Cholelithiasis has become today one of the most common occurrences among the pathologies of the abdominal cavity, and the operation to remove stones in the gallbladder is one of the methods of cardinal solution of the problem.
Cholelithiasis - what is it?
This is a disease associated with the formation of stones (calculi) in the bile ducts and gallbladder. It develops for the following reasons:
- stagnation or change in the composition of bile;
- inflammatory processes;
- impaired bile secretion (dyskinesia).
The composition distinguishes three types of stones. The most common (in 80-90% of cases) are cholesterol stones. Their formation contributes to the excess content of cholesterol in the composition of bile. In this case, the formation of crystals occurs due to the precipitation of excess cholesterol in the sediment. If the motility of the gallbladder is impaired, then these formations are not removed into the intestinal space, but remain inside it and begin to increase.
Pigment stones are formed due to increased cell breakdownblood - erythrocytes. Most often this can be observed with hemolytic anemia. There are also mixed formations. They are a combination of both forms. They contain cholesterol, bilirubin and calcium.
Do I need surgery
Everyone who has been diagnosed with gallstones sooner or later faces the question of whether surgery is needed or conservative treatment will suffice. It is worth mentioning that the stones themselves are not a reason to remove the gallbladder. If they do not manifest themselves in any way and do not affect the normal functioning of other organs, then you can not think about the operation. However, if there are pains in the gallbladder, a violation of the general condition, jaundice, then it is urgent to consult a surgeon. It is he who, after the examination, will decide whether surgery is necessary, and which one. But it must be borne in mind that cholecystitis of the gallbladder implies an inflammatory process that has already begun. If the decision is excessively delayed, then the chances of fully recovering he alth after the operation are sharply reduced. Even if there was a single attack, it is better to remove gallstones.
Indications for surgery
When deciding on the need for surgery, specialists usually take into account the following factors:
- the presence of stones (calculi) of various sizes, occupying more than a third of the volume of the gallbladder;
- if the disease proceeds with frequent bouts of painin the gallbladder (biliary colic), then the operation is carried out regardless of the size of the stones;
- if the stones are located both in the gallbladder and in the ducts;
- with a decrease in the ability of the gallbladder to contract or its complete shutdown;
- with the development of biliary pancreatitis;
- in violation of the integrity of the walls of the gallbladder;
- with blockage of the common hepatic duct.
There are international guidelines for determining the need for surgery for gallstone disease. By summing up the scores that are assigned to various diagnostic indicators, the doctor determines whether surgery is required, as well as relative and absolute indications for it.
Types of transactions
As a rule, the process of formation of gallstones is not a quick matter. Of course, if you are unlucky and the ambulance took you to the surgical hospital with an acute attack, which was diagnosed as gallbladder cholecystitis, then you have little choice. But in most cases, people who know about their problem discuss all the details with the attending physician in advance, determine the date of the planned surgical intervention.
In modern medicine, there are two methods for removing the gallbladder (cholecystectomy):
- open cholecystectomy - a traditional method that involves opening the abdominal cavity;
- laparoscopic cholecystectomy is a more modern technique, which is now preferred.
Opencholecystectomy
This gallbladder stone removal surgery is a classic surgery. Through a wide incision in the midline of the abdomen, the abdominal cavity is examined, the gallbladder is removed and, if necessary, drainage (installation of tubes in order to ensure the outflow of the resulting exudate and other biological fluids).
Despite the emergence of more modern and high-tech methods, open cholecystectomy continues to be relevant. This can be explained by the fact that some clinics do not have the equipment or specialists with the necessary qualifications to perform laparoscopic operations. In addition, there are certain contraindications for them.
Laparoscopy of the gallbladder
This is another type of surgery for gallstone disease. To date, this method is becoming more widespread due to its effectiveness, low trauma, and shortening of recovery time. The operation is performed using a laparoscope - a special device that allows access to the damaged organ with the help of several punctures of the abdominal wall, through which manipulators and, in fact, the laparoscope are inserted. This method allows not only to remove the gallbladder without leaving postoperative scars, but in some cases to remove only stones, leaving the organ in place. A similar method is used not only for the treatment of gallstone disease, but also for the removal of appendicitis, the treatment of inguinal hernia,some gynecological diseases, as well as diagnostic operations. Despite the clear advantages of laparoscopic cholecystectomy, this method has its contraindications. These include:
- abscess located in the operation area;
- last three months of pregnancy;
- severe cardiopulmonary pathologies.
In addition, it should be taken into account that during laparoscopic surgery, in case of the slightest difficulty in its course, surgeons switch to open cholecystectomy. Approximately 5% of laparoscopic operations end up like this.
Preparation for surgery
Like any surgical intervention, the operation to remove gallstones requires some preparation. In addition to the standard examination, which includes the delivery of tests (general blood count and urinalysis, blood biochemistry, coagulogram - blood coagulation test, liver tests), it is necessary to do an abdominal ultrasound, ECG, chest x-ray, according to FGS and colonoscopy, as well as get a therapist's opinion. In addition, preparation for a planned operation includes the abolition of drugs that affect blood clotting. These include various anticoagulants, vitamin E, non-steroidal anti-inflammatory drugs. A few days before the operation, special attention should be paid to the diet for cholelithiasis. The menu should not contain heavy meals, and from midnight on the day when the operation is performed, food and drink should be completely excluded. On the eve of the business day forcleansing the intestines in the morning and evening do cleansing enemas or take special preparations. Shower in the morning with antibacterial soap.
Post-operative period
Today it is difficult to surprise someone with a cholecystectomy. This operation to remove gallstones has long been put on stream, and is done about as often as an appendectomy. The patient is allowed to turn in bed four hours after the completion of the operation, during which he should not drink and make sudden movements. Then you can start drinking small portions of water without gas (1-2 sips, but not more than 500 ml). Six hours after laparoscopic surgery, the patient can get up. It is better to do this if one of the medical staff or relatives is nearby, since after the body has been in a horizontal position and in a state of anesthesia for a long time, dizziness and fainting may occur when trying to get up. Already on the next day after the operation, the patient can move freely around the hospital.
After surgery, the diet for gallstone disease is of great importance. The menu for the next day may include liquid food - oatmeal on the water, diet soups, dairy products. In the future, boiled beef, chicken breast, baked apples or bananas can be included in the diet. It must be remembered that in the first week after the operation, alcohol, strong tea or coffee, sugar, fried and fatty foods are prohibited.
Litholytic therapy
In the event that surgical intervention is not possible due to severe somatic diseases or blood clotting disorders, as well as if the patient refuses to undergo surgery, litholytic therapy is performed. This is a method that uses preparations containing bile acids to dissolve the formed stones. Starting it, you need to take into account that the duration of treatment can be from one to two years, and even if you manage to dissolve the stones in the gallbladder completely, this does not guarantee that they will not reappear. In addition, various complications of gallstone disease may occur during treatment, including those that require surgical intervention.
Criteria for litholytic therapy
Another limitation of litholytic therapy is certain requirements for disease criteria:
- Gallstones in the gallbladder must be cholesterol, no larger than 20 mm.
- The functions of the gallbladder are preserved, and the stones do not occupy more than half of its volume.
- The cystic and common bile ducts must remain open.
- No more than two years have passed since the formation of stones.
- A history of an uncomplicated course of the disease should be present - moderate pain, rare attacks of hepatic colic.
Treatment is carried out under ultrasound control once every 3-6 months. If after six months there is no improvement, then it is recognized as ineffective, and againraises the question of surgical intervention. If litholytic therapy was successful, then in order to detect newly formed stones in the gallbladder in time, ultrasound is done at least once every three months.
