Laparoscopic cholecystectomy is considered a new step in the treatment of gallstones. Many experts say with confidence that this technology is a significant step forward for all surgery in general. Just a few years of development of the technology has already allowed it to gain popularity in many European powers. Laparoscopic cholecystectomy is common in both Asian and American clinics. Doctors today have access to experience gained from many thousands of surgical interventions. As can be seen from practice, the operation equally helps with the chronic course of the disease, and with cholecystitis in the calculous form. In our country, for the first time such an intervention was carried out in 1991.
General view
Doctors Highlight Numerous Benefits of Laparoscopic Surgerycholecystectomy before conventional surgery. The classic form is called "laparotomy" and involves the dissection of the abdominal wall in front, which involves a long recovery. The new method allows you to shorten the rehabilitation period, you need to spend much less time in the hospital, recovering from treatment.
Compared to laparotomy, this technique gives complications much less frequently. Patients, as shown by clinical trials, return to a working state faster. The cosmetic aspect is also important, since the modern method of intervention leaves only barely noticeable scars.
Operation laparoscopic cholecystectomy by many doctors is estimated almost as a piece of jewelry. The intervention is complex, and only a highly qualified surgeon who knows the anatomical features of this area of the human body, as well as the topography of internal organs, can cope with it. It is necessary to be able to manipulate high-precision instruments, focusing on the image transmitted to the screen. Such skills require long-term training, long-term practice.
When needed?
Indications for laparoscopic cholecystectomy are exactly the same as for classical surgery. The main task of the doctor is to remove the gallbladder effectively, without consequences for the patient, if the pathology cannot be effectively eliminated by conservative methods.
Most often, surgery is prescribed if diagnosedcalculous cholecystitis in a chronic form. Experts note that neither the severity of the disease, nor the number of formations, nor the duration of the pathology affect the choice in favor of the traditional method or a more modern one.
In addition to the specified diagnosis, laparoscopic cholecystectomy is necessary for acute cholecystitis. With this disease, treatment should be carried out in the first two days of the attack. An event is prescribed if polyps in the gallbladder, cholesterosis are established, cholecystolithiasis is detected without symptoms. Especially difficult is the case, not accompanied by symptoms. Doctors pay attention: surgical intervention is extremely necessary, since the absence of the manifestation of stones does not protect against complications in the future. There is a risk that small neoplasms will eventually move into the bile ducts of the bladder, causing a bedsore of the bladder wall. Both small and large stones are considered equally dangerous, so the identification of such an aspect always becomes the basis for referral for surgical intervention.
Sometimes you can't
Contraindications for removal of the gallbladder are divided into local and general. The general conditions should include conditions, pathologies of the patient, which do not allow for surgical intervention. Doctors, assessing the patient's condition, may come to the conclusion that such an event can cause serious complications, so they will suggest looking for alternative methods to alleviate the course of the disease. Are considered dangeroussituations:
- cardiac, vascular diseases;
- impaired lung function;
- blood clotting problems that cannot be corrected with medication;
- peritonitis (general, diffuse);
- excess weight (2nd-3rd degree);
- bearing fetus (late dates).
From among the local contraindications for removal of the gallbladder, it should be noted:
- acute pancreatitis;
- mechanical jaundice;
- malignant neoplasms in the gallbladder;
- cicatricial changes, infiltrative, found on the neck of the bladder, ligaments;
- intrahepatic gallbladder;
- surgical interventions in the upper abdomen.
Proper preparation is the key to success
If it is necessary to carry out a surgical intervention, the patient is assigned a full examination in order to determine the individual characteristics of the organism. Preparation for laparoscopic cholecystectomy is generally similar to the measures taken when planning a traditional form of intervention. First, the patient is sent for an ultrasound, as a result of which they can decide on additional measures of instrumental clarification of the condition.
Before laparoscopic cholecystectomy, you will have to take blood tests, studies of other body fluids are possible. A set of specific tests is determined by the attending physician, taking into account individual characteristicssick.
Step by step: how is it done?
There are several consecutive obligatory stages of laparoscopic cholecystectomy. First, the abdominal cavity is filled with a special gas - nitric oxide, or carbon dioxide, after which the instruments are introduced directly for work. The first step is a revision of the internal organs, after which the actual object of intervention, the gallbladder, is isolated from the adhesions. The doctor determines the location of the cystic duct, the artery that feeds the organ, crosses, bandages the necessary areas, and then allocates the organ from the hepatic bed and removes it from the cavity. The final moment is an examination of all organs in order to summarize, control the patient's condition. This completes the operation.
Trouble: is it possible?
Complications after laparoscopic cholecystectomy are known in medicine. In some cases, urgent surgical intervention is required to alleviate the patient's condition. Complications are known that appeared already at the stage of the primary event, as well as those identified during rehabilitation after surgery.
Operation completed, what next?
The postoperative period with laparoscopic cholecystectomy is characterized by ease of flow, since the intervention itself is quite insignificant. In comparison with classical methods of surgery, rehabilitation proceeds quite easily, and the pain syndrome practically does not bother the patient.
In most cases, immediately after the event, you can completely abandon pain medication or reducetaking them to the lowest dose. The initial activation of the patient occurs a couple of hours after the completion of the intervention, and the free mode is acceptable on the second day after the event. The patient is discharged on the third or fourth day. Before discharge, it is necessary to carefully examine the patient in order to prevent complications.
Since the postoperative period for laparoscopic cholecystectomy is easy, requires a relatively short time period for recovery, after a week or two the patient can return to work. Specific terms are determined by the profession of a person, the physical load that he faces while performing official duties.
Anatomical features
The relevance of such a surgical intervention is due to the importance of the gallbladder for the human body. The organ belongs to the digestive system, located slightly below the liver. Its activity is important for the normal processing of food: the bile generated by cells through the liver is sent through the ducts to the bladder. When food enters the body, bile passes into the intestine, where it actively participates in the breakdown of fatty compounds, and also initiates the activity of enzyme structures.
Diseases of the gallbladder, as well as stones in this organ, are a serious problem for a person, worsen the general condition of the body and can be life-threatening for the patient. In a number of pathologies, emergency laparoscopic cholecystectomy is necessary - such an interventioncarried out within the first two days from the moment of an acute attack, but only if the disease is diagnosed. During the operation, the doctor removes the diseased organ.
Features and diagnoses
It is possible to suspect that laparoscopic cholecystectomy is necessary if a person suffers from nausea, from time to time it hurts on the right side under the ribs, and after food is ingested, a feeling of discomfort appears. With such manifestations, it is reasonable to visit a doctor for the formulation of an accurate diagnosis. The doctor prescribes an ultrasound to clarify the condition. Stones are not always found, the reason may be in polyps, oncology.
Women aged 50 and older are known to be at risk for stone formation. The predisposition is more significant if excess weight is observed, diabetes mellitus is established, or other metabolic problems are known. Statistics show that laparoscopic cholecystectomy in 60% of cases is prescribed to patients in whom the disease proceeded without symptoms or rarely manifested itself as colic, and the pain attack lasted from a quarter of an hour to six hours, and the sensations were given to the shoulder on the right, to the stomach and between the shoulder blades. Most likely this is possible in the evening, at night. The patient suffers from vomiting. If the diagnosis is confirmed, the patient is scheduled for elective surgery.
Important features: what to look out for?
Currently, laparoscopic cholecystectomy is one of the most gentle techniques availablequalified surgeons. It allows you to solve the problem of stone formation by a radical method, when crushing, removing such elements does not give a positive effect. Since the appearance of objects is due to metabolic problems, over time, more and more new instances will be formed. Only radical intervention can solve the problem once and for all. As can be seen from medical statistics, the removal of only stones by modern doctors is practiced in extremely rare cases, more often the patient is advised to sign up for a laparoscopic cholecystectomy. The cost of such an intervention varies quite strongly - from ten to one hundred thousand rubles. True, doctors assure that it is worth its price: the method is effective, safe, and the terms of disability with laparoscopic cholecystectomy are just a few days in the hospital, no more than two weeks before full discharge.
The intervention involves the creation of only two-centimeter incisions, while the traditional technique is performed with incisions exceeding this value ten times. Therefore, the risk of hernia after the intervention is minimized. The traditional technique is especially difficult for patients with a loose physique, since the recovery processes will require long time periods, but the method under consideration is not so weak. When performing the intervention in the described way, four minor incisions are created, the healing of which takes place almost without pain.
Check everything
If scheduledlaparoscopic cholecystectomy, usually the doctor prescribes a comprehensive examination to determine the patient's he alth status. Above were the basic analyzes, studies. In addition to them, the doctor may prescribe a test for infection with syphilis, hepatitis, HIV. Doctors will find out what the patient's blood type is, the Rh factor. In most cases, an additional patient is sent for fluorography, an analysis that allows you to assess blood clotting, and urine is also taken for a general study. The conclusions are formulated by the therapist, the dentist. Only after their positive decisions, you can choose the day for the operation.
When the initial stage of collecting information about the patient's condition is completed, the patient is assigned to the ward. A surgeon comes here for a visual examination of the patient, checking information from the tests, questioning the patient and clarifying his well-being. A professional will tell you what risks the operation entails, what will be the rehabilitation for laparoscopic cholecystectomy, what restrictions will you have to face in the future.
Technical points
Already ten days before the operation, they impose restrictions on taking medications. This includes drugs that reduce blood clotting, such as aspirin. You can not use vitamin E in food. Restrictions are imposed on non-steroidal medicines that stop inflammatory processes. After choosing the optimal date and time for the surgical intervention, the clinic staff will inform the patient on how to prepare for the event. Generally no foodsuperimposed from six in the evening of the previous day before the intervention. Drinks, including water, should not be consumed after midnight. In the morning, the patient is given an enema to cleanse the body.
Immediately before the operation, the patient is put to sleep. A prerequisite is general anesthesia. In order to have access to the image of all internal organs, gas, a video camera, and the tools used are injected through a needle. The largest incision created will be used to extract the diseased organ. During the operation, there is a risk of detecting an acute inflammatory process. It is not possible to cope with it using sparing methods of intervention, it is necessary to urgently change the format and complete the intervention by laparotomy. This will require the tension of the bladder, the presence of numerous adhesions, as well as the growth of nearby organs. Before the start of the operation, the patient is informed of this possibility of the development of the situation.
Operation Complete: First Feelings
As the intervention is completed, the patient is sent to the ward, where he wakes up - usually already within the first hour after the completion of the operation. There is a possibility of nausea, dyspepsia. With such manifestations, it is necessary to use Cerucal. After a few hours, the pain syndrome may disturb. The intensity of sensations varies, much depends on the specific case. Doctors prescribe analgesics to relieve the syndrome. If the pain is very severe, drugs may be used.connections. If there are indications for this, infusion therapy is prescribed. If the organ is depressurized during the operation, a course of antimicrobial agents is prescribed.
Nutrition after laparoscopic cholecystectomy may be limited. On the first day after the intervention, eating is prohibited in principle. On the second day, the patient is bandaged, the drainage is removed in the absence of discharge. On the second day, you can start feeding the patient. Return to normal daily activities (walking, eating) occurs on the second or third day after the intervention. At first, you need to eat fractionally, use strictly dietary foods.
I want to go home
Usually, discharge occurs within the first week after the operation, although sometimes the patient is advised to stay in the hospital for a longer period. Before discharge, they take a blood test, check urine. If the indicators are normal, there is no fever, the patient does not feel severe pain, and the wounds gradually heal, you can send him home for aftercare. At home, you will also have to strictly observe dietary restrictions after laparoscopic cholecystectomy so as not to create an additional load on the body.
They come for a follow-up appointment after discharge within a week. At the same time, doctors remove the stitches, recommend which nutrition program to follow in the future, and also issue an official sick leave. After some more time (up to a couple of weeks), the patient is fully restored. Canwork again, do daily activities, sports.
Keep yourself in order
Usually, doctors, when they discharge patients, give recommendations on lifestyle. Approximately two months after the intervention, reasonable distances should be walked every day (slowly). The duration of the walk is at least 30 minutes. Liquid restrictions are imposed - up to one and a half liters per day. Of the products, preference should be given to steamed. You will have to give up fatty, spicy and other heavy foods, alcoholic beverages. At first, you should avoid lifting loads that weigh more than 4 kg.
To increase the effectiveness of the rehabilitation period, the doctor may prescribe a course of enzymes, diuretics. This measure allows you to quickly bring the intestinal microflora back to normal.
