Currently, up to 90% of all surgical interventions are performed using the laparoscopic method. This is due to the fact that this method is less traumatic and safer. Gallbladder surgery is no exception. After laparoscopy, the risk of complications is minimal. In addition, the recovery period is shorter compared to traditional surgery. According to reviews, laparoscopy of the gallbladder is well tolerated by most patients. In addition, you can start your daily activities after a few days.
Description of the method, its advantages
The term "laparoscopy of the gallbladder" means a surgical intervention, during which the doctor completely excises the affected organ or removes stones from it. A distinctive feature of the method is the type of access that is provided during the operation. It is done using a laparoscope, a special medical instrument.
Standard gallbladder surgery involves cutting soft tissues. Thanks to this, the doctor can visualize the organ and perform manipulations with the help of instruments. After the operation is completed, the specialist sutures the tissues. Subsequently, a visible scar will form at the site of the incision, which can only be removed with the help of cosmetic procedures, such as laser resurfacing.
Laparoscopy, on the other hand, implies access in the form of 3 punctures, the diameter of which does not exceed 2 cm. The surgeon places a video camera equipped with a light device and trocars (in other words, manipulators) into them. The image from the instruments hits the screen, thanks to which the doctor can visualize the internal organs and perform the operation. Thus, with this type of intervention, the specialist controls the process using a video camera, and not through an incision.
During the operation, the surgeon can remove the entire organ or remove stones from it. According to medical reviews, laparoscopy of gallbladder stones is now being performed less and less. This is due to the fact that in the presence of a large number of calculi, it is necessary to remove the entire organ, and if left, it will become a source of development of inflammatory processes in other organs. In the presence of single formations, doctors prefer another method of their removal - lithotripsy.
However, according to reviews, during laparoscopy, gallstonessubsequently formed rarely, that is, the risk of recurrence is minimized. But at the same time, the inflammatory process can affect other organs. In other words, based on medical reviews, gallstones can be removed during surgery (laparoscopy). But it is preferable to cut the organ completely.
Indications
The gallbladder, which is part of the biliary system, is considered an important organ. It is a reservoir for secretion produced by the liver. In addition, bile is brought to the required concentration in its cavity. After that, the hepatic secret enters the intestine when it enters the last food. It is bile that stimulates the pancreas, breaks down heavy fats and fights bacteria.
However, in the presence of serious diseases of the organ, its removal is indicated. Excision of the gallbladder is carried out in the presence of the following pathologies:
- Choledocholithiasis.
- Acute cholecystitis.
- Severe gallstone disease.
- Chronic cholecystitis of calculous form.
- Pancreatitis.
In addition, according to medical reviews, laparoscopy (an operation to remove the gallbladder) is performed if there are contraindications to traditional surgical intervention. In some cases, it is necessary in the development of other pathologies, the course of which is associated with a high risk of complications.
Contraindications
Like any other operation, laparoscopy has a number of limitations. It is not carried outin the presence of the following pathological conditions:
- Abscess in the gallbladder area.
- Severe diseases of the respiratory and cardiovascular systems at the stage of decompensation.
- Mechanical jaundice.
- Anatomically incorrect location of the internal organs, including the intrahepatic location of the bubble.
- Malignant neoplasms in the organ.
- Significant scarring in soft tissues.
- Disorders of the blood coagulation process.
- Fistula between intestines and bile ducts.
- "Porcelain" cholecystitis.
In addition, according to medical reviews, removal of the gallbladder by laparoscopy is not performed in women in the third trimester of pregnancy and in people who have undergone traditional abdominal surgery in the past. The presence of a pacemaker is also a contraindication.
Preparation
Approximately 2 weeks before the planned operation, the patient needs to undergo a comprehensive examination. According to reviews, preparing for laparoscopy of the gallbladder does not take much time.
The patient needs to undergo the following examinations:
- Blood and urine test (clinical).
- Coagulogram.
- Biochemical blood test. The most important for the doctor are indicators of total protein, bilirubin, alkaline phosphatase and glucose.
- Analysis for determining the blood type and Rh factor.
- Electrocardiogram.
- Blood test forexclusion of hepatitis B and C, syphilis and HIV infection.
- Women additionally need to take a smear from the vagina for flora.
A patient is allowed to undergo surgery only if the results of his tests are within the normal range. If they deviate up or down, appropriate treatment is indicated. In this case, the operation is postponed until the normalization of the indicators. Reviews of laparoscopy of the gallbladder in most cases are positive due to the fact that doctors timely identify contraindications, which reduces the risk of undesirable consequences of the intervention to a minimum.
In the presence of pathologies of a chronic nature, consultations of specialized specialists are required. Each of them must draw up a treatment regimen in such a way that by the time the operation is performed, inflammatory processes are stopped, foci of pathologies are sanitized, etc.
Immediately before the laparoscopy (the night before), the last meal should take place before 18.00. It is allowed to drink clean still water until 22.00. After that, it is forbidden to consume any food and liquids.
A cleansing enema should be given the day before surgery. This is necessary for a complete bowel cleansing before the intervention. In addition, an enema must be given a few hours before the removal of the organ.
Judging by medical reviews, the operation (laparoscopy of the gallbladder) does not require specific preparatory measures. However, if the treating specialist has additional recommendations, you need to listen to them.
Algorithm for the operation
Resection of the gallbladder by laparoscopic method is performed under general anesthesia. This is due to the need to reduce the sensitivity of soft tissues, stop pain and relax the muscles of the abdominal cavity. With the introduction of local anesthesia, it is impossible to achieve all of the above conditions at once.
Then the doctor proceeds directly to the operation. Laparoscopy algorithm:
- The anesthetist inserts a tube into the stomach. This is necessary in order to remove accumulated fluid and gases from the body. Thanks to these manipulations, the risk of vomiting and inhalation of the contents of the stomach with the subsequent development of asphyxia disappears. The tube remains in the stomach during the operation.
- The patient is connected to the artificial lung ventilation system, covering his mouth and nose with a mask. Throughout the operation, the respiratory function will be maintained with the help of the device. Artificial ventilation of the lungs is a must. This is due to the fact that the gas, which is injected into the abdominal cavity during laparoscopy, strongly presses on the diaphragm. She, in turn, compresses the lungs. As a result, the person cannot breathe on their own.
- In the crease of the navel, the surgeon makes a small semicircular incision. In order to enlarge the abdominal cavity and straighten the internal organs, the specialist injects sterile gas (most often carbon dioxide) inside. Through the incision made, the doctor introduces a trocar equipped withflashlight and video camera. Due to the presence of gas in the abdominal cavity, the surgeon is able to freely operate the trocar without touching or injuring nearby organs.
- The doctor makes 2 more incisions along the line of the right hypochondrium. Through them, manipulators are introduced, with the help of which the gallbladder will be removed.
- After inserting the instruments into the body, the surgeon evaluates the appearance and location of the gallbladder. It happens that against the background of an inflammatory process of a chronic nature, the organ is blocked by adhesions. If the latter are found, they are initially dissected.
- The doctor evaluates the degree of fullness and tension of the bladder. If these indicators are pronounced, the surgeon makes an incision in the wall of the organ and, using a probe, sucks out a small amount of accumulated fluid.
- The doctor puts a clamp on the gallbladder. After that, he allocates choledochus from the soft tissues. Then the last one is cut. After that, the doctor selects the cystic artery from the tissues and heals it. The surgeon makes an incision between them. He then stitches the vascular lumen.
- After the organ is freed from the choledochus and cystic artery, the doctor removes it from the hepatic bed. This process is very slow. At the same time, cauterization of bleeding vessels is performed. When the bubble is completely separated, it is removed through a puncture made in the navel.
- The doctor examines the abdominal cavity in order to detect bleeding vessels, liver secretions and other pathologically altered tissues. The latter, when discoveredare removed. Vessels coagulate.
- The doctor injects an antiseptic into the abdominal cavity and rinses the operated area. After completion of this manipulation, the liquid is pumped out.
At this stage, the laparoscopic operation is considered completed. The doctor removes the trocar and manipulators, then sutures the incisions or simply seals them with a regular plaster. In some cases, one puncture remains open. A drainage tube is inserted into it. It is necessary in order to remove the remnants of the antiseptic solution from the abdominal cavity.
According to medical reviews, laparoscopy of the gallbladder is an operation that has already become routine. However, in some cases, it happens that with the help of tools it is not possible to dissect strong adhesions and remove the organ. In such situations, the trocar and manipulators are removed, and the doctor proceeds to traditional open surgery.
According to reviews, removal of the gallbladder by laparoscopy does not take much time. As a rule, the duration of the operation is, on average, 1 hour.
The algorithm for removing calculi from an organ is similar to that described above. The patient is injected with an anesthetic, fluid and accumulated gases are pumped out of his stomach, and the patient himself is connected to a ventilator. After that, a trocar and manipulators are inserted into the pre-made incisions in the abdominal cavity.
When adhesions are detected, the latter are dissected. The doctor then cuts the wall of the gallbladder. After that, a special suction is introduced into the organ, extractingstones. Then the wall of the gallbladder is sutured, the abdominal cavity is treated with an antiseptic. The final step is to remove the instruments and suture the incisions. If there are any complications, the doctor has the right to remove the laparoscope and manipulators and proceed with the traditional surgical intervention. The patient is also informed in advance of a possible change in technique.
Features of the postoperative period
Based on the feedback, laparoscopy of the gallbladder has become a familiar and frequently practiced type of surgical intervention. However, even after the simplest operation, the patient needs some time to recover. During this period, it is necessary to strictly follow all the doctor's instructions in order to prevent the development of complications.
Immediately after the completion of the operation, the anesthesiologist closes the access to the human body of the gas mixture. For the next 4-6 hours, the patient must strictly observe bed rest. After the specified time, it is allowed to sit down, roll over in bed, get up and walk. Eating is still prohibited. It is only allowed to drink pure non-carbonated water.
Judging by medical reviews, after laparoscopy of the gallbladder, patients feel hungry only a day later. On the second day after the operation, it is allowed to eat soft food, giving preference to broths, yogurts, fruits. In this case, portions should be small. Also on the second day you need to drink plenty of water. On the third day it is allowed to return tohabitual diet, excluding from it only foods that increase gas formation.
According to reviews, pain after laparoscopy of the gallbladder is not uncommon. The presence of discomfort in the first 2 days is the norm. Pain can be localized in the puncture zone, above the collarbone, and also in the right hypochondrium. After 2 days, the intensity of sensations begins to decrease, then they disappear altogether. If the pain persists for 4 or more days, you should immediately inform your doctor about it, as in this case it may be a sign of the development of complications.
Judging by the reviews, after the removal of the gallbladder by laparoscopy, you can begin to perform your usual activities in full in 7-10 days. Until this time, it is necessary to wear soft underwear that does not irritate the wounds, and exclude physical activity. On the 7th or 10th day, you must come to a medical facility where the doctor will remove the stitches from the punctures.
According to reviews, after surgery (gall bladder laparoscopy), the patient is discharged after 3-7 days. If necessary, he is issued a sick leave, the duration of which is up to 19 days.
Complete recovery of the body occurs in 5-6 months. During this period, he manages to fill his own mental and physical reserves. It is not recommended to have sexual intercourse in the first month after the operation. At the same time, it is not recommended to expose the body to physical activity.
Features of food
Based on medical reviews, diet after removalgallbladder laparoscopy - a key point. Diet adjustment is necessary in order to ensure the normal functioning of the liver. Diets should be followed in the first 2 years after gallbladder removal.
You need to eat 5-6 times a day. At the same time, the size of one serving should not exceed 200 g. Dishes should be stewed, boiled or steamed. Eating too hot or cold food is prohibited.
It is necessary to exclude from the diet:
- high-fat foods;
- canned food;
- smoked meats;
- pickles;
- offal;
- mushrooms;
- raw vegetables;
- peas;
- fresh bread;
- confectionery;
- chocolate;
- alcoholic beverages;
- coffee;
- cocoa.
The menu must be present:
- lean meat and fish;
- porridge;
- soups with weak broth;
- vegetables (stewed or steamed);
- lactic acid products;
- fruits and berries;
- bread (yesterday);
- med.
You can fill dishes with both butter and vegetable oil. After 2 years, the diet should be gradually expanded, returning to the old gastronomic habits. Judging by the reviews, laparoscopy of the gallbladder is an operation that is easy to transfer. But it takes a lot of willpower to stay on a diet for such a long time.
Possible consequences
Reviews on the removal of the gallbladderlaparoscopy in most cases are positive. However, against the background of the release of bile into the duodenum of a person, pain, nausea, heartburn, flatulence and diarrhea can periodically disturb throughout life.
If these unpleasant symptoms occur frequently, it is necessary to strictly follow the postoperative diet. Severe pain can be stopped by taking any antispasmodic, for example, "No-shpu". Nausea disappears with the use of alkaline mineral water ("Borjomi").
Reviews
Laparoscopy of the gallbladder in St. Petersburg, Moscow and any other city can be done both in a public and private medical institution. In the first case, you will need a medical insurance policy.
Judging by the reviews, most patients tolerate the operation well. After a few days, they can start their daily activities. Subject to all doctor's prescriptions, general well-being is not disturbed, complications do not develop.
In conclusion
The term "laparoscopy of the gallbladder" in surgery refers to the removal of the entire organ or stones accumulated in it. The operation requires careful preparation. In the absence of contraindications, the patient is removed the organ. At the same time, strict bed rest must be observed only for the first few hours after the operation. In the absence of complications, a person is discharged after 3-7 days.
