When not to operate on the gallbladder. Cholecystectomy - what is it. Rehabilitation after cholecystectomy in stages

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

What is cholecystectomy

The gallbladder (GB) is a pear-shaped organ located under the liver. It is intended for the accumulation of bile and its reflux into the duodenum. Unhealthy diet, unhealthy lifestyle and metabolic disorders lead to diseases of the gallbladder. The organ and ducts can become inflamed, clogged with stones. In such cases, an operation is prescribed to remove the gallbladder.

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

Although the organ is not vital, the intervention is carried out by surgeons with extensive clinical experience. Incorrect removal of the gallbladder threatens with serious consequences: bleeding, damage to the liver and nearby organs, an outpouring of bile.

When is surgery needed?

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

(JCB). Often becomes the reason for operation. It is accompanied by the formation of stones that clog the ducts, provoke biliary colic, threaten gallbladder perforation and peritonitis.
- one of the manifestations of GSD. It is characterized by pain in the right hypochondrium, bitter taste, nausea, biliary colic.
- inflammation of the walls of the gallbladder, can spread to neighboring organs. It leads to cholelithiasis, local circulatory disorders. Cholecystectomy for this reason is more often done in older adults.
. Manifested by the deposition of fat in the wall of the gallbladder. It can be detected by chance, in such cases, the operation of cholecystectomy is prescribed after a routine examination.
. This is the formation of benign tumors - polyps. Indications for removal are neoplasms that grow rapidly and exceed 10 mm. Such formations tend to be malignant.

Polyposis

However, there are cases when the gallbladder is not cut out. Absolute contraindications - acute heart attack and stroke, hemophilia, pregnancy in the I and II trimester, peritonitis.

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

Obesity grades III and IV, adhesions and seals in the neck of the organ are contraindications for laparoscopic cholecystectomy (LC). Choose laparotomy.

Types and features of operations to remove the gallbladder

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

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

Open cavity surgery - laparotomy

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

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

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

How long does an abdominal operation to remove the gallbladder last depends on the patient's physique, whether there is inflammation or stones, complications.

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

Laparoscopic cholecystectomy

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

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

laparoscope - an optical tube with lenses, video cameras and illumination;
insufflator - delivers sterile gas into the abdominal cavity;
trocar - tubes with stylets designed to pierce tissues;
aspirator - for washing the cavity and pumping out the liquid;
endoscopic instruments - scissors, staplers, clamps, etc.

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

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

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

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

The disadvantages are limited access and the inability to intervene with adhesions, obesity, inflammation, fistulas. If complications arise during laparoscopy, the gallbladder will be removed in the classical way - by the cavity.

Single port laparoscopy - SILS

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

A flexible SILS port with 3 holes is inserted into the incision. They include all the equipment. The main requirement is the flexibility of the tools. Rigid ones will intersect with each other, and laparoscopy of the gallbladder will be complicated.

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

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

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

Cholecystectomy by mini-access

This method is a variation of the classic laparotomy. The difference lies in the smaller cut. If during abdominal intervention its length is 20 cm, then with mini-access it is 3-7 cm. The surgeon has the same access as with the open method, however, tissues are less injured, and rehabilitation is easier.

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

Video: laparoscopic cholecystectomy, operation progress

Is the operation dangerous: possible complications

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

suppuration and divergence of seams - due to the fault of the patient or due to poor antiseptic treatment;
pain in the abdomen, with laparoscopic intervention - radiating to the zone of the collarbone and sternum due to the introduction of gas;
digestive problems - since the gallbladder is removed, diarrhea, constipation, nausea, indigestion are noted for 2 weeks.

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

damage to blood vessels with subsequent bleeding;
trauma to the bile ducts or bladder with an outpouring of secretions into the abdominal cavity - threatens the development of pancreatitis;
perforation of the intestine, liver, other organs;
tumor metastasis in the abdominal cavity - occurs if the operation was performed on the background of liver or gallbladder cancer.

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

If surgery was performed using an endoscope and one of these complications occurred, the laparoscope is removed and a laparotomy is performed, since damage can only be repaired through open access. Thus, the operation to remove the gallbladder takes more time.

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

How to prepare for surgery

Before cholecystectomy perform preliminary measures. Initially, the patient is examined 1-1.5 weeks before cholecystectomy. The patient submits:

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

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

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

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

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

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

How is gallbladder surgery performed?

With any type of surgery to remove the gallbladder, general anesthesia is performed. Further surgical intervention varies. Stages of abdominal cholecystectomy:

an incision along the midline of the abdomen or under the costal arch;
identification and ligation of the artery supplying blood to the gallbladder;
cutting off the gallbladder and its removal;
processing of the organ lodge;
installation of drains if necessary;
suturing wounds.

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

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

4 punctures are made: 1st - above or below the navel, 2nd - under the sternum, 3rd - 4-5 cm under the costal arch, 4th - in the navel;
carbon dioxide is pumped into the abdominal cavity to push the organs apart, provide visibility and access to the gallbladder;
enter the laparoscope, aspirator and endoscopic instruments;
clamps are applied and the gallbladder is cut off from the bile duct connecting the organ with the duodenum;
cut the artery and sew up its lumen;
the bladder is separated, as it is excised, cauterizing bleeding wounds with an electrocoagulator;
the gallbladder is removed through an incision in the navel;
the operated area is washed with an antiseptic, the liquid is pumped out and the punctures are sewn up.

These are the main points. The attending physician will tell you more about how the gallbladder is removed by laparoscopy or laparotomy.

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

After operation

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

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

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

you can not roll over on the bed, rise or walk for 6-7 hours. Then you need to carefully walk along the ward or hospital corridor so that blood clots do not form;
it is forbidden to eat and drink on the first day;
you can not wet the seams;
4 weeks do not lift weights over 3 kg, in the next - more than 5 kg;
sexual life is excluded for 2-8 weeks.

From the second day, they use decoctions of herbs, rose hips, fat-free kefir. On the third day, they eat light broth, soft fruits, mashed potatoes, smoothies. Then the diet is expanded with grated lean meat, soups, cereals, dairy products. This diet is followed for 2 weeks.

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

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

Video: rehabilitation after cholecystectomy

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

Insofar as hepatic angle of the colon often closes the descending part of the duodenum and the head of the pancreas, it is mobilized by dissecting the peritoneal ligaments cranial to the hepatic angle. The colon is then retracted caudally using a Mikulicz spacer. The stomach is moved medially with the same pad.

On the infundibular part of the gallbladder apply a Kelly clamp, after which it is pulled cranially and laterally. The serous membrane covering the hilum of the liver is dissected, and then the portal structures are identified (Fig. 2). The cystic duct is usually easily found first. It is tied with silk ligature No. 2/0. Double ligation of the cystic duct prevents the migration of gallstones through the cystic duct into the common bile duct, which is possible during manipulations on the gallbladder.

Preparation of Callot's triangle allows identification of the cystic artery, which may originate from the common hepatic or (more often) from the right hepatic artery. Their anatomy is highly variable, so dissection in this area should be done carefully, carefully isolating the cystic duct and artery along its entire length so as not to injure abnormal structures. The right hepatic artery often accompanies the cystic duct and/or gallbladder and only then curves back to the liver parenchyma. Therefore, for 1-2 cm, it is easy to confuse it with the cystic artery.

dissect arteries it is necessary so that the place of entry of the cystic artery into the gallbladder is clearly visible. The cystic artery often reaches just above the cystic duct, in a perpendicular direction. Again, we emphasize that the artery running parallel to the cystic duct is most likely the right hepatic one.

Anatomy of the cystic duct can also confuse the surgeon. The cystic duct usually drains into the common bile duct, but it may drain into the right hepatic duct or one of the two segmental ducts of the right lobe of the liver. In addition, it can form very low, behind the duodenum and rise parallel to the common bile duct into the portal of the liver, only then deviating to the right to the gallbladder.

This area should be dissected with all care, completely, in order to be confident in her anatomy- only in this case there will be no injury to important structures in the gates of the liver. If the anatomical features of the place where the cystic duct enters the common bile duct remain unclear, the surgeon should stop dissection in this area and begin to mobilize the gallbladder from the bottom. When the gallbladder is mobilized from its bed on the liver, the anatomy of the cystic duct region becomes clear. Sometimes early cholangiography, performed by injecting contrast directly into the gallbladder or ducts, helps. Opinions about whether cholangiography should be performed with every cholecystectomy remain controversial.

After implementation laparoscopic cholecystectomy, in which routine cholangiography is more complex and time-consuming, the arguments in its favor have become less significant. Nowadays, many surgeons believe that cholangiography should be performed only in selected cases. Nevertheless, everyone agrees that when the anatomy of the biliary tract is not clear, cholangiography is necessary.

After cystic artery anatomy becomes clear, it is tied with three silk ligatures No. 2/0 and crossed. We again want to emphasize that it is unacceptable to tie and cross this vessel if there is no complete certainty that it is the cystic artery. Mobilization of the gallbladder fundus and retraction from top to bottom before transection of the cystic artery usually helps to understand the anatomy.

When cystic artery will be crossed, the gallbladder is mobilized from its bed on the liver. I prefer to mobilize it from top to bottom. The serous membrane is dissected at a distance of 3-4 mm from the liver and then lifted with an elegant clamp. Using an electroknife, the serous membrane is cut from top to bottom along the circumference of the entire gallbladder. The bubble is then husked out of its bed using a coagulator, sharp (scissors) or blunt dissection. It must be remembered that small abnormal ducts can flow into the bladder directly from the liver. They need to be clamped and ligated or tied with stitching.

If cystic artery was bandaged before mobilization of the gallbladder, the mobilization proceeds almost bloodlessly. Any bleeding can be easily stopped with an electric knife or an argon-plasma coagulator.

After complete mobilization of the gallbladder from its bed, the anatomy usually becomes clear, and if the cystic artery has not yet been ligated, it becomes possible to ligate it. If the surgeon wishes to perform intraoperative cholangiography, after the mobilization of the gallbladder, the turn of this procedure comes.

Most patients with a normally functioning liver, in the absence of clear indications for cholangiography, the latter is not needed. Nevertheless, in some cases, intraoperative cholangiography is indispensable. If a patient has a history of cholangitis or pancreatitis, and multiple small stones are found in the gallbladder, many surgeons tend to perform cholangiography. If the common bile duct is dilated, and there are clear indications of choledocholithiasis in the anamnesis, cholangiography is also necessary.

After ligation of the cystic duct near the neck of the gallbladder, distal to the ligature on the cystic duct (about 1 cm from the confluence of the cystic duct into the common bile duct), a small hole is formed. A cholangiographic catheter is inserted through the hole and fixed with a silk ligature No. 2/0 tightened around the distal part of the duct containing the catheter. After obtaining adequate cholangiograms, the cholangiocatheter is removed, two clamps are applied to the duct, and then the gallbladder is removed from the surgical field between them.

Cystic duct stump ligated with silk No. 2/0. Many surgeons, like us, continue to use silk. Others believe that silk ligature can become a source of gallstone formation, so they use a synthetic absorbable thread. You can also use clips. The latter are routinely used in laparoscopic cholecystectomy. The right outer quadrant is thoroughly washed with a saline solution with antibiotics or an antiseptic (for example, an aqueous solution of chlorhexidine), final hemostasis is carried out in the bladder bed using an electric knife or an argon-plasma coagulator, and the abdominal cavity is closed.

Majority surgeons do not install a drain after a conventional cholecystectomy. However, if this operation is performed in connection with acute cholecystitis, or if there was bile leakage from the liver bed, it is reasonable to install a closed aspiration silicone drain*.

*If there is any doubt about the possible development of complications (inflammation with exudation, bile leakage, bleeding, even capillary), external drainage of the subhepatic space is required.

In many research it has been proven that there is no need for drainage after cholecystectomy. The only argument in favor of leaving drainage in the subhepatic space is unpredictable bile leakage from a small, inconspicuous bile duct in the gallbladder bed. The drainage tube eliminates the need for percutaneous drainage in the event of a bile duct or abscess. Although the likelihood of such complications is low, but, in our opinion, the discomfort of the drainage tube is better than the threat of subhepatic abscess or biliary peritonitis after surgery for acute cholecystitis, or leakage of bile from the bladder bed.

If there is no discharge through the drainage within 48 hours, it can be removed, often even in a day hospital. There is practically nothing wrong with draining the surgical site after an elective cholecystectomy.

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

Causes of gallstone disease

The gallbladder is a small organ shaped like a sac. Its main function is the production of bile (an aggressive fluid necessary for normal digestion). Stagnant phenomena lead to the fact that the individual components of bile precipitate, from which they later form stones. There are several reasons for this:

Eating disorders. Abuse of foods high in cholesterol, fatty or salty foods, prolonged use of highly mineralized water leads to metabolic disorders and the formation of stones in the bile ducts.
Taking certain types of drugs, especially hormonal contraceptives, increases the risk of developing calculous (inflammation of the bladder with stone formation) cholecystitis.
Sedentary lifestyle, obesity, adherence to low-calorie diets for a long time lead to digestive disorders and congestion in the biliary tract.
The anatomical features of the structure of the gallbladder (the presence of bends or kinks) prevent the normal excretion 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 right hypochondrium).

Choledocholithiasis (stones in the bile duct) are dangerous due to the possible development of 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 outpouring of bile into its cavity.

Prolonged 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 the reason for urgent hospitalization and the appointment of surgical treatment, but even the asymptomatic course of the pathology does not exclude the possibility of an operation in the presence of the following indications:

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

Indications for removal of the gallbladder

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

the presence of sharp stones that increase the risk of perforation of the organ or its parts;
mechanical jaundice;
acute clinical symptoms - severe pain, fever, diarrhea, vomiting;
narrowing of the bile ducts;
anomalies of the anatomical structure of the organ;
the patient's desire.

Contraindications

There are general and local contraindications for cholecystectomy. If an 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. General contraindications include:

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

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

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

Types of surgical intervention and their features

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

Abdominal or open surgery to remove the gallbladder - median laparotomy (incision of the anterior abdominal wall) or oblique incisions under the costal arch. This type of surgical intervention is indicated for acute peritonitis, complex lesions of the biliary tract. During the procedure, the surgeon has good access to the affected organ, can examine in detail its location, assess the condition, and probe the bile ducts. The downside is the risk of complications and cosmetic skin defects (scars).
Laparoscopy is the latest surgical method, thanks 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" for the treatment of chronic cholecystitis, an acute inflammatory process. With laparoscopy, the surgeon has limited access, so he cannot assess the condition of the internal organs. The advantages of a minimally invasive technique are:

minimum pain in the postoperative period;
fast recovery;
reducing the risk of postoperative complications;
reduction in the number of days spent in the hospital;
minimum cosmetic defects on the skin.

Mini-access cholecystectomy is a single laparoendoscopic approach through the navel or right hypochondrium area. 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 the operation

Before carrying out any type of cholecystectomy in the hospital, the patient is visited by a surgeon and an anesthesiologist. They tell how the procedure will go, about the anesthesia used, possible complications and take a written consent to the treatment. It is advisable to start preparing for the procedure before hospitalization in the department of gastroenterology, after clarifying with the doctor recommendations on diet and lifestyle, to take 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 analysis of blood and urine - are given in 7-10 days.
Clarifying analysis for blood type and Rh factor - 3-5 days before the procedure.
Examination for syphilis, hepatitis C and B, HIV - 3 months before cholecystectomy.
Coagulogram - tests for the study of the hemostasis system (blood clotting test). More often it is carried out in conjunction with general or biochemical analyzes.
Ultrasound of the gallbladder, biliary tract, abdominal organs - 2 weeks before the procedure.
Electrocardiography (ECG) - diagnostics of pathologies of the cardiovascular system. It is carried out a few days or a week before cholecystectomy.
Fluorography or X-ray of the chest organs - helps to identify pathologies from the heart, lungs, diaphragm. It is given 3-5 days before cholecystectomy.

Only those people whose test results are within the normal range 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 to consult narrow specialists (cardiologist, gastroenterologist, endocrinologist) and clarify 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. The general steps include following the rules:

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

anesthesia

For cholecystectomy, general (endotracheal) anesthesia is used. With local anesthesia, it is impossible to provide complete control over breathing, stop 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 an anxiolytic effect). Thanks to the premedication stage, a person approaches the surgical intervention calmly, in a balanced state.
Before cholecystectomy, an introductory administration of anesthesia is performed. For this, sedatives are injected intravenously to ensure falling asleep before the start of the main stage of the procedure.
The third stage is to provide muscle relaxation. To do this, muscle relaxants are administered intravenously - drugs that tension and help to relax smooth muscles.
At the final stage, an endotracheal tube is inserted through the larynx and its end is connected to the 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 failures in the respiratory or cardiovascular system. After recovery from anesthesia, confusion, mild dizziness, headache, and nausea may occur.

How is a cholecystectomy performed?

The stages of cholecystectomy may vary 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 carried out only with the written consent of the patient and under general anesthesia.

Laparoscopy

Operations 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 a short time and involve minimal blood loss for the patient (up to 10 times less than with conventional surgery). Laparoscopy is carried out according to the following scheme:

The doctor completely disinfects the skin at the puncture site using special chemicals.
3-4 deep incisions about 1 cm long 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 raise the peritoneum, expanding the viewing area of the surgical field as much as possible.
Through other incisions, a light source and special laparoscopic devices are inserted. The optics are connected to a video camera, which transmits a detailed color image of the organ to the monitor.
The doctor controls his actions by looking at the monitor. Using tools, cuts off the arteries and cystic duct, then removes the organ itself.
Drainage is placed in place of the excised organ, all bleeding wounds are cauterized with electric current.
At this stage, laparoscopy is completed. The surgeon removes all devices, sews or seals the puncture site.

Abdominal operation

Open surgery is rarely used today. Indications for the appointment of such a procedure are: adhesions of the organ with nearby soft tissues, peritonitis, complex lesions of the biliary tract. Cavity 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.
Then a small incision about 15 cm long is made on the right side.
Neighboring organs are forcibly retracted to provide maximum access to the damaged area.
Special clips (clamps) are placed on the arteries and cystic ducts, which prevent the outflow of fluid.
The damaged organ is separated and removed, the organ bed is treated.
If necessary, drain is applied, and the incision is sutured.

Mini-access cholecystectomy

The development of a single laparoendoscopic approach 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 the 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 introducing devices through the umbilical ring.

How long does the operation take

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

Laparoscopy usually takes one to two hours to complete. Stay in the hospital (if there were no complications during or after the operation) is 1-4 days.
The mini-access operation lasts from 30 minutes to an hour and a half. After the surgical intervention, the patient remains under the supervision of doctors for another 1-2 days.
Open cholecystectomy takes from one and a half to two hours. After the operation, a person spends at least ten days in the hospital, provided that there were no complications during or after the procedure. Full recovery 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 day after the procedure. Before removing the stitches, the skin is dressed daily and the skin is treated with antiseptic solutions. The first few hours (from 4 to 6) after cholecystectomy, you need to refrain from eating, drinking, it is forbidden to get out of bed. After a day, small walks around the ward, food and water intake are allowed.

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

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

Rehabilitation and recovery

The return to the patient's usual way of life after laparoscopy occurs quickly and without complications. Full recovery of the body takes from 1 to 3 months. When choosing an open cavity method of excision, the rehabilitation period is delayed and is about six months. Good health and ability to work returns to the patient two to three weeks after treatment. Starting from this period, you must adhere to the following rules:

For a month (at least three weeks), it is necessary to adhere to rest, 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. It is worth starting with minimal loads, avoiding exercises for the press.
During the first three months, do not lift more than three kilograms, starting from the fourth month - no more than 5 kg.
To accelerate the healing of postoperative wounds, it is recommended to undergo a course of physiotherapy procedures 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 rehabilitation stage, it is important to establish proper nutrition at home, according to the treatment table No. 5. You need to eat fractionally, giving preference to dietary products. All daily food should be divided into 6-7 servings. Daily calorie content of dishes: 1600–2900 kcal. It is desirable 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. It can be a rosehip broth, non-acidic sterilized juices, non-carbonated mineral water. For the first few weeks, all fresh fruits and vegetables are banned. After two months, the diet can be gradually expanded, focusing on protein foods. The preferred culinary processing of dishes is 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 the gallbladder is removed

The diet needs to be built so that the body can more easily cope with the incoming food. It is allowed to eat no more than 50 grams of butter or 70 grams of vegetable oil per day, it is desirable to completely exclude all other animal fats. The general norm of 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 the following products:

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

List of prohibited products

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

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

Consequences of cholecystectomy

After laparoscopic removal of the organ, some patients develop postcholecystectomy syndrome associated with the periodic occurrence of such unpleasant sensations as nausea, heartburn, flatulence, and diarrhea. All symptoms are successfully stopped by a diet, taking digestive enzymes in tablets and antispasmodics (if necessary, eliminating the pain syndrome).

It is impossible to reliably establish whether other consequences will occur after the removal of the gallbladder with stones, but the patient will be informed about possible problems and will be given recommendations for their elimination. More often occur:

Digestive disorder. Normally, bile is produced in the liver, then enters the gallbladder, where it accumulates and becomes more concentrated. After removal of the accumulating organ, the liquid directly enters the intestine, while 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, nausea.
risk of relapse. The absence of a gallbladder is not a guarantee that new stones will not appear again after a while. You can solve the problem by following a diet, reducing cholesterol intake, leading an active lifestyle.
Excessive bacterial growth in the intestine. Concentrated bile not only digests food better, but also destroys some of the harmful bacteria and microbes that live in the duodenum. The bactericidal effect of the liquid coming directly from the liver is much weaker. Hence, many patients after removal of the bladder are concerned about frequent constipation, diarrhea, and flatulence.
Allergy. After the operation, the digestive system undergoes a number of changes: the motor function of the gastrointestinal tract slows down, the composition of the flora changes. These factors can serve as a trigger for the development of allergic reactions to certain foods, dust, pollen. Allergy tests are performed to identify the irritant.
Stagnation of bile. It is eliminated using a safe procedure - duodenal sounding. A special tube is inserted through the esophagus, through which a solution enters, which helps to speed up bile excretion.

Possible Complications

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

Damage to internal organs, internal bleeding when blood vessels are damaged. It often occurs at the site of the introduction of a trocar (laparoscopic manipulator) and stops with suturing. Sometimes bleeding is possible from the liver, then they resort to the method of electrocoagulation.
duct damage. This causes bile to build up in the abdominal cavity. If the damage was visible at the stage of laparoscopy, the surgeon continues the operation in an open way, otherwise a second surgical intervention will be necessary.
Suppuration of the postoperative suture. Complication occurs very rarely. To stop suppuration, antibiotics and antiseptic drugs are prescribed.
Subcutaneous emphysema (accumulation of carbon dioxide under the skin). It often occurs in obese patients due to the tube not getting into the abdominal cavity, but under the skin. The gas is removed after the operation with a needle.
thromboembolic complications. Occur extremely rarely and lead to thrombosis of the pulmonary arteries or inferior vena cava. The patient is prescribed bed rest and taking anticoagulants - drugs that reduce blood clotting.

Medical treatment for relapses

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

Enzymes - help break down food, improve the functioning of the digestive system, stimulate the production of pancreatic juice. The composition of such drugs are pancreatic enzymes that break down proteins, fats and carbohydrates. Enzyme preparations are well tolerated, and side effects (constipation, nausea, diarrhea) are extremely rare. Popular pills 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 the liver secretion, normalize digestion and bowel function. Most of these medicines are herbal and rarely cause side effects. Popular choleretic medications 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 medicines (hepatoprotectors) - restore damaged liver cells, increase the production of bile, thin and improve its composition. The following medicines have proven themselves well:

Ursofalk (for 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 where the patient lives. Emergency cholecystectomy is free of charge, regardless of the citizenship and place of residence of the patient. Approximate prices for procedures in Moscow are presented in the table:

Clinic name	Type of surgical intervention	Price, rubles
Medical Clinic NAKFF	laparoscopy
Crede Experto	laparoscopy
Central Clinical Hospital No. 2 named after ON THE. Semashko Russian Railways	open cholecystectomy
Federal Bureau of Medical and Social Expertise	open cholecystectomy
Family Clinic	laparoscopy

Video

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A complete process of digestion in the gastrointestinal tract is provided by the gallbladder, which accumulates bile in the required quantities. Excessive forms a stone, and it clogs the bile ducts. The appearance of symptoms of pancreatitis, cholecystitis can cause complications, require cholecystectomy (the so-called removal of the gallbladder). Learn about the operation.

What is gallbladder removal

Cholecystectomy is performed for cholecystitis (purulent), tumors of the gallbladder. It may take place in two types: through an incision in the peritoneum (laparotomy) or without incisions using laparoscopy (only three holes will remain in the abdominal wall). Laparoscopy has a number of advantages: it is much easier to tolerate, the postoperative period is shorter, there are practically no cosmetic defects.

Indications for removal

There are several testimony to remove the gall sac:

constant pain in the right hypochondrium, frequent infection of the organ, which is not amenable to conservative methods of treatment;
organ pathology;
chronic cholecystitis;
persistent jaundice;
blockage of the bile ducts;
cholangitis (cause - conservative treatment does not help);
the presence of chronic diseases in the liver;
secondary pancreatitis.

These symptoms are common indications for cholecystectomy. Each individual patient is individual, some cases require urgent surgical intervention, and some may wait a couple of days or weeks. To determine the degree of urgency and the patient's condition, doctors conduct a complete list of diagnostic tests.

Training

Complete preparation for any type of gallbladder surgery includes:

ultrasonography ( ultrasound) gallbladder and abdominal organs (liver, pancreas, intestines, etc.);
computed tomography - it helps to evaluate perivesical tissues, walls, bladder contours, the presence of nodes or adhesive processes;
fistulography;
MRI- a reliable research method that determines stones, inflammation, narrowing from scars, pathology of the ducts.

Laboratory methods of examination of the patient make it possible to detect violations. Assign the determination of the content of transaminases, bilirubin, alkaline phosphatase, thymol test, the amount of bile and others. A comprehensive examination of the heart and lungs is often required. The operation is not performed if the patient suffers from acute cholecystitis, in the presence of acute inflammatory processes, acute pancreatitis.

Before complete removal, the patient should:

stop taking drugs that thin the blood(affect clotting) to avoid heavy bleeding during surgery;
the night before the operation, according to the doctor's recommendations, stop eating;
in the morning, conduct a cleansing enema or drink laxatives in the evening;
take a shower with antibacterial agents before the operation.

Diet before surgery

Before cutting out an organ, 3-4 days before a planned operation, a diet is prescribed:

without foods that cause bloating (flatulence);
without too fried and spicy food;
recommend the use of dairy products, lean meat and fish;
completely exclude products that lead to fermentation - fruits, vegetables, beans, bread (especially rye).

Removal methods

To remove the organ, a laparotomy or laparoscopy is performed. Laparotomy is the removal of a calculus through the incision organ walls. It is carried out from the xiphoid process along the midline of the abdomen to the navel. Another removal option is through mini access. The incision is made at the location of the walls of the gallbladder, the diameter is 3-5 cm. Laparotomy has the following advantages:

a large incision makes it easy for the doctor to assess the condition of the organ, to feel it from all sides, the duration of the operation is 1-2 hours;
cut faster than with laparoscopy, which is required in emergency situations;
during the operation there is no high pressure of gases.

Disadvantages of Intervention:

tissues are severely injured, there will be a visible, rough scar;
the operation is being carried out open, organs are in contact with the environment, instruments, the operating field is more contaminated with microorganisms;
the patient's stay in the hospital is at least two weeks;
severe pain after surgery.

Laparoscopy is an operation to remove the gallbladder, which is performed through small holes (0.5-1.5 cm) on the abdominal wall. There may be only two or four such holes. A telescopic tube is inserted into one hole, called a laparoscope, which is attached to a video camera, the entire course of the operation is displayed on the monitor. The same method is easy to remove stones.

Advantages:

injury is very small;
after 3 days, the patient can already be allowed to go home;
no pain, fast recovery;
reviews are positive;
laparoscopic surgery does not leave large scars;
The monitor allows the surgeon to better see the surgical field, increasing it up to 40 times.

Flaws:

the movements of the surgeon are limited;
the definition of the depth of the wound is distorted;
it is difficult to determine the force of impact on the body;
the surgeon gets used to the reverse (his hands) movement of the instruments;
intra-abdominal pressure rises.

How to remove

The gallbladder is removed by one of the operations chosen by the patient (the person himself chooses the method of removal) - laparoscopy or laparotomy. Before this, they introduce the person to the course of the operation, and its consequences, sign agreement and begin preoperative preparation. If there are no emergency indications, then the patient begins preparation with a diet at home.

Abdominal operation

The procedure for abdominal surgery is as follows:

Dissect the skin and tissue. After the incision, the wound is dried. Hemostatic clamps are applied to the loans.
Dissect the aponeurosis (ligament). The peritoneum is exposed, the rectus abdominis muscles are bred to the sides.
The abdominal walls are cut. Aspirate blood, liquid by suction and dry with tampons.
An audit of the abdominal organs is carried out, the organ is cut out.
Install drains to drain exudate.
The anterior abdominal wall is sutured.

Laparoscopic cholecystectomy

If adhesions and inflammations are found during the operation, abdominal surgery can be started. Laparoscopy of the gallbladder is performed under general anesthesia, artificial respiration is applied:

A special needle is used to introduce the prepared substance into the abdominal cavity.
Next, punctures are made into which the instrumentation and the video camera are inserted.
During removal, the arteries and duct are cut off, sealed with metal clips, the pancreas is not affected.
The organ is taken out through the largest hole.
Thin drainage is laid, the wound is sutured, the hole is processed.

Treatment after gallbladder removal

After surgery, antibiotics are prescribed to prevent complications. They take them for the first three days while in the hospital. Then appoint antispasmodics: Drotaverine, No-shpa, Buskopan. Further, drugs that contain ursodeoxycholic acid are used to reduce the risk of stones. To avoid problems with digestion, the body is helped with drugs.

Preparations

Conservative treatments include broad-spectrum antibiotics such as:

Ceftriaxone;
Streptomycin;
Levomycetin.

Medicines that contain ursodeoxycholic acid - hepatoprotector and choleretic;

Ursosan;
Ursofalk;
Urso;
Ursoliv;
Ursodex.

Assign the reception of analgesics to eliminate pain:

Spazmalgon;
No-shpu.

Ursosan is a drug that contains ursodeoxycholic acid. It reduces the synthesis of cholesterol in the liver, absorbs it in the intestine, dissolves cholesterol stones, reduces bile stasis and lowers the cholatholesterol index. Ursosan is shown:

after surgery to remove;
in the presence of stones with preserved bladder function;
possible appointment for stomach disease;
for symptomatic therapy in primary biliary cirrhosis and other liver diseases.

The advantage of the drug is its ability to replace toxic bile acids with non-toxic ursodeoxycholic acid, improves the secretory ability of hepatocytes, and stimulates immunoregulation. Cons of the drug:

may feel sick;
cause attacks of pain in the liver;
cause cough;
increase the activity of liver enzymes;
often stones are formed.

Ursodex is one of the types of hepatoprotectors. Well drives bile, has an immunomodulatory and cholelitholytic effect. Normalizes the membranes of hepatocytes and cholangiocytes. It is indicated when as a symptomatic therapy:

with primary biliary cirrhosis;
presence of stones or prevention of their formation;
with biliary reflux gastritis.

A big plus of Ursodex is its ability to significantly reduce the size of stones. Cons:

can cause acute inflammatory processes in the gallbladder or in the ducts;
clog the bile ducts (including the common one);
often causes indigestion;
skin itching;
vomiting as a side effect;
able to increase the activity of normal hepatic transaminases.

To avoid postoperative complications, follow recommendations for rehabilitation within 4-8 weeks (regularly):

Limit physical activity and carrying weights over four kilograms. This promotes frequent breathing and tension of the internal abdominal muscles.
There is no escape from observing a strict diet: eat fractionally, but often, chicken broth, lean meats and fish, cereals, etc. are allowed.
It is necessary to drink 1.5 liters of clean water per day.

Life after gallbladder removal

Most people believe that with surgery and when there is no gallbladder, normal life stops, and a person is forever chained to pills, a healthy lifestyle, eating only wholesome food. This is far from true. Only a strict diet is followed first time, and a large number of drugs will be gradually reduced to minimal maintenance therapy.

Complications

The main and dangerous complication is bleeding. It can be internal and external. The internal is more dangerous, when it appears, an emergency operation is performed. Abscesses, inflammation of the pancreas, peritonitis may develop. Jaundice is a late complication. Problems can also occur due to surgical errors during the operation.

Temperature

If a high temperature of 38°C or 39°C occurs, which is combined with headache, chills, muscle pain, you should immediately consult a doctor. These symptoms indicate the development of the inflammatory process. If you do not pay attention to this, more serious complications may develop, the condition of the body will worsen, it will be difficult to return all processes to normal.

Seizure after removal

A postoperative attack in patients may occur with a lesion extrahepatic pathways. Frequent causes:

Stones or cyst formation in the ducts.
Diseases of the liver.
Stagnation of bile, which accumulates and causes pain when the capsule expands.
The work of the digestive organs is disrupted due to the chaotic flow of bile into the intestines and duodenum, fat is poorly absorbed, and the intestinal microflora is weakened.

Consequences

All the consequences are united by the term "postcholecystectomy syndrome". It includes:

Pathological changes, biliary colic after surgery.
Physician's mistakes and damage to the ducts, remaining stones, incomplete removal, pathological changes, the cystic duct remained very long, foreign body granuloma.
Complaints of organs that did not bother before surgery.

Among women

According to statistics, surgical interventions are performed three times more often for women than for men. This is due to sharp hormonal surges, as well as pregnancy. In most cases attacks of pain and inflammation processes were observed in women in an "interesting position". The consequences of gallbladder removal in women are the same as in men.

In men

It is believed that men suffer from diseases of the bile ducts less frequently. This is far from the case, because they immediately fall on the operating table without being treated before. This is because they endure pain for a long time when it would be worthwhile to see a doctor. After the operation, the recovery of the body is faster than in women, they begin to live a normal life if they follow a diet and exclude alcohol.

bowel problems

When the gallbladder is removed, bile acids constantly enter the intestinal mucosa, which leads to flatulence, diarrhea, which causes problems for patients in the postoperative period. Over time, digestion adapt to the absence of an organ and everything will be back to normal. But there is also the opposite problem - constipation. It occurs due to slow intestinal motility after surgery.

Allergy

If the patient has a history of allergic reactions, the operation should be performed after examination for the presence of antibodies to allergens (drugs). If this is not done, anesthesia can cause a serious allergic reaction in a person, which sometimes leads to fatal consequences. If you know you have allergies, be sure to tell your doctor.

How long do they live after gallbladder removal?

This operation is not problematic, the absence of a gallbladder does not affect the quality and duration of life, disability is not assigned, you can work. By adhering to simple dietary changes and prescriptions from your doctor, you can live to a ripe old age, even if the bladder was removed at a young age. It does not affect liver function.

Price

Prices for surgical intervention range from 38,500 rubles. up to 280047 r. The table shows the clinics and the price for the operation, the region - Moscow (Internet resource).

Video

All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

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

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

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

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

When is an operation needed?

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

Cholelithiasis.
Acute and chronic inflammation of the bladder.
Cholesterosis with impaired biliary function.
Polypos.
Some functional disorders.

cholelithiasis

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

In some cases, the disease proceeds without acute symptoms, but with heaviness in the hypochondrium, dyspeptic disorders. These patients also need surgery, which is carried out in a planned manner, and its main goal is to prevent complications.

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

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

Cholecystitis

Cholecystitis- this is inflammation of the wall of the gallbladder, occurring acutely or chronically, with relapses and improvements that replace each other. Acute cholecystitis with the presence of stones is the reason for urgent surgery. The chronic course of the disease allows it to be planned, possibly laparoscopically.

cholesterosis it is asymptomatic for a long time and can be detected by chance, and it becomes an indication for cholecystectomy when it causes symptoms of gallbladder damage and impaired function (pain, jaundice, dyspepsia). In the presence of stones, even asymptomatic cholesterosis is the reason for the removal of the organ. If calcification occurs in the gallbladder, when calcium salts are deposited in the wall, then the operation is performed without fail.

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

Functional Disorders biliary excretion is usually the reason for conservative treatment, but abroad, such patients are still operated on due to pain, decreased bile release into the intestine, and dyspeptic disorders.

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

TO general contraindications include terminal states, severe decompensated pathology of internal organs, metabolic disorders that can complicate the operation, but the surgeon will “close his eyes” to them if the patient needs to save his life.

Common contraindications for laparoscopy consider diseases of internal organs in the stage of decompensation, peritonitis, long-term pregnancy, pathology of hemostasis.

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

Types and features of operations to remove the gallbladder

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

left: laparoscopic cholecystectomy, right: open surgery

Open operation

Abdominal removal of the gallbladder involves a median laparotomy (access along the midline of the abdomen) or oblique incisions under the costal arch. At the same time, the surgeon has good access to the gallbladder and ducts, the ability to examine, measure, probe, and examine them using contrast agents.

Open surgery is indicated for acute inflammation with peritonitis, complex lesions of the biliary tract. Among the disadvantages of cholecystectomy in this way, one can indicate a large surgical injury, poor cosmetic results, complications (disruption of the intestines and other internal organs).

The course of an open operation includes:

Incision of the anterior wall of the abdomen, revision of the affected area;
Isolation and ligation (or clipping) of the cystic duct and artery supplying the gallbladder;
Separation and extraction of the bladder, processing of the organ bed;
The imposition of drains (according to indications), suturing the surgical wound.

Laparoscopic cholecystectomy

Laparoscopic surgery is recognized as the "gold standard" of treatment for chronic cholecystitis and cholelithiasis, and is the method of choice for acute inflammatory processes. The undoubted advantage of the method is considered to be a small surgical injury, a short recovery time, and a slight pain syndrome. Laparoscopy allows the patient to leave the hospital as early as 2-3 days after treatment and quickly return to normal life.

The stages of laparoscopic surgery include:

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

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

Video: laparoscopic cholecystectomy, operation progress

Mini-access cholecystectomy

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

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

gallbladder removal steps

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

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

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

Preoperative preparation

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

For this purpose, they carry out:

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

Some patients need to consult narrow specialists (gastroenterologist, cardiologist, endocrinologist), all need a therapist. To clarify the state of the biliary tract, additional studies are carried out using ultrasound and radiopaque techniques. Severe pathology of internal organs should be compensated as much as possible, pressure should be normalized, blood sugar levels in diabetics should be controlled.

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

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

After operation…

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

The day after the operation, the drainage is removed, if one has been installed. This procedure is painless. Before removing the sutures, they are treated daily with antiseptic solutions.

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

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

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

Since after cholecystectomy the patient loses an important organ that accumulates and releases bile in a timely manner, he will have to adapt to the changed conditions of digestion. The diet after removal of the gallbladder corresponds to table number 5 (liver). You can not eat fried and fatty foods, smoked meats and many spices that require increased secretion of digestive secrets, canned food, marinades, eggs, alcohol, coffee, sweets, fatty creams and butter are prohibited.

First month after surgery you need to adhere to 5-6 meals a day, eating in small portions, you need to drink water up to one and a half liters a day. It is allowed to eat white bread, boiled meat and fish, cereals, kissels, fermented milk products, stewed or steamed vegetables.

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

In the first month after the operation, it will be necessary to somewhat limit physical activity, not to lift more than 2-3 kg and not to perform exercises that require tension in the abdominal muscles. During this period, a scar is formed, with which the restrictions are associated.

Video: rehabilitation after cholecystectomy

Possible Complications

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

Among the consequences are:

Suppuration of the postoperative suture;
Bleeding and abscesses in the abdomen (very rare);
Expiration of bile;
Damage to the bile ducts during surgery;
allergic reactions;
thromboembolic complications;
Exacerbation of another chronic pathology.

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