia;
• extensive inflammation in the peritoneal space (peritonitis);
• 3–4 trimesters of pregnancy;
• cancerous tumors and local purulent formations in the gallbladder;
• obesity with excess body weight from the optimal by 50–70% (3–4th degree);
• decreased blood clotting that cannot be corrected by taking medications;
• the formation of pathological communications (fistulas) between the bile ducts and the small (large) intestine;
• pronounced scarring of the tissue of the neck of the gallbladder or the ligament connecting the liver and intestines.

Relative contraindications to laparoscopic gallbladder excision include:

1. spicy inflammatory process in the common bile duct;
2. obstructive jaundice;
3. pancreatitis in acute stage;
4. Mirizzi syndrome - an inflammatory process with destruction of the neck of the gallbladder due to stone obstruction, narrowing or fistula formation;
5. atrophic changes in the tissues of the gallbladder and a decrease in the size of the organ;
6. condition at acute course cholecystitis, if from the onset of development inflammatory changes more than 72 hours have passed;
7. surgical manipulations on the organs of the peritoneal space (if the operation was performed less than six months ago).

Preparation for the procedure

In the vast majority of cases, gallstone laparoscopy is a planned intervention. In order to identify possible contraindications and the general condition of the body in advance, 14 days before the procedure the patient undergoes an examination and submits a list of tests:

• physical examination by a surgeon;
• visiting a dentist, therapist;
• general analysis of urine and blood;
• blood biochemistry with the establishment of a number of indicators (bilirubin, sugar, total and C-reactive protein, alkaline phosphatase);
• establishing the exact blood type, Rh factor;
• blood for HIV and Wasserman reaction, hepatitis viruses;
• hemostasiogram identifying activated partial thromboplastin time, thrombosed time and index, fibrinogen;
• fluorography;
• retrograde cholangiopancreatography;
• electrocardiography;
• for women - vaginal smear for microflora.

An operation to remove the gallbladder using the laparoscopic method will be carried out only if the results of the above tests correspond to the norm. If there are deviations, the patient will need to undergo a course of treatment to eliminate the identified violations. If the patient has pathologies of the respiratory or digestive systems, in agreement with the operating doctor, a course of drug therapy to eliminate negative symptoms and stabilization of the condition.

Preparation for laparoscopy of the gallbladder in the inpatient department includes a number of sequential activities:

1. on the eve of surgery, the patient's diet should consist of: easily digestible food, the last meal is dinner at 19-00, after which you cannot take any food; after 22-00 it is forbidden to drink liquids, including water;
2. on the day when the operation is scheduled, eating food and liquid is prohibited;
3. in order to cleanse the intestines, it is necessary to do cleansing enemas - the evening before the intervention and in the morning; for greater effectiveness, it is possible to take laxatives 24 hours before surgery;
4. in the morning it is necessary to carry out hygiene procedures- take a shower and use a razor to remove hair on your stomach.

On the eve of the operation, doctors - a surgeon, an anesthesiologist - have a conversation with the patient, during which they talk about the upcoming intervention, anesthesia, possible risks and negative consequences. The conversation is conducted in a consultation form - the patient can ask questions of interest. Afterwards, the patient gives written consent to the intervention and the use of anesthesia.

Technique of the procedure

Before surgical manipulation of the gallbladder, anesthesia is used, the best option is general endotrachial anesthesia. Additionally required artificial ventilation lungs. Anesthesia for gallbladder laparoscopy is administered by pumping gas through a tube. Subsequently, mechanical ventilation is organized through it. In situations where endotrachial anesthesia is not suitable for the patient, anesthesia is provided with anesthetic injections with the connection of a mechanical ventilation.

Before laparoscopic excision of the gallbladder, the patient is placed on operating table, in a supine position. Manipulations for organ excision laparoscopic method are carried out in two versions - American and French. The difference lies in the location of the surgeon in relation to the patient:

• with the American method, the patient lies on his back, legs are brought together, and the surgeon takes his place on the left;
• with the French method, the surgeon is positioned between the patient’s legs spread apart.

After administering anesthesia, the operation itself begins. To excise the gallbladder during laparoscopy, 4 protocols are made on the outer wall of the peritoneum, the sequence of their implementation is strictly defined.

• The first puncture is just below (occasionally above) the navel; a laparoscope is inserted into the peritoneal cavity through the resulting hole. An insufflator pumps carbon dioxide into the peritoneum. The doctor performs further punctures while monitoring the process with a video camera to avoid injury. internal organs.
• The second puncture is made under the sternum, in the middle part.
• The third one is performed 40–50 mm downward from the outer ribs on the right on an imaginary line drawn through the middle part of the clavicle.
• The fourth puncture is at the intersection of imaginary lines, one of which runs parallel through the navel, the second vertically from the front edge of the armpit.

If the patient has an enlarged liver, an additional (5th) puncture is required. In modern surgery, there is a special technique with a cosmetic focus, when the operation is performed with 3-point punctures.

Organ removal sequence:

• Trocars (manipulators) are inserted into the peritoneal cavity through punctures, the doctor evaluates the location and shape of the gall bladder; if adhesions are present, they are dissected, freeing access to the bladder;
• the doctor determines how full and tense the gallbladder is; in case of excessive tension, the surgeon removes excess fluid by making an incision in the wall;
• the gallbladder is covered with a clamp, the common bile duct is cut off, the cystic artery is clamped and the resulting lumen is cut, and the resulting lumen is sutured;
• after cutting off the cystic artery and general cystic duct, the gallbladder is separated from the hepatic bed; the process is carried out slowly, with cauterization of damaged vessels;
• After separation of the organ, it is carefully removed from the peritoneum through the umbilical puncture.

An important step after excision of the gallbladder is a thorough examination of the peritoneal area with cauterization of bleeding veins and arteries. If there are tissues with signs of destruction or remnants of bile secretions, they are removed. The cavity is washed using antiseptics. After washing, the liquid is sucked off.

The punctures remaining after the intervention are sutured or sealed. A drainage tube is left in one puncture for 24 hours to completely remove the antiseptic liquid. In uncomplicated pathologies with no effusion of bile into the peritoneum, drainage is not installed. At this point, the removal of the organ is considered complete.

The intervention for laparoscopic excision of the gallbladder lasts no more than 40–90 minutes. The duration of laparoscopy depends on the qualifications of the surgeon and the severity of pathological disorders. Experienced surgeons The gallbladder is removed using laparoscopy in 30 minutes.

Indications for intervention with laparotomy access

In surgical gastroenterology, situations often occur when, after the start of laparoscopy, previously hidden complications are revealed. In such cases, laparoscopy is stopped and an open access intervention is organized.

Reasons for switching from laparoscopy to laparotomy:

1. intense swelling of the gall bladder, which does not allow laparoscopy to be performed safely;
2. extensive adhesive process;
3. cancerous tumors of the bladder and bile ducts;
4. massive blood loss;
5. damage to the biliary tract and neighboring organs.

Postoperative period

Laparoscopy of the gallbladder is tolerated by patients normally in most cases. Complete recovery of the body from surgery physically and emotionally takes 6 months. 24 hours after the intervention, the patient is bandaged. A person can get up and move around after 4 hours of surgery or on the 2nd day - it all depends on how he feels.

Almost 90% of patients who undergo laparoscopy are discharged from the hospital one day after the procedure. But it is necessary to appear a week later for a follow-up examination. Be sure to follow the recommendations during the rehabilitation period:

• You cannot eat food for 24 hours after laparoscopy; you are allowed to drink still water 4 hours after the procedure;
• refusal of sexual activity for 14–28 days;
• rational nutrition for the prevention of constipation, diet No. 5 is optimal;
• a course of antibiotic therapy as prescribed by a doctor;
• complete exclusion of physical activity for a month, after which light exercises, yoga, and swimming are allowed.

People who have undergone bile duct excision by laparoscopy should increase their loads gradually. The optimal load for 3 months after the intervention is lifting no more than 3 kg. Over the next 2 months, you can lift no more than 5 kg.

On the recommendation of the attending physician, a course of physiotherapy (UHF, ultrasound, magnets) can be prescribed to improve tissue regeneration and normalize the functionality of the biliary tract. Physiotherapy is prescribed no earlier than a month from the date of laparoscopy. After laparoscopy, a course of vitamin and mineral complexes (Univit Energy, Supradin) will be useful.

Pain syndrome after surgery

Laparoscopy of the gallbladder, due to its low invasiveness, does not cause intense pain after manipulation. The pain syndrome is mild or moderate in nature and is relieved by oral painkillers (Ketorol, Nise, Baralgin). Typically, the duration of taking painkillers is no more than 48 hours. Within a week the pain completely disappears. If the pain syndrome intensifies, this is an alarming signal indicating the development of complications.

If the patient had sutures placed on the puncture area, after their removal (on days 7–10), discomfort and discomfort during physical activity and when the abdominal muscles are tense - when bowel movements, coughing, bending over. Such moments completely disappear after 2-3 weeks. If pain and discomfort persist for more than 1–2 months, this indicates the presence of other pathologies of the peritoneal cavity.

Diet

The question regarding diet during gallbladder laparoscopy is important for patients during the recovery period and in the next 2 years. Target dietary nutrition- establish and maintain optimal liver function. After deleting important digestive tract the gallbladder changes the process of bile release. The liver produces about 700 ml of bile secretion, which in persons with the bladder removed is immediately released into the duodenum. Some digestive difficulties occur, so diet is necessary to minimize negative consequences from the lack of gall.

The first day after the intervention, eating is prohibited. After 48–72 hours, the patient's diet may include vegetable purees. Boiled (lean) meat is allowed. This diet is maintained for 5 days. On day 6 the patient is transferred to table No. 5.

Nutrition in diet No. 5 is based on fractional meals, at least 5 times a day, small portions - 200–250 ml. Food is served thoroughly crushed, in the form of a homogeneous puree. It is important to maintain the optimal temperature for serving food - 50–60 degrees. Allowed options heat treatment- cooking (including steaming), stewing, baking without oil.

Persons who have undergone laparoscopic gallbladder removal should avoid consuming a number of foods:

• food with high concentration animal fats - meat, fish with high fat content, lard, whole milk and cream;
• any fried foods;
• canned food and marinades;
• offal dishes;
• spices and seasonings in the form of mustard, hot ketchups, sauces;
• baked goods;
• raw vegetables with coarse fiber - cabbage, peas;
• alcohol;
• mushrooms;
• strong coffee, cocoa.

Products allowed for consumption:

1. meat and poultry with low fat content (chicken breast fillet, turkey, rabbit), fish (pollock, pike perch);
2. semi-liquid porridges and side dishes from cereals;
3. vegetable or secondary soups meat broth with the addition of cereals, pasta;
4. boiled vegetables;
5. dairy products - with zero and low fat content;
6. dried white bread;
7. sweet fruits;
8. honey in limited quantities.

The diet is supplemented with oils - vegetable (up to 70 g per day) and butter (up to 40 g per day). Oils are not used for cooking, but are added to ready meals. Daily consumption white bread(not fresh, but yesterday's) should not exceed 250 g. Sugar is also limited - up to 25 g per day. To improve digestive processes at night, it is recommended to take a glass of kefir with a fat content of no more than 1%.

Drinks allowed are compotes, jelly made from non-acidic berries, and dried fruits. Drinking regime adjusted based on the activity of the bile secretion process - if bile is released into the duodenum too often, the amount of fluid consumed is reduced. If bile production is reduced, it is recommended to drink more.

The duration of diet No. 5 for persons who have undergone gallstone laparoscopy is 4 months. Then the diet is gradually expanded, focusing on the condition digestive system. After 5 months after laparoscopy, it is allowed to eat vegetables without heat treatment and meat in pieces. After 2 years you can switch to a common table, but both alcohol and fatty foods remain banned for life.

Consequences and complications

After excision of the gallbladder using laparoscopy, many patients develop postcholecystectomy syndrome - a condition associated with periodic leakage of bile secretion directly into the duodenum. Postcholecystectomy syndrome causes a lot of discomfort in the form of negative manifestations:

• pain syndrome;
• attacks of nausea, vomiting;
• belching;
• feeling of bitterness in the mouth;
• increased gas formation and bloating;
• loose stool.

It is impossible to completely eliminate the manifestations of postcholecystectomy syndrome due to the physiological characteristics of the gastrointestinal tract, but the condition can be alleviated by correcting nutrition (table No. 5) and taking medications (Duspatalin, Drotaverine). Attacks of nausea can be suppressed by taking mineral water containing alkalis (Borjomi).

The operation of excision of the gallbladder by laparoscopy sometimes leads to a number of complications. But the frequency of their occurrence is low - no more than 0.5%. Complications during laparoscopy can arise both during the intervention and after the procedure, in long term.

Frequent complications that arise during the operation:

1. heavy bleeding occurs when large arteries are injured and serves as an indication for intervention with an open incision; light bleeding is stopped by suturing or cauterization;
2. effusion of bile into the abdominal cavity due to injury to the bile ducts;
3. damage to the intestines and liver, which causes slow bleeding;
4. subcutaneous emphysema - a condition associated with the formation of swelling in the abdominal wall; emphysema occurs when gas is forced into the subcutaneous layer, and not into the peritoneal cavity;
5. perforation of internal organs (stomach, intestines).

Complications that occur after surgery and in the long-term period include:

• peritonitis;
• inflammation in the tissues surrounding the navel (omphalitis);
• hernia (often occurs in people with overweight body);
• spreading malignant tumor throughout the peritoneal region and activation of the metastasis process is possible in the presence of oncopathology.

Almost all people who have undergone laparoscopic gallbladder removal speak positively about the procedure. Low morbidity, recovery within short term and the minimal likelihood of complications make laparoscopy the best option for diagnosing and treating gallbladder pathologies. The main thing for a patient undergoing laparoscopy is to carefully prepare for it and follow medical recommendations.

Gallstone disease is chronic, and the only way to be completely cured is surgery to remove gallstones. Unfortunately, it is impossible to completely remove stones without damaging the organ itself due to its anatomical structure. Therefore, in severe cases, it is necessary to remove the gallbladder along with pathological stones.

Surgery to remove gallstones - types of surgery

Cavity (open) surgery to remove the gallbladder is called cholecystectomy and can be performed in several ways. Surgical intervention can be performed urgently for biliary colic, or planned, and then it requires special training. In the second case, removal of the organ is associated with less risk to health, which means that recovery is faster and does not threaten serious complications.

In addition, in recent years widely used alternative methods treatment of cholelithiasis using advanced technologies. These are techniques such as:

• – crushing gallstones with ultrasound or laser.
• Cholecystolithotomy– minimally invasive intervention involving the removal of stones while preserving the gallbladder and its functions;
• Litolysis(contact) – alternative procedure, the essence of which is dissolution gallstones acids.

Let us dwell in more detail on each type of intervention and talk about its features, methods of implementation, advantages and disadvantages.

Indications for cholecystectomy

Cholecystectomy (removal of the gallbladder) can be performed urgently or electively, depending on the patient’s condition. Urgent cholecystectomy is included in the so-called surgical seven - a list of the most common surgical operations. It is performed for biliary colic caused by blockage of the bile ducts with stones. This is the only indication for urgent removal of the gallbladder.

Such an operation is planned to be performed in the following cases:

• beyond exacerbation;
• acalculous chronic cholecystitis;
• anatomical pathologies of the biliary tract;
• neoplasms of the gallbladder;
• pathologies of neighboring organs that can cause cholelithiasis.

If the operation is carried out as planned, then it requires preliminary preparation for 1-1.5 months. During this period, the patient, in addition to special diet, prescribe a course enzyme preparations, antispasmodics and medications with antisecretory effects. After removal of the gallbladder, in any case, a strict diet and medications are prescribed to support the normal flow of bile. You should not ignore your doctor's instructions, as this can lead to an inflammatory process in the liver.

The list of contraindications to removal of the gallbladder is currently extremely narrowed, since modern technologies make this operation faster and safer. However, cholecystectomy cannot be performed in case of severe pathologies of the heart, lungs, bleeding disorders, pregnancy and inflammatory processes.

There are also relative contraindications to the operation. In such situations, the surgeon decides whether surgery to remove gallstones is necessary, taking into account general condition patient. Such contraindications include the presence of diabetes mellitus, oncological diseases gallbladder, adhesions in the abdominal organs.

The decision on the possibility of carrying out a planned operation is made taking into account the ratio possible benefits and harm to the patient's health. In this case, the intervention requires longer preparation. If surgery is urgently needed, in most cases it is performed despite the presence of relative contraindications.

Types of cholecystectomy

There are two main ways of performing the operation - laparoscopic (without an incision) and laparotomy (with an incision).

Laparoscopy. Currently endoscopic surgery is increasingly replacing laparotomy. It is safer for the patient, has fewer contraindications and, importantly, can be performed under local anesthesia. However, laparoscopy requires a more highly qualified surgeon and the availability of special equipment.

Surgical intervention is carried out using a special device - a laparoscope. During the operation, the surgeon sees what is happening on a special screen. To perform the operation, no incision is needed; only a puncture of the skin in the abdominal cavity is performed, where the endoscope is inserted.

The advantages of this type of operation are low morbidity, rapid removal of the gallbladder, absence cosmetic defects on the skin (scars). Unlike laparotomy surgery, it can be performed in patients who are contraindicated general anesthesia. Elective surgery is most often performed laparoscopically. But such an operation is impossible for complicated forms of cholecystitis.

Laparotomy cholecystectomy is considered a classic version of the operation. It is performed through an incision on the anterior wall of the abdominal cavity, under general anesthesia. During the operation, the surgeon has the opportunity to examine neighboring organs and notice their pathologies, if any. This method of operation is preferable for atypical location of the gallbladder, high risk its rupture during the intervention, the likelihood of pathologies of the liver, duodenum and gall bladder. Laparotomy is also performed in case of complications during endoscopic removal.

This type of intervention has two important disadvantages - it is traumatic for the patient, and general anesthesia can cause severe complications, therefore laparotomy is contraindicated for pregnant women at any stage (in case biliary colic the question of the ratio of possible benefits for the mother and the risk for the fetus is resolved) in patients with severe cardiac and respiratory failure.

Recovery period and possible complications

Rehabilitation period after classical abdominal surgery may take several months. During the first 2-3 weeks after the intervention, you must follow a strict diet prescribed by your doctor. In the future, diet No. 5 will have to be followed for life and constantly taken choleretic agents and other drugs that support the normal functioning of the digestive system. The patient must get used to fractional meals and other restrictions associated with the characteristics of digestive process after removal of the gallbladder.

Strictly limited physical activity, as the patient’s condition improves, a course of therapeutic exercises. Thereafter, annual resort and sanatorium treatment.

According to many experts, even radical surgery does not avoid complications. The most common consequences:

• Problems with normal functioning Gastrointestinal tract (almost 100% of patients).
• Development of postcholecystectomy syndrome (in 30%). It is expressed in dysfunction of the sphincter of Oddi and is manifested by prolonged, severe pain.
• Damage to the mucous membrane of the duodenum due to constant reflux of bile, which leads to the development of duodenitis or reflux esophagitis.

The risk of complications increases in elderly patients and in cases where there is excess weight. It is not excluded medical errors. After classical cholecystectomy, almost 12% of patients are assigned disability.

Laparoscopic surgery is much more fewer complications. The recovery period is much faster, since there are no incisions, and small punctures in the abdominal cavity heal in just a few days.

Minimally invasive techniques

In recent years, new technologies have emerged that make it possible to remove stones from the gallbladder while preserving the organ and its functions. These are popular procedures that are safe, have minimal risk of complications, are carried out on an outpatient basis using modern, high-precision equipment and help the patient quickly return to normal life.

Lithotripsy or extracoparie shock wave surgery involves exposure to ultrasonic waves and excludes external influence on fabric (cuts). The essence of the procedure is that certain type ultrasound travels quickly soft tissues, without damaging them, but when colliding with solid formations (stones), causes their deformation and destruction.

The operation is performed under local anesthesia. The progress of the procedure is monitored using ultrasound. The surgeon chooses for the patient optimal position and brings it to problem area a device that emits ultrasonic waves of a certain power. The patient may only feel slight tremors. Exposure to ultrasound allows stones to be crushed into small particles not exceeding 5 mm. Subsequently, the patient is prescribed a course bile acids, which dissolve the remaining particles. They need to be taken for a long time, up to 12 months.

Laser treatment

Stones are crushed laser beam high density, which is directed to the problem area through a small puncture in the abdominal cavity. Powerful radiation crushes stones, turning them into sand and small fragments, which are then eliminated from the body naturally.

But this method is applicable only for crushing small cholesterol stones (up to 3 cm). Disadvantages include pain when sand comes out through the ureters and the risk of damage to the mucosa from small fragments. In addition, a lot depends on the qualifications of the surgeon, since there is a high risk of burns when using laser radiation, which threatens the formation of ulcers and the development of complications.

Contact lipolysis

This procedure ensures complete preservation of the organ and has a very good further prognosis, but is carried out mainly abroad, since it is at the development stage in Russia. It is carried out in several stages:

1. A special drainage tube (microcholecystotome) is placed through which the contents of the gallbladder are removed.
2. Introduced contrast agent, allowing you to estimate the size of the stones and calculate the volume of the dissolving substance.
3. A litholytic is injected into the cavity of the gallbladder, completely dissolving the stones.
4. The contents of the bladder are removed through the drainage tube along with the litholytic and dissolved formations.

On final stage Anti-inflammatory drugs are injected into the gallbladder cavity. They make it possible to eliminate damage to the mucous membrane and completely restore the functioning of the organ.

Cost of operations

How much surgery to remove gallstones costs for a patient depends on how it is performed, what type of anesthesia is used, and often on medical institution, in which the operation is carried out. The cost of laparoscopic cholecystectomy, depending on the category of complexity, ranges from 14,000 to 25,000. Urgent cholecystectomy is performed free of charge.

The cost of a laser procedure for crushing stones starts from 12,000 rubles. But it should be taken into account that one session may not be enough and you will have to repeated procedures. That's why total amount can be quite impressive.

The price of lithotripsy using ultrasound ranges from 13,000 rubles per session. At the same time, intervention using modern technologies Not carried out in every medical center. This means that additional costs for travel and accommodation will be required, which should also be taken into account when choosing a method of performing the operation.

Unfortunately, even organ-preserving operations do not provide a complete guarantee of cure and do not exclude relapses of the disease. Therefore, it is necessary to make a difficult decision about choosing a treatment method, taking into account possible risks and after consultation with your doctor.

Features of the diet after surgery

Since bile is constantly produced in the liver, and food enters the intestines periodically, the function of the gallbladder is very important - it accumulates excess bile in order to then release it into the intestines. Absorption of water from bile allows you to accumulate a larger volume and makes it more concentrated, but the same process causes the formation of stones.

After removal of the gallbladder, this function is lost, and bile begins to constantly flow into the common bile duct and accumulate in biliary tract. To prevent this from leading to inflammatory processes in the liver, it is necessary after surgery. After removing stones from the gallbladder using minimally invasive methods, following a diet is also considered mandatory, as it prevents the re-formation of stones and eliminates relapses of the disease.

The diet after surgery to remove gallstones includes: fractional meals– 5-6 times a day, and sometimes more often, in small portions. It is advisable to eat food at the same time. This is necessary so that bile is gradually released into the intestines without damaging the liver and bile ducts.

The diet necessarily includes foods containing fiber - cereals, vegetables, fruits - which stimulate intestinal function. Low-fat varieties of meat and fish are preferred; low-fat milk and low-fat fermented milk products, eggs, seafood. Vegetarian soups, viscous porridges, vegetable side dishes, steam omelettes, and non-food products are welcome in the diet. fatty varieties meat ( steam cutlets, dumplings, meatballs). Meals should be as gentle as possible; all dishes should be served warm. Vegetable fats practically unlimited. Any non-carbonated soft drinks, juices, fruit drinks, compotes, green and herbal tea, mineral water.

It is recommended to reduce to a minimum the consumption of animal fats, spicy foods, seasonings, smoked foods, fatty sauces, and fried foods. Fatty meats are prohibited - lamb, pork, lard, sausages. All dishes are steamed, boiled, baked or stewed; heat treatment such as frying is not recommended. Alcoholic drinks any fortress should be completely excluded.

In what cases is surgery performed?

The gall bladder is an organ of the digestive system that serves as a reservoir for bile and lies on the lower surface of the liver in the right hypochondrium. Bile, located in the gallbladder, is important for the digestion process and increased peristalsis. If gallbladder dysfunction occurs, surgical intervention to remove it is necessary. This operation is called cholecystectomy. Cholecystectomy is not included complex operations and the patient does not stay long in the clinic.

This operation is performed in the following cases:

• Finding stones in the gall bladder;
• Finding stones in the bile duct;
• Cholecystitis (calculous, non-calculous);
• Empyema and hydrocele;
• Neoplasms.

The operation is indicated when internal therapy has been unsuccessfully carried out: pharmacotherapy, regimen, diet, duodenal tube, mineral waters; with frequent and painful colic that interferes with work.

There are several types of this operation, but the main ones are:
- open cholecystectomy;
- removal of the gallbladder using a laparoscope.
The attending surgeon decides which type to use.

Is it possible to avoid surgery?

If the stones in the gall bladder do not bother you or interfere with your life, if the gall bladder performs its function properly, then there is no need to cut it off. But you need to know that by postponing surgery after the first colic, the number of attacks will increase, and the chances of a complete recovery after surgery will decrease. The liver and pancreas will be at risk, but they are vital for the body. Their removal can lead to the death of the organism as a whole. Therefore, the question of surgery to cut off the gallbladder will remain open and its belated decision may no longer give the desired positive result. If a person is undergoing surgery late dates, then the inflammatory process has already spread to other organs: the stomach, duodenum, head of the pancreas. Such patients will need additional treatment even after discharge.

What can you expect

If you decided to have surgery, and it was successfully performed, then now you need to slightly change your usual routine. But only a few. The period of gallbladder disease occurred gradually, and your body has already adapted a little to the new conditions. Therefore, its removal will not cause serious disruption. And, thanks to the operation, the inflammatory process will be eliminated, which will facilitate the secretion of bile.

But there is something you must understand. After removal of the gallbladder, the flow of bile occurs more slowly, and its bactericidal effect is not fully manifested. As a result, the microflora in the intestines may be disrupted, and It's a dull pain abdomen, flatulence, constipation or diarrhea may occur.

But don’t let this scare you, since this is all a matter of time. The body will recover quite quickly and, using the appropriate nutrition system, the gastrointestinal tract will continue to perform its functions normally. There is diet No. 5, which involves limiting the consumption of high-calorie foods, easily digestible carbohydrates, fatty foods. Such a diet will stimulate the production of a moderate amount of bile, improve it chemical composition, speed up and facilitate the digestion of food. Of course, the period of use of this diet varies from patient to patient and may vary, but nutritionists recommend its use for at least a year.

What should the diet be like?

And the following should be excluded from your diet: baked goods, all sweets, fatty, fried, canned foods. For obese people, pay attention to the amount of carbohydrates, the daily amount of which is no more than 200 grams. You will also have to abstain from fresh milk, as lactase becomes less active. Use should be avoided legumes(beans, peas, lentils); greenery with great content essential oil(onion, garlic, wild garlic); offal (kidneys, liver); mushrooms, nuts, alcohol, carbonated drinks, hot spices.

But it is necessary and necessary to include in the diet: wheat bran, cereals, vegetable salads, fruits and berries. Will be useful sour milk, lean meat, fish, seafood. Soups should not be made with meat. The bread is only white, it is better to dry it in the oven.
Overeating is unacceptable! Portions should be small, which will facilitate normal absorption and digestion of food.

For those who want to be healthy

In order to prevent gallbladder diseases, I would like to recommend the following measures: constant physical exercise; periodic procedures to cleanse the gallbladder; avoid stress; drinking special choleretic mineral water without gas; proper nutrition, which should contain magnesium and zinc.

In addition, be careful and beware of contacting unknown healers. There is a whole army of charlatans with dubious licenses and certificates that promise complete cure, and as a result, your illness remains with you. Use it traditional medicine. Good health to you!

The review was prepared by journalist Vera Aleksandrovna Andreeva (on our instructions).

Need for removal gallbladder occurs quite often, since many diseases of this organ (especially in the acute stage) are not treatable conservative treatment. Of course, any surgical intervention is a big risk, but in a number of situations it is completely justified. Life without a gallbladder soon after the operation returns to normal, including not limiting yourself too much in food (with the exception of alcohol, fatty, fried and smoked foods).

Most often, surgery to remove the gallbladder is required due to the presence of calculi (stones of various origins) in it. Stone crushing different methods and their subsequent removal from the body gives only a temporary effect, since the cause of their formation is not eliminated.

Therefore, if stones are found in the gall bladder, you should not refuse surgery.

Otherwise, after some time the problem returns.

General indications for surgery:

• cholecystitis;
• disruption of the outflow of bile, accompanied by severe pain;
• blockage of ducts.

Gallbladder surgery is often indicated for chronic cholecystitis in the acute stage, with acute and calculous forms of the disease.

Types and duration of surgical intervention

Life without a gallbladder can return to its usual rhythm no earlier than 1.5–2 months after surgery. If you have your gallbladder removed, you will have to strictly adhere to a diet for at least a year. After removal of the gallbladder, the load on the stomach and pancreas increases, food digestion worsens, possible disruption of the intestinal and stool microflora, and flatulence. Therefore, following a diet after removal of the gallbladder is absolutely necessary.

In the future it is permissible to use folk remedies, aimed at preventing gastrointestinal diseases, but only after consulting a doctor. Pharmacies offer a large assortment of ready-made herbal choleretic teas, but if desired, herbs can be purchased separately. Chicory is widely used and can be drunk with honey instead of coffee. Drink the root tincture in small sips throughout the day.