The main indications for the removal of the gallbladder. Cholecystectomy (surgical removal of the gallbladder): indications, methods, rehabilitation

On the first day after surgical intervention patients are more likely to be in intensive care or in the intensive care unit. During these hours, the patient recovers consciousness after anesthesia, intensive intravenous drip treatment with anti-inflammatory drugs and antibiotics is carried out.

The first feeding of the patient is carried out approximately one day after the operation, but not later. If the patient is in serious condition, feeding is carried out through a tube (a special tube that descends through the esophagus into the stomach). Such patients need light food, rich in vitamins and proteins, children's food is ideal. milk nutrition. Formulas for children are nutritious and contain useful material that the body needs after surgery.

In cases where the patient can eat on his own, his diet consists of easily digestible food. It is recommended to drink warm broths, as they are rich in proteins, from which the body receives amino acids - a building material for cell regeneration. The patient's diet includes cereal porridges boiled in water. They are rich in minerals and vitamins, and also contain fiber, which promotes peristaltic bowel movements.

Doctors in advice regarding the nutrition of postoperative patients, focus on food containing fiber, which promotes peristalsis. The more active the intestinal motility, the greater the blood flow and the faster the inflammatory processes stop. But at the same time, on the first day, you can not eat fresh vegetables and fruits, but only steamed or boiled. Fresh fruits cause bloating, which increases inflammation in the intestines. abdominal cavity and promotes the formation of adhesive processes.

On the first day, it is strictly forbidden to use foods that provoke flatulence - brown bread, milk, sparkling water, etc.

Late postoperative period

A few days after the operation, the patient's diet expands. It is recommended to use low-fat varieties of meat and fish - beef, rabbit meat, pike perch, hake, pollock, etc. All dishes must be steamed or boiled, it is strictly forbidden to eat fried foods, as well as canned food. Fish and meat are rich in proteins, which form connective tissue during wound healing, as well as B vitamins and some minerals.

To saturate the body with vitamins, patients are recommended dried fruit compote, rosehip broth, etc. In the diet, it is necessary to focus on greens and vegetables, because. they are rich in minerals, fiber, and some, such as cranberries, parsley, prunes, also contain anti-inflammatory substances.

In the postoperative diet, it is recommended to limit the consumption of sugary foods, because. elevated glucose levels slow down recovery processes. If the operation was performed on the pancreas, such products are usually excluded for life.

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Fundamentals of recovery after cholecystectomy

Rehabilitation of patients after removal of the gallbladder does not require numerous therapeutic measures. Its basis is scrupulous adherence to the doctor's recommendations. Full recovery provides a set of measures, including:

medical procedures;
regime moments and dosing loads;
correction of eating habits.
The rehabilitation process itself can be primary, post-hospital and remote.

early recovery

Primary rehabilitation after removal of the organ takes place in a hospital. Here its foundations are laid, the patient is informed about the measures that must be taken after the operation.

Depending on the type of operation and the dynamics of recovery, the hospital period lasts from 2 to 7 days.

The bladder removal operation is carried out by traditional and laparoscopic methods. With a planned surgical intervention, preference is given to the second. Abdominal surgery is performed in emergency, life threatening complicated cases or if during laparoscopy, previously undetected complications are detected.

The postoperative period after removal of the gallbladder by a less invasive method of laparoscopy demonstrates the advantages of this type of intervention:

intensive care takes a minimum of time (up to 2 hours);
a small surface of wounds heals well;
prolonged bed rest is not required after removal of the organ;
a small percentage of complications from the digestive tract;
the stationary recovery period is significantly reduced;
the patient's return to active life occurs quite quickly.

Events in the hospital

Stationary monitoring involves 3 phases: intensive therapy, general regimen, discharge for outpatient treatment.

Intensive therapy

Immediately after the operation to remove the bladder, the patient is observed until complete recovery from anesthesia, on average, 2 hours. At the same time, the final stage antibiotic therapy(introduction of antibiotics), examination of wound surfaces or applied bandages to identify excessive secretions. If the temperature and stitches are normal, the patient is adequate, can talk about his state of health and describe the sensations, then the intensive period is over, the patient is transferred to the general mode.

General Mode

The main goal of recovery after removal of the gallbladder in the hospital is as soon as possible and complete inclusion of the operated biliary tract in the digestive system. This prevents the formation of adhesions in the abdominal cavity and inside the ducts. To achieve this goal, the filling of the stomach emptied before the operation and motor activity are required. Therefore, with an uncomplicated postoperative period, bed rest is canceled after a few hours.

On the first day after the gallbladder removal surgery, it is recommended to drink water in small portions. This not only "turns on" digestion, but also promotes the removal of anesthetic drugs from the body, provides the beginning of recovery. On the second day, fractional nutrition in liquid form is added.

On the same day, the drainage tube is removed, which removes fluid from the abdominal cavity, because. by this time the problem with drainage is usually solved.

By the end of the first day, it is recommended to get out of bed. For the first time, the patient gets up under the supervision of health workers, because. sudden movements can lead to fainting. With absence side effects the patient moves further independently.

Daily during recovery in the hospital, the sutures are examined and processed.

Extract

The condition after uncomplicated removal does not require constant monitoring by a doctor, therefore, with normal recovery rates, the patient is transferred to outpatient monitoring. In his hands he receives a sick leave (if required), an extract with data on the size of the intervention (for the local surgeon) and written recommendations for recovery.

outpatient period

After discharge, you must register with the surgeon at the place of residence. It is he who monitors the rehabilitation process, removes postoperative sutures, corrects medical appointments. This period can last from 2 weeks to 1 month.

Important! Visits to the doctor are mandatory not only for those who need to close the sick leave: at this postoperative moment, small, but significant complications for later life are very likely. Their timely detection and prevention of consequences can only be done by a specialist.

Lifestyle changes

The most important thing in rehabilitation after removal of an organ is the correct actions of the patient. No doctor guarantees a favorable outcome if the patient does not fulfill all the requirements of this recovery period.

Diet and catering

The production of bile by the liver is restored in the hospital. But since the situation when an excessive portion of it is not excreted, but stagnates in the ducts, is extremely undesirable, it is required to ensure its unhindered movement. This is achieved:

meals - each serving stimulates the movement of bile from the liver to the intestines;
physical activity - the necessary peristalsis of the ducts and intestines is provided;
elimination of spasms and expansion of the lumen of the biliary tract - this is facilitated by antispasmodic drugs prescribed by a doctor;
elimination of mechanical obstacles - you can not sit for a long time, especially after eating, wear tight clothes in the waist and abdomen.

Nutrition Features

Proper nutrition is one of key points rehabilitation after cholecystectomy. Quality, quantity of bile, its inclusion in general exchange directly depends on the regularity of the intake and the composition of the food.

Eating mode

The basic rule of nutrition after removal of the gallbladder is fragmentation and regularity. The daily volume of products is divided into 5 - 6 doses. You need to eat every 3-3.5 hours. Perhaps, for this you will have to change the daily routine, and make adjustments to the organization of work.

Important! It is required to reduce the size of the usual portions: if you keep the volume of one-time food intake as with three or four meals a day, then weight gain is almost inevitable.

Quality composition of food

do not include fried and smoked in the diet;
limit the intake of animal fats, sweets, pastries, spicy and salty foods;
prefer natural products to canned ones;
exclude alcohol, strong tea and coffee;
do not reheat dishes, but cook immediately before use.

Special conditions

Immediately after discharge, during the first month, puree-like food is prepared. Expand the diet gradually, no more than 1 product for each meal (to identify the causes of complications, if any). Vegetables and fruits are subjected to heat treatment - stew or bake.

From the second month to six months of recovery after the operation, they gradually switch to chopped food, with time the size of the pieces increases. Vegetables and fruits are taken fresh.

From the second half of the year of rehabilitation, the composition of the products becomes complete.

Important! The principles of healthy eating during this period are observed in most cases - exceptions, although possible with good health, should not become the norm.

Possible digestive problems

In the first days and weeks after the operation, there are troubles with bowel movements. Most often, convalescents are concerned about constipation. Quite understandable from the point of view of physiology, the situation does not add optimism. Recommended:

increase the amount of vegetables in the diet;
regularly consume fresh dairy products;
dose physical activity- its excessive increase or decrease can cause constipation;
on the recommendation of a doctor, take a laxative that does not reduce peristalsis in the future;
do not abuse enemas - in addition to overstretching the large intestine, this can cause depletion of the microflora, which is already unstable in the early stages of rehabilitation.

Another nuisance is diarrhea or frequent loose stools, diarrhea. In this case, you should:

return to the heat treatment of vegetables and fruits (but do not exclude them from the diet);
eat porridge regularly;
consult a doctor about the possibility of taking special supplements (lactobacilli, bifidumbacterin, etc.), which inseminate the intestines with beneficial microorganisms.

At first, other dyspeptic disorders are possible: belching, heartburn, bitterness in the mouth, nausea. If observation by a doctor does not reveal concomitant diseases of the digestive system, then these phenomena are temporary. Usually, each person understands which product caused this or that undesirable reaction of the body, and draws conclusions about the advisability of using it.

Physical activity

Neglect of physical activity can negate all measures to achieve a high quality of life after gallbladder surgery. A sedentary lifestyle is the cause of many troubles, including those associated with the movement of bile.

From the first days after the operation, the body is given a feasible load.

Regular (or better daily) should be hiking. Their duration and intensity increase gradually, you can add jogging over time. But intensive running is not recommended.

Swimming is very helpful. This is the most gentle way to activate muscles and metabolic processes.

Weightlifting, traumatic sports (wrestling, boxing, team contact games), rowing are contraindicated after removal of the gallbladder.

Results

In the vast majority of cases, compliance with these simple rules ensures successful rehabilitation after surgery to remove the gallbladder. Do not forget about scheduled examinations by a doctor, as well as the need for a consultation in case of new symptoms, if your health changes for the worse.

Approximately 1 year after removal, the body gets used to a new way of life, learns to secrete the bile secretion of the desired composition and density, the digestion process stabilizes. A patient who has undergone a successful operation and no less successful rehabilitation ceases to be a convalescent patient, and moves into the category of practically healthy people. This prospect is all the more likely, the more carefully the recommendations of doctors are followed at the initial stages.

Video: Happy life without a gallbladder

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Types of operations and features of training

Surgery to remove the gallbladder is called a cholecystectomy. There are such types of it:

open cavity; indications for such an operation are:

large stones in the bladder;
organ infection;
bladder gangrene;
intestinal obstruction.

Laparoscopic: small incisions are made on the abdominal wall, through which the doctor inserts instruments and a laparoscope - a mini-device equipped with a camera that allows you to monitor the operation. Indications for laparoscopic surgery:

acute (chronic) calculous cholecystitis;
bladder cholesterosis;
polyposis.

To determine the optimal way to remove the affected organ, the patient must undergo the following diagnostic procedures:

ultrasound examination of the digestive tract;
computed tomography of the abdominal organs;
electrocardiography;
blood chemistry.

Preoperative diagnostics is necessary to prevent negative consequences that can be provoked by an incorrectly selected tactic of gallbladder removal.

All types of surgery require prior hospitalization. In the last few days before surgery, a person should take laxatives prescribed by a doctor, since the operation requires a clean bowel. On the day of the operation, you can not eat or drink. If the patient is taking any drugs to regulate blood clotting, this should be notified to the doctor. You also need to provide information about taking other medications.

Execution technique

Features of the operation depend on the chosen method of its implementation. Open cholecystectomy consists of the following steps:

The patient is put into a state of narcotic sleep.
The skin of the abdomen is treated with an antiseptic, after which a long incision is made on it from the navel to the sternum.
The gallbladder is separated from fat and adhesions, after which the surgeon bandages the organ with a thread.
On the bile ducts and bladder vessels are attached with surgical clips.
The surgeon separates the bladder from the liver, and then proceeds to remove it.
Provides stopping bleeding from the hepatic vessels. For this, a laser and ultrasound are used.
The incision on the peritoneum is sutured with surgical threads.

The operation takes up to 1.5 hours. In the first days after surgery, a person is shown painkillers and antibiotics, as well as enzymes to normalize the functions of the gastrointestinal tract. normal operation The gastrointestinal tract is also provided with the help of diet No. 5, however, in the first 2 days after the intervention, a person can only drink water and sweet tea. The sutures are removed approximately on the 6-8th day.

Patients who have undergone abdominal surgery to remove the gallbladder are discharged no earlier than 10 days later, but full recovery occurs only after 1-2 months. A person should observe a sparing regimen. It is forbidden to lift weights over 4 kilograms.

After open cholecystectomy, the following complications may occur:

damage to the common bile duct;
sepsis;
leakage of bile from the liver;
damage to the vessels of the liver;
outflow of bile from the biliary tract;
bleeding from the site of the incision of the peritoneum.

Laparoscopic organ removal also requires general anesthesia. The progress of laparoscopy is as follows:

The skin of the abdomen is disinfected, after which 3-4 incisions are made around the navel with trocars: 2 by 1 cm, 2 by 0.5 cm.
A camera connected to the laparoscope is inserted through the tube of the device. This method allows you to visually monitor the process of organ removal.
Through other incisions, the surgeon inserts scissors, clamps and a device for applying titanium clips.
Clips are applied to the vessels and the common bile duct.
The bubble is detached from the liver, after which it is removed from the peritoneum. If there are stones in the bladder, they are removed first of all.
The surgeon proceeds to perform procedures to stop bleeding from the liver.
Incisions up to 1 cm are sutured with dissolving threads.
Incisions up to 0.5 cm are sealed with a surgical plaster.

Laparoscopic intervention is prohibited for patients who have:

irregular structure of the ducts;
diseases of the lungs and heart;
severe flatulence;
adhesions;
acute inflammation of the walls of the bladder.

Laparoscopic surgery has the following advantages:

minimal trauma to the patient;
no scars after surgery;
low risk of infection;
minor blood loss.

The recovery period after laparoscopic surgery lasts no more than 1 week. After laparoscopic surgery, a person is recommended diet No. 5 and a sparing regimen.

Treatment after bladder removal

In most cases, the absence of this organ does not affect the quality of human life. But every patient who underwent removal of the gallbladder should remember that after the operation, the amount of enzymes that break down fat decreases. Therefore, a person should limit the consumption of animal fat and trans fats as much as possible, which are contained in such products:

muffin;
offal;
onion, garlic, radish, horseradish;
fried meat, fish and other dishes;
mushrooms;
fat;
margarine;
fatty dairy products;
cakes, pastries with cream, ice cream.

You should also refrain from drinking alcohol and spicy foods. The diet should include:

lean meat and fish, as well as steam meatballs and meatballs;
boiled fish;
low-fat dairy products;
cereals;
soups with vegetable broth;
vegetables, berries and fruits;
marmalade, jam, jelly;
toasted bread and biscuits.

Eat should be fractional, avoiding overeating. It is necessary to eat at the same time, and prolonged hunger is not allowed. Cold food should not be consumed, as it provokes a spasm of the bile ducts. The diet after removal of the bladder is observed for life. In addition to a special diet, the patient is prescribed probiotics, hepatoprotectors, choleretic and enzyme preparations. Medications are selected by the doctor and taken by the patient according to the scheme prescribed by him.

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How to perform an operation to remove the gallbladder

There are two methods of removing the gallbladder:

Open cholecystectomy is a traditionally performed operation to remove the gallbladder through a wide incision in the right hypochondrium. The technique of its implementation has been worked out for a long time and in all details, and every self-respecting surgeon knows it thoroughly.
Laparoscopy of the gallbladder is a sparing operation technology that is gaining popularity, based on the achievements of modern television and other technology.

Ideally, these technologies should complement each other, not compete, but, unfortunately, this phenomenon does occur.

Laparoscopy of the gallbladder

Laparoscopic cholecystectomy involves surgical intervention through narrow channels in the abdominal wall (0.5-1 cm) using a telescopic device equipped with a video camera, light and other devices - a laparoscope, as well as a number of special tools.

Gone are the days when laparoscopic techniques had to prove their superiority over traditional open cholecystectomy. Laparoscopy has successfully won back its well-deserved place in abdominal surgery, the critical attitude towards it has remained the lot of inveterate retrogrades.

The advantages of laparoscopic gallbladder removal are obvious and undeniable:

The most important advantage of the method, which is less emphasized, is the closed and apodactyl method of operation, when contact with the operated tissues is carried out exclusively with the help of instruments, which significantly reduces the risk of infectious complications.
Minor injury surgical intervention.
Short-term hospitalization - 1-2 days, in some cases outpatient operations are also possible.
Very small incisions (0.5-1 cm) guarantee an excellent cosmetic result.
Rapid recovery of working capacity - within 20 days.
One more thing should be noted positive quality methods - for patients with indications for surgery, it is easier to decide on laparoscopic intervention, which reduces the number of neglected cases.

Disadvantages of laparoscopic cholecystectomy

The laparoscopic technique, along with indisputable advantages, also has specific disadvantages, which in some cases force it to be abandoned in favor of open operation.

To ensure the working space and sufficient visibility during laparoscopy, carbon dioxide is introduced into the abdominal cavity under a certain pressure. Increased pressure in the venous system for this reason great circle blood circulation (the so-called central venous pressure), as well as pressure on the diaphragm, worsen the conditions for cardiac activity and respiration. This negative effect is significant only in the presence of serious problems with the cardiovascular and respiratory systems.

Laparoscopic technology significantly limits the possibilities of intraoperative (performed during the operation) diagnostics in comparison with open surgery, which provides the surgeon with the opportunity to “feel everything with his hands”.

Laparoscopy is not applicable in unclear cases, when it may be necessary to change the operation plan in the course of its implementation, depending on the identified pathological changes.

The last two circumstances require the surgeon to have a different philosophy of preparation for the operation. The most thorough preoperative examination and the resolute rejection of the tactics of some old surgeons: "we cut it - we'll see" allows to avoid embarrassment.

Contraindications for laparoscopy of the gallbladder

Contraindications to laparoscopic removal of the gallbladder are determined by the above features of laparoscopy:

Severe general condition.
Diseases that occur with severe heart and respiratory failure.
Tumor nature of the disease.
Obstructive jaundice (jaundice that has developed as a result of a mechanical obstruction to the outflow of bile in the extrahepatic ducts: stone, cicatricial narrowing, tumor, etc.).
Increased bleeding.
Expressed adhesive process in the upper abdomen.
Calcification of the walls of the gallbladder, or the so-called. "porcelain" gallbladder. In this condition of the bladder, it can prematurely collapse in the abdominal cavity.
Late pregnancy.
Presence of acute pancreatitis.
Peritonitis is a diffuse inflammation of the abdominal cavity.

It should be said that the development of laparoscopic techniques and the growing experience of surgeons are steadily narrowing the range of contraindications. So, until recently, acute cholecystitis and the presence of stones in the bile ducts were considered absolute contraindications to laparoscopic removal of the gallbladder. Now these contraindications have been successfully overcome.

Preoperative examination

Preoperative examination, in order to avoid unforeseen difficulties, often forcing to complete the started laparoscopy with an open operation through a large incision, should be thoughtful and comprehensive:

A high-quality and comprehensive examination preceding laparoscopy of the gallbladder makes it possible to foresee possible difficulties and make a decision in time about the method, volume, and, finally, the very expediency of surgical intervention.

Preparation for laparoscopy of the gallbladder

Like any abdominal surgery, laparoscopy of the gallbladder requires some preparation:

a week before surgery, in agreement with the attending physician, it is necessary to stop drugs that reduce blood clotting (anticoagulants, non-steroidal anti-inflammatory drugs, vitamin E)
on the day before surgery, eat only light meals
after midnight before the operation, you can not eat or drink anything
to cleanse the intestines the night before and in the morning, take as prescribed by the attending surgeon special preparations, or produce cleansing enemas
take a shower in the morning before surgery, preferably with antibacterial soap

Open cholecystectomy

Open cholecystectomy, or removal of the gallbladder traditional way through a wide cut, should not be considered a relic of the past. Despite the expansion of the possibilities of laparoscopy of the gallbladder, open cholecystectomy remains relevant. It is indicated in the presence of specific contraindications to laparoscopy.

Open cholecystectomy has to complete 3-5% of laparoscopic operations when unforeseen difficulties appear.

A significant number of open cholecystectomies continue to be performed due to lack of real opportunity spend laparoscopic removal gallbladder: lack of necessary equipment in a particular hospital, an experienced laparoscopist, etc.

And finally, the prejudice of some surgeons regarding laparoscopy also contributes.

So which is better: laparoscopy or open surgery?

	laparoscopy of the gallbladder	open removal of the gallbladder
testimony	▪ cholelithiasis	▪ acute and chronic cholecystitis ▪ cholelithiasis ▪ diseases of a tumor nature, etc.
contraindications	has contraindications	no contraindications for vital indications
preparation for surgery		normal for abdominal operations
operation duration	30-80 minutes	30-80 minutes
equipment requirements	Laparoscopic equipment required	conventional surgical instruments required
requirements for the qualification of a surgeon	+++	++
anesthesia	anesthesia	anesthesia
number and length of cuts	3-4 cuts 0.5-1 cm long	one incision 15-20 cm long
% complications	1-5%	1-5%
pain after operation	+	+++
seams	do not take off	removed for 6-7 days
development of postoperative hernias	—	++
cosmetic defect	—	++
food after surgery	on the 1st day you can eat and drink	on the 1st day you can drink, from the 2nd day you can eat
movement after surgery	on the 1st day you can sit up in bed, on the 2nd you can get up and walk	3-4 days you can get up and walk
length of hospital stay	1-2 days	10-14 days
disability	up to 20 days	up to two months
after 5 weeks	after 2-2.5 months
full recovery	3-4 months	3.5-4.5 months

If a stone is in the common bile duct

It is not uncommon for gallstones to migrate from the gallbladder into the common bile duct. When a stone gets stuck in the common bile duct, a complete or partial violation of the outflow of bile from the liver to the intestine is possible, which is the cause of obstructive jaundice. There is also an asymptomatic stay of a stone in the duct.

Ideally, this should be known in advance. However, cases of undiagnosed stones in the duct were and are still taking place. Naturally, the operation does not bring the expected result, and only after an additional examination is the true cause of the failure revealed. Such cases, of course, do not benefit the reputation of the surgeon, and therefore a good practice in gallbladder surgery is to check the patency of the common bile duct during cholecystectomy - intraoperative cholangiography. Such a check is performed by introducing a radiopaque substance into the bile ducts, followed by x-rays. Cholangiography is practiced both during open and laparoscopic cholecystectomy.

Until recently, a stone in the common bile duct, or even such a suspicion, was an absolute contraindication to laparoscopic removal of the gallbladder. Now, thanks to the improvement of laparoscopic techniques, surgeons are increasingly deciding to operate on such patients through a laparoscope.

Postcholecystectomy syndrome

Postcholecystectomy syndrome is a syndrome that develops after removal of the gallbladder. AT medical science There is no single interpretation of this concept.

talking plain language, postcholecystectomy syndrome combines those cases when, after removal of the gallbladder, it did not get better, or it became even worse. According to various estimates, the incidence of postcholecystectomy syndrome reaches 20-50%. The reasons for such situations are varied:

Undiagnosed diseases of the hepatopancreatic zone ( chronic pancreatitis, cholangitis, stones and cicatricial narrowing of the common bile duct, tumors, etc.), gastric ulcer and duodenal ulcer, reflux esophagitis, diaphragmatic hernia, the manifestations of which were mistaken for chronic cholecystitis.
Errors in the operation, when too long a remnant of the cystic bile duct or even a part of the gallbladder is left, in which the inflammatory process finds shelter and even new stones form. There are also damage to the bile ducts, which leads to their cicatricial narrowing.

The best way to avoid the development of postcholecystectomy syndrome is the most thorough preoperative examination of not only the gallbladder, but also other abdominal organs, as well as full confidence in the expediency of cholecystectomy and in the ability of the surgeon to do it.

Diet after gallbladder removal

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rehabilitation period

The length of recovery directly depends on the method by which cholecystectomy was performed - an operation to remove the gallbladder. There are two main types of such manipulations:

Hollow removal. It is carried out extremely rarely in cases where the use of laparoscopy for some reason is impossible. During this removal, a large longitudinal incision is made. After completion, a suture is applied, which heals for several weeks or months. A large incision carries the risk of fistulas and adhesions. Women after abdominal cholecystectomy may have problems with the onset of pregnancy. recovery period in case cavity removal lasts up to 2 months.
Laparoscopy. Is less dangerous method therefore, for the removal of the gallbladder, it is prescribed in the vast majority of cases. Instead of extensive incisions, small punctures are made to insert instruments. These punctures heal very quickly, leaving no noticeable scars behind. After a few days, the patient can be discharged from the hospital, after which he can start working in the near future. Using the most modern equipment, laparoscopic cholecystectomy can be performed on an outpatient basis.

After surgery, digestion is restored: on the first day it is allowed to drink water, and the next day he is given a light breakfast.

Several days after surgery pain syndrome during breathing in the seam area and in the shoulder girdle is normal. But if there is too much pain that is difficult to endure, this should be reported to the doctor immediately, as this may be a sign of internal bleeding or other complications after surgery.

Late rehabilitation includes Spa treatment. Appoint him in six months or 8 months. During the sanatorium recovery apply:

warm mineral water without gas before meals in the prescribed volume;
mud therapy with radon, coniferous extract or minerals;
electrophoresis using succinic acid;
taking Riboxin or Mildronate.

After six months, most people who have had their gallbladder removed have a full recovery.

Dangerous manifestations

After the bladder is removed, bile begins to flow from the liver directly to the duodenum through the duct. This duct partially takes over the functions of the gallbladder, which is expressed in its expansion. In the normal state, its volume is 1.5 mm, and a year after the operation, it increases 10 times for a small reserve of bile. But this does not fully replace the presence of the gallbladder.

The bile secretion becomes more liquid, enters the intestines not as dosed as it should be in the norm, which affects the peristalsis of the gastrointestinal tract. Since the bubble performed a bactericidal function, dysbacteriosis is now more likely to develop.

Due to the increased load on the digestive system, the following symptoms may appear:

aching or sharp pain in the abdominal cavity, which can radiate to the back;
heaviness in the right hypochondrium;
skin itching;
bouts of nausea;
taste of bitterness;
diarrhea or constipation;
increased gas formation and bloating;
periodic hepatic colic;
yellowing of the skin.

Interruptions in the flow of bile secretion into the intestine cause a violation of the composition of the microflora. Breakdown, digestion and absorption of lipids deteriorates, which can give rise to intestinal inflammation.

The situation is worse if, in parallel, comorbidity digestive tract: ulcer, gastritis, pancreatitis, etc. In this case, digestive disorders will become more serious, and pain will intensify. With such a clinical picture, the patient, under the guidance of a gastroenterologist, is treated for concomitant pathology and corrects nutrition, as well as lifestyle.

Another cause of pain after cholecystectomy are stones in the bile ducts. Stone formation is of two types:

true - when stones are re-formed after the operation;
false - when the surgeon could not find the stones during the removal of the bladder, and they remained inside the ducts.

False stone formation is more common, and true stone formation rarely occurs, in cases where there are cicatricial formations in the ducts, where the bile secretion stagnates.

A serious complication after removal of the bladder is an inflammatory process in the ducts, which occurs due to a violation of the outflow and stagnation of the secret that comes out of the liver into the duodenum. This condition is accompanied by severe pain, sometimes with fever.

All these pathological processes need treatment that can relieve the patient of discomfort and restore normal digestion.

Medical therapy

After removal of the gallbladder, an individual selection is carried out medications. Pharmaceutical therapy aims to provide normal level movement of pancreatic juice and bile secretion into the intestine. If you establish this process, then the pain syndrome will disappear.

For this, the following groups of drugs are used:

Antispasmodics. For quick pain relief in this case, Nitroglycerin is prescribed, which allows you to stop the pain as soon as possible. But due to the expressed side effects on the cardiovascular system, it is not recommended to systematically apply it. In addition, it is addictive, which reduces its effectiveness.
Anticholinergists (anticholinergics). For these purposes, Buxopan or Metacin is prescribed. They also reduce spasms, but in some patients they cause unpleasant side effects, such as tachycardia, decreased visual acuity, difficulty urinating and dry mouth.
Myotropes. For some patients, myotropic antispasmodics are the most effective means. In some cases, they affect vascular tone, urination and the activity of the digestive system. Of the myotropes, Benziklan, No-shpu and Drotaverin are most often prescribed.
Hepatoprotectors. To protect against the destructive action of liver cells, the combined drug Gepabene is prescribed. It exhibits not only the action of a hepatoprotector, but also relieves spasms, and also activates bile secretion.
enzyme preparations. For better digestion of lipids, Pancitrate or Creon is prescribed. Sometimes they are combined with Festal or Panzinorm Forte.
Non-steroidal anti-inflammatory drugs. Recommended for pain relief. Diclofenac is commonly used for this purpose.
Antibiotics. In the case of a clear violation of the intestinal microflora and the development of pathogenic microbes, Intetrix, Doxycycline, etc. are used, after which the patient drinks pro- and prebiotics (Hilak, Linex, Bifidumbacterin).
Assign to prevent the destruction of the intestinal epithelium by bile (Almagel, Maalox).
Defoamers. With severe flatulence, Sineticon, Dimethicone are used.

Each of the groups of drugs is prescribed as needed, depending on the indications, for a short or longer period, which is determined by the attending physician.

Diet

Due to the decrease in the activity of enzymes in the intestine, the diet and diet after removal of the gallbladder should be adjusted. If a person has always eaten rationally, significant changes will not follow. Otherwise, you will have to get used to the new rules of nutrition:

For the first few months, preference should be given to steamed or boiled dishes. Ideally, they should be ground or whipped in a blender. Rich in fat, spicy and salty food, alcohol must be removed from the list of permitted products. Such measures will allow gastrointestinal tract get used to new conditions without additional burden.
Six months later, fresh vegetables and fruits are added to the menu. But you should avoid those that contain a lot of acids. You can also eat boiled meat and fish.
After a year, you can return to a normal diet. The only amendment is made for bacon, lamb fat and spicy: it is better to exclude such dishes forever.
Eat slowly and chew food thoroughly so that the liver has time to start secreting the necessary enzymes.
Eat often, but in small portions. This will avoid stagnation of bile and the threat of stones.
In order to avoid flatulence, you need to replace sweets with more healthy desserts: sweet berries or dried fruits, natural honey. This will not only get rid of increased gas formation, but will also have a mild bactericidal effect. Cloves and cinnamon have the same effect, so they can be safely added to dishes.

Along with fractional nutrition, the drinking regimen is no less important. To protect the intestines from aggressive acids, you need to drink a glass of water every 2 hours. A more accurate dosage is calculated as follows: 30 ml of water is drunk per 1 kg of weight. Such a measure will not only protect the intestines from aggressive juice, but also reduce the manifestations of flatulence.

Physiotherapy and exercise therapy

Physiotherapy complexes are successfully used to restore and prevent the formation of stones after surgery. The most effective technique- ozone therapy. The use of this natural antibiotic is considered a novelty, but its affordable cost and high performance contributed to the rapid spread of the method.

Ozone therapy is carried out by means of microclysters, the concentration and frequency of repetition of which is determined by the doctor. Ozone activates the body's defenses and restores the function of liver hepatocytes that form bile.

After the operation, you can take a course of physical therapy. It is usually prescribed 2-3 weeks after surgery. The gymnastic complex is developed and performed in a group under the guidance of a specialist.

Physical therapy exercises at first must be performed in a special bandage, especially for overweight people. The doctor will tell you when you can start exercising without a supporting bandage.

A month after the operation, you need to start daily walking, lasting for half an hour. This will allow you to gradually restore the abdominal muscles and will serve as a prevention of stagnation of bile.

Swimming also has a wonderful choleretic effect. You can sign up for the pool in six months. Water produces soft but effective massage deep layers of the abdominal muscles and smooth muscles of the internal organs.

However, it will be possible to return to serious loads and exercises for the abdominal muscles only after a year and a half.

From the foregoing, we can conclude that the quality of life after cholecystectomy does not deteriorate. But for this you need to follow all the recommendations of the doctor during the rehabilitation period, carefully monitor your health and adhere to necessary recommendations on nutrition.

In the video, doctors talk in detail about the lifestyle that patients should lead after gallbladder removal.

Medicines to dissolve gallstones Stones in the gallbladder what to do

Laparoscopic gallbladder removal surgery is well tolerated by patients. A minimum of complications and a short rehabilitation period are its main advantages.

Gallbladder disease is far from always amenable to conservative treatment, therefore, to alleviate the patient's condition, doctors offer surgery. Today, laparoscopy of the gallbladder is among the most commonly used methods of minimally invasive surgical treatment and examination. The operation is performed with minimal damage to the abdominal wall, but allows you to completely remove the diseased organ and stones accumulated in it.

Laparoscopic cholecystectomy is a gentle surgical procedure that is performed through miniature incisions with right side abdominal cavity.

The absence of a large wound surface area allows patients to be discharged from the hospital after 2-3 days. The recovery period lasts less than during the operation with a full opening of the abdominal wall - laparotomy.

There are 2 types of laparoscopic interventions for cholelithiasis. In the first case, a complete removal of the organ and neoplasms inside it is performed. In the second, with the help of a special tool, only stones are removed from the gallbladder, but the organ itself remains. This type of operation is considered ineffective today and is used much less frequently than removal of the gallbladder, since the risk of re-stone formation is high.

When comparing the approach of laparoscopic removal of the gallbladder with cholecystectomy, there are clear advantages to the newer surgical technique. Laparoscopic cholecystectomy is not accompanied by serious damage to the integrity of tissues in the abdominal cavity - all manipulations are performed by the surgeon through several small punctures. In addition, the physical condition of the patient after removal of the gallbladder is much better. Insignificant pain disappears within a day and a half, and already 3-4 hours after the operation you can walk.

When stones were removed from the gallbladder or the entire organ was removed laparoscopically, the following is noted:

there is no need for a long stay in the hospital;
the body recovers quickly, and a person can return to the usual mode;
occurs much less frequently;
scars at the puncture sites are almost invisible.

Contraindications and indications for laparoscopic cholecystectomy

calculous cholecystitis (in chronic form);
sticking of cholesterol deposits on the walls of the organ;
an attack of acute cholecystitis;
asymptomatic calculus in the gallbladder.

From the gallbladder and the bladder itself is not carried out if the found gallstone fragment is very large. In such cases, the recommendation of surgeons is to remove the organ through the opening of the abdominal wall.

Laparoscopic removal of the gallbladder has a list of contraindications to surgery. It cannot be performed for all pathologies associated with a high degree risk of serious postoperative complication. These states include the following:

severe disease of the respiratory and cardiovascular systems;
problems with blood clotting that cannot be corrected;
inflammation of the peritoneum (peritonitis);
obesity (2 and 3 degrees);
the presence of a pacemaker.

In addition to the above, there are contraindications to laparoscopy for local cholelithiasis, which are detected both in the process of preparing for the operation and after it has begun:

atypical location of the gallbladder (in the liver);
a significant change in the structure of the tissues of the ducts and adjacent organs;
acute pancreatitis;
obstructive jaundice as a result of blockage of the bile ducts;
malignant neoplasm in the gallbladder;
laparoscopic operations in the upper segment of the abdominal cavity, transferred earlier.

Preparing for the operation

Laparoscopic cholecystectomy is a procedure that requires high skill from the surgeon. For it to go well, the patient must prepare in advance for a planned operation. At chronic diseases you need to visit specialists and undergo a course of treatment.

Preoperative examination should also begin in advance. It will take ultrasound diagnostics abdominal organs. Sometimes specialists prescribe an x-ray of the gallbladder and ducts (retrograde cholangiography), in which a contrast agent is injected into the patient through a tube.

Be sure to do tests:

biochemical - liver tests (alkaline phosphatase, AST, ALT);
total blood and urine;
RW (analysis for syphilis);
HIV test;
hepatitis virus test (B and C).

If the patient's medical documents do not contain a mark on the blood type and the presence of the Rh factor, then this study will also have to be done before the operation.

On the day before the operation to remove gallstones, you can not eat, later than 18 hours. Drinking is allowed only until 10 pm. This recommendation is not accidental - the body must have time to digest what is eaten and cleanse itself. To help him in this, enemas are given to the patient in the evening and in the morning of the operation day. Proper preparation for laparoscopy of the gallbladder contributes to the fastest possible recovery.

Procedure for laparoscopic gallbladder removal

During the operation, the patient lies on his back. The surgeon is between his spread legs (if the French technique is used) or to the left of the operated person (when the doctor adheres to the American technique of manipulation). The most convenient method is determined by the doctor himself.

Laparoscopic cholecystectomy is performed in several stages.

Nitrous oxide or carbon dioxide is pumped into the patient's abdominal cavity.
Through a puncture (make from 3 to 5 holes), a trocar and special instruments are inserted.
An examination of the gallbladder and adjacent organs is carried out using an inserted video camera that transmits an image to the monitor.
By coagulation, the gallbladder is cut off from anatomical adhesions, the cystic artery and duct are separated, and a clip is applied to them.
Separate the gallbladder from the liver bed.
Remove the bubble from the abdominal cavity.
After removal of the gallbladder, the organs in the abdominal cavity are examined.

Laparoscopy of the gallbladder is performed with 4 punctures, which are done in a certain sequence.

Slightly above (below) the navel.
By middle line under the breastbone.
On the right side, 4-5 cm below the ribs, vertically drawn from the middle of the clavicle.
At the height of the navel along the line corresponding to the anterior edge of the armpit.

With a significant increase in the liver, another puncture is made. After the operation, the doctor sews up the holes. After overgrowing, they look like barely noticeable scars.

Usually, general anesthesia is performed during laparoscopy of the gallbladder, but local anesthesia may be used. The operation to remove gallstones requires mandatory tracheal intubation. tube inserted into Airways, provides a free flow of air and prevents the contents of the stomach from getting into the lungs.

Laparoscopic cholecystectomy can last from half an hour if the procedure is carried out for the purpose of diagnosis, and up to 3 hours when it is necessary to remove the bladder with stones.

Postoperative period

After the operation, the anesthesiologist wakes the patient up and checks his reactions. The first 4-6 hours you need to observe bed rest. When is that time will pass, it is allowed to roll over on one side, sit on the bed. After another hour, you can walk a little. Then the doctors give the go-ahead for the patient to drink some water without gas. While a person is in the hospital, he is advised to perform breathing exercises so that it does not occur unpleasant consequence artificial lung ventilation - pneumonia.

The day after laparoscopic cholecystectomy, you need to drink a lot and start eating food that will not irritate the stomach and intestines:

light broth;
fermented milk products (yogurt, low-fat cottage cheese);
mashed boiled lean meat;
fruits that do not cause gas formation.

After 3-4 days, dietary table No. 5 is shown. The main recommendation of doctors regarding nutrition: you need to eat often and little by little.

Do not worry if in the first days after laparoscopy of the gallbladder there is pain in the puncture area. Unpleasant sensations are a consequence of damage to the integrity of tissues, but they will disappear by the 4th day. Then the patient is discharged home.

If the pain gets worse instead of getting better, you should immediately contact your doctor. Perhaps, a complication associated with the presence of gas residues in the abdominal cavity or irritation of the membrane lining its inner wall - the peritoneum, makes itself felt. Other possible complications of laparoscopic cholecystectomy:

internal bleeding;
damage to the integrity of nearby organs;
prolapse of a stone in the abdominal cavity;
leakage of bile from the gallbladder and poorly applied internal sutures;
inflammatory processes (omphalitis, peritonitis).

For 10 days after the operation, it is forbidden to lift heavy things, as well as to perform any work that involves physical activity. In order not to irritate the puncture sites, doctors advise wearing soft underwear.

To remove postoperative sutures, you must contact the clinic at the place of residence. This should be done 7-10 days after the operation.

Recovery

It is much easier and faster than in cases where a laparotomy is performed. Within six months, the body will be strong enough to function normally even at high loads without the threat that a complication will arise. And to engage in the usual work, which does not require significant physical effort, is allowed already 2 weeks after the removal of the gallbladder.

refrain from having sex for 2-4 weeks;
eat foods that prevent;
stick to diet number 5;
don't lift heavy things.

Athletes who have had a laparoscopic procedure are advised by most physicians to return to training a month after the operation. During the first classes, the load should be minimal.

Postoperative rehabilitation involves monitoring the patient's health. To do this, you need to do an ultrasound of the abdominal cavity one month and one year after the intervention. At the same time, take a biochemical blood test and consult a gastroenterologist.

1-2 times a year it is necessary to undergo a course of sanatorium treatment:

intake of mineral water prescribed by the doctor;
therapeutic baths (with radon, coniferous extract, as well as carbonic and mineral);
electrophoresis with succinic acid;
physiotherapy.

How is a cholecystectomy performed?

With an open cholecystectomy, an incision is made in the right side of the abdominal cavity, having a length of 3-10 cm. In this case, the muscles and tissues are lifted to free the liver and gallbladder. After that, the gallbladder is removed, then a control cholangiography is performed. The patient is stitched, after full awakening the patient is transferred to the postoperative department. Open cholecystectomy lasts one to two hours.

The night before surgery, you should not eat, and you should also stop taking medications and supplements.

After an open cholecystectomy, the patient must be at least a week. Full recovery will take four to six weeks, during which you must follow the activities recommended by your doctor. The duration of the rehabilitation period of the patient also depends on the general state of health. After cholecystectomy, a person must observe special diet and diet.

A few decades ago, cholelithiasis mostly affected people of mature age, but now very young people have to remove stones from them. There are many reasons for this: people began to move less and eat more, frequent stress, alcohol also play a role. As a result, the formation of stones that have to be removed surgically.

Preparing for the operation

First of all, you need to go full examination body: complete blood count; general urine analysis; blood sugar test; for the time of blood clotting, ; definition and Rh factor; blood chemistry; EMF or RW (syphilis detection); HIV test; hepatitis markers; fluorography or radiography chest; ECG; Ultrasound of the abdominal organs.

On the eve of surgery, you can not eat up, dinner should be light. In the morning you should do a cleansing enema. Prepare the anterior abdominal wall, for this you need to shave off the hairline on the day of the procedure. On the eve of the operation, you should be examined by an anesthesiologist, inform him about the presence of an allergy to drugs and previous diseases.

It is not advisable to perform surgery for women during menstruation, as blood clotting is disturbed.

Removable dentures must be removed and left in the ward. The nurse should bandage your lower limbs elastic bandages, starting from the fingers, ending with the inguinal folds. Before it is desirable to buy a bandage, which is useful in the postoperative period. On the day of the laparoscopy, you can not eat or drink.

Bandage lower extremities necessary for the prevention of thromboembolic complications.

Carrying out laparoscopy

You should be taken to the operating room lying on a gurney with elastic bandages already applied. From the gurney you will already be transferred to the table and fixed with straps in the thigh area (during the operation, you will be turned over to your left side along with the operating table in order to improve the view of the problem area). The anesthetist enters, you will fall asleep.

A team of doctors and treat your hands, put on sterile gloves and gowns, treat your stomach. Then the correct connection of wires, tubes and cables is checked. The surgeon makes a small incision in the navel area, a puncture of the abdominal wall is made with a special needle. Carbon dioxide begins to flow through the needle. After that, this device is removed and a trocar is inserted through the same puncture, along it is already a laparoscope with a video camera.

The doctor carefully examines the abdominal cavity to identify or rule out possible pathologies. Then an incision is made in the stomach area, a second trocar is inserted into the belly area. The next two trocars (sometimes one) are inserted in the area of the right hypochondrium. The gallbladder removed using a laparoscope is placed in a sterile plastic container, which is removed through the wound in the projection of the stomach.

It is placed in the subhepatic region to control or remove possible effusion. The gas is removed, the wounds are sutured. Next, you are transferred on a gurney to the ward, where the doctor will carry out follow-up observation.

Removal of the gallbladder is performed according to strict indications in the case when the organ can no longer perform its functions. Due to fear of surgery or a lack of knowledge about the consequences of refusing it, patients sometimes doubt the need for cholecystectomy, hoping to be cured with drugs or folk remedies.

Indications for removal of the gallbladder

The gallbladder is usually removed when stones form in the cavity of the gallbladder itself or the bile ducts. If the presence of stones is not accompanied by any painful symptoms, the doctor may postpone the removal, but this is not a cancellation of the operation, but rather a delay - the prolonged presence of stones can lead to perforation of the bladder, the occurrence malignant tumor, the development of acute inflammatory process.

Acute cholecystitis (inflammation of the gallbladder) is an absolute indication for surgery, as well as chronic cholecystitis, which often recurs and is difficult to respond to drug therapy.

Also, the need for removal arises in case of obstruction of the biliary tract, dysfunction of the liver or pancreas, provoked by gallbladder disease, or the development of malignant or benign tumor.

Can surgery be avoided?

Get rid of stones with pills or decoctions medicinal herbs impossible. Sometimes patients believe that by following a strict diet and taking their usual medications, they can avoid surgery, or at least postpone it indefinitely. It often ends badly - with advanced gallstone disease or with chronic inflammation high risk of perforation of the walls of the bladder, peritonitis, gangrene of the bladder.

The longer the operation is delayed, the higher the risk of liver and gallbladder dysfunction. Over time, the chances of a full recovery after surgery also decrease.

Fear of cholecystectomy is often caused by misconceptions about this operation, possible complications and lifestyle features after the bubble. Currently, more and more often, removal is performed by laparoscopy - this is a low-traumatic method in which surgical manipulations in the abdominal cavity are performed through one or more small punctures.

Laparoscopic surgeries are characterized by a shorter recovery period, and complications are less likely to occur after them. It is also important that the puncture marks are less noticeable than the long postoperative scar remaining after open cholecystectomy. However, with an advanced disease, laparoscopy may not be possible - traditional open surgery is necessary.

Full recovery after cholecystectomy is possible provided that all doctor's recommendations are followed. The compensatory possibilities of the body are not unlimited - if you delay the operation for a long time, it will be much more difficult to return to your usual way of life after it.

The gallbladder is an important organ of the human digestive system. Inflammatory processes that occur in this organ, in many cases, are not amenable to traditional drug treatment. In such situations, the gallbladder is removed. The operation of cholecystectomy is carried out if a lot of hard and small stones are found in the organ. Abdominal surgery is performed when an inflammatory process is detected and if there are contraindications for laparoscopy.

There are several types of gallbladder removal surgery. One of them is laparoscopy. This type of operation is performed with a special device called a laparoscope. Laparoscopy is a modern and gentle method of removing the gallbladder.

Benefits of laparoscopy

This type of surgery has positive sides compared to conventional abdominal surgery. These include:

During the procedure, an incision will not be made in the abdominal cavity. It is carried out by the method of several punctures, which do not exceed one centimeter in size.
No consequences after the operation.
The rehabilitation period in the hospital lasts three days.
After the operation, the patient does not feel severe pain, so there is no need to use a strong narcotic pain reliever.
The body recovers completely in two weeks, during abdominal surgery this period can take two months.

Disadvantages of laparoscopy

A number of contraindications during laparoscopy:

Malfunctions of the heart and lungs.
Pregnancy. The operation is contraindicated in the last trimester.
The inability of the blood to clot.
Excess weight.

Duration of gallbladder removal surgery

To determine how long the operation will take from the beginning (preparatory stage) to completion (final stage), it is necessary to carefully examine the entire sequence of the surgical intervention. Laparoscopy is a modern way to remove the gallbladder. How long to stay in the hospital after such an operation is determined by the doctor, focusing on the individual characteristics of the patient's body.

How long does an organ removal surgery take? The operation takes an average of one hour. Many factors affect its duration: the patient's equipment, features of the liver and gallbladder, the presence of concomitant pathologies, the severity of inflammatory and cicatricial processes in the abdominal cavity. The doctor will not be able to determine exactly how long the operation will last. The volume of the operation is expanding, and the time for its implementation is longer due to the presence of stones in the bile duct and signs of jaundice. It will be better for the patient if the period of action of anesthesia does not last long, and the operation will take place as quickly as possible. The duration of the operation may be delayed. There are cases when the duration of the surgical intervention lasts more than fifteen hours. Depending on the quality of the operation performed, the result and duration of recovery in the postoperative period depend.

Preparatory stage

The patient gives necessary tests and undergoes diagnostics before the start of the operation.

The stage includes the following activities:

General blood analysis

Consultation with doctors such as a dentist and a general practitioner.
Change general analysis blood and urine.
Determination of the level of urea and bilirubin, their indicators are obtained by passing a biochemical blood test.
Undergo examinations such as coagulogram, fluorography, electrocardiogram.
It is necessary to undergo a study to detect HIV infection, syphilis, hepatitis, for this they donate blood for analysis.

After the examination, the doctor analyzes the results, examines the patient and sends him to the preoperative ward.

anesthesia

An operation is performed to remove the gallbladder to a patient under general endotracheal (gas) anesthesia. The patient is connected to a ventilator. Under anesthesia, a person breathes through a special tube connected to a ventilator. If the patient has bronchial asthma, then the possibility this species anesthesia is not possible. In this case, intravenous anesthesia is used, combined with artificial ventilation.

Operation

For a visual assessment of the state of the internal organs, four incisions are made in the abdominal cavity and gas is injected with a special type of device. Through the same incisions medical device and a video camera that allows you to visually observe the progress of the operation.

With the help of clips, the duct of the organ - the artery - is blocked. Then the gallbladder is removed, the accumulated bile in the ducts is removed, and instead of the organ, a drain is placed, which produces a constant outflow of fluids from the wound. Next, each incision is sutured. The duration of such an operation depends on the difficulties encountered during the procedure and the experience of the doctor. On average, this period takes from one to two hours. Inpatient stay lasts a day after the operation. A person begins to lead a habitual way of life after 24 hours, following the recommendations of a doctor. The duration of the rehabilitation period is approximately twenty days.

Abdominal operation

This type of surgery is also performed under general anesthesia. The right side is cut with a scalpel. The length of the incision is fifteen centimeters. Next, neighboring organs are forcibly displaced in order to gain access to the gallbladder and it is directly removed. After the control examination, the area where the operation was performed is sutured. After the operation, the patient for several days uses drugs that reduce pain. The patient stays in the hospital under the supervision of specialists for fourteen days. The abdominal operation lasts much longer than laparoscopy, on average it takes 3-4 hours.

Postoperative period

After removal of the gallbladder, the patient is recommended to stay in bed for six hours. After this time, you can sit down, get up, turn around.
On the second day after the operation, light food is allowed - weak broths, low-fat cottage cheese, yogurt, lean soft meat. On the third day, the diet can be expanded, excluding those foods that lead to flatulence and bile secretion. After the operation, the pain will go away gradually over two days. It occurs after traumatic injury fabrics.
The postoperative period lasts approximately ten days. At this time, it is forbidden to carry out all kinds of physical strength exercises. On the tenth day, the suture is removed and the postoperative period ends.

Doctor's recommendations after ten days after the operation:

Do not visit the solarium, bath and sauna for three months.
Exclude sports for one month.
Wear special stockings for three weeks.

Hospital for laparoscopy of the gallbladder

The sick leave, which is issued to the patient upon discharge, indicates all the days of his stay in the hospital. Twelve more days are added to these days. Since the patient is discharged from the hospital on the seventh day after surgery, the total number of days is nineteen.

If there are consequences or complications, the sick leave is extended.
The duration of the operation depends on its complexity, the qualifications of the doctor and individual features person. Depending on the complexity of the surgical intervention, the doctor determines how many days the patient needs to stay in the hospital.

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Anatomy of the gallbladder

The gallbladder is a hollow organ located in the abdomen, on the right, under the liver. Its volume is approximately 50-70 ml, and the shape resembles a pear. Its main purpose is the accumulation and concentration of bile, which is synthesized by liver cells, and its subsequent release into the duodenum, periodically, mainly in connection with food intake. Bile helps in the digestion and absorption of fats, the absorption of fat-soluble vitamins, cholesterol, amino acids and calcium salts, and also bile is involved in the activation of parietal digestion in the intestine, enhances the secretion and motor activity of the small intestine.

When is the gallbladder removed? Indications for cholecystectomy

Cholecystectomy is performed to treat diseases of the gallbladder, mainly from the formation gallstones in the gallbladder (cholelithiasis). Stones can be hard and small, like pebbles inside the gallbladder. Stones can be as small as grains of sand or as big as a golf ball.

Common indications for cholecystectomy are:

Obstruction of the normal flow of bile leading to severe abdominal pain (biliary colic)
- Infection or inflammation of the gallbladder (cholecystitis)
- Blockage of the bile ducts leading to the duodenum (biliary obstruction)
- Blockage of the duct leading from the pancreas to the duodenum (pancreatitis)

Indications for cholecystectomy include exacerbation chronic cholecystitis, calculous cholecystitis, acute cholecystitis, not amenable to conservative therapy, cholesterosis.

How to prepare for cholecystectomy, an operation to remove the gallbladder?

- To prepare for a cholecystectomy, your surgeon may ask you to take a laxative 3-4 days before surgery to clear out your bowels.
- Do not eat anything the night before the operation. You should not drink or eat for at least four hours before surgery, but you can drink a sip of medicated water.
- It is necessary to stop taking certain drugs and dietary supplements that affect blood clotting, because they can increase the risk of bleeding. In any case, tell your doctor about all medications and supplements you are taking.
- Hygiene procedures before surgery, such as showering with antibacterial soap.
- Plan your hospital stay ahead of time. Most patients are able to go home the same day after their cholecystectomy, but complications may arise that require one or more nights in the hospital. If the surgeon has to make a long incision in the abdomen to remove the gallbladder, you may have to stay longer in the hospital. It is not always possible to know in advance which procedure will be used. Plan ahead, in case you have to stay in the hospital, what personal items you may need, such as Toothbrush, comfortable clothes, and books or magazines to pass the time.

Most gallbladder surgeries today are performed using laparoscopic surgical methods, in which thin surgical instruments - trocars - are inserted into the abdominal cavity through small incisions. The operation is performed under anesthesia, so the patient is asleep and does not feel any pain.

During a laparoscopic cholecystectomy, the surgeon makes four small incisions in the abdomen, two of which are 5 millimeters long and the other two are 10 millimeters long. A tube with a tiny video camera is inserted into the abdomen through one of the incisions. During insertion, trocars do not cut tissue, but only move apart. An anesthetized patient is inflated with carbon dioxide. The remaining instruments are inserted through 2 more incisions. Then, when the gallbladder is found, it is removed.

Next, cholangiography, a special X-ray, is performed to check the bile duct for abnormalities. If your doctor thinks there are other problems in the bile ducts, they can be fixed. After that, the incisions are sutured. Laparoscopic cholecystectomy takes one or two hours.

However, laparoscopic cholecystectomy is not suitable for everyone. In some cases, a large incision needs to be made, for example due to scar tissue from previous surgeries or complications, or very large stones. In this case, an open cholecystectomy is performed.

If the gallbladder is extremely inflamed, infected, or has large stones, another surgical approach called open cholecystectomy is used.

During an open cholecystectomy, the surgeon makes a 15 cm incision in the abdomen just below the chest and ribs on the right side. Muscles and tissues are retracted to facilitate access to the liver and gallbladder. Next, the liver is displaced to open the gallbladder. Vessels, cystic ducts and arteries to and from the gallbladder are excised and the gallbladder is removed. The common bile duct, which carries bile from the liver to small intestine, is also checked for stones. A small drainage tube may be left in place for a few days to drain fluid if there is inflammation or infection in the abdomen. The incision is then sutured.

Open cholecystectomy lasts one or two hours.

Recovery after removal of the gallbladder (cholecystectomy)

After the operation, you will be sent to the intensive care unit to recover from anesthesia. When the anesthesia wears off, you will be taken to your room. Further recovery varies depending on your procedure:

After laparoscopic cholecystectomy, patients are often allowed to go home the same day after surgery, although sometimes a one-night hospital stay is required. After discharge, you can return to your normal diet and activities almost immediately.

After open surgery, you can expect to be allowed to go home as soon as you are able to eat and drink without pain and are able to walk without assistance. It usually takes two to three days to a week. The ability to return to a normal diet occurs after 1 week and return to normal activities after 4 to 6 weeks.

You may experience some of these symptoms during your recovery:

Abdominal pain. You may experience pain in one or both shoulders for several days after surgery. This is due to gas in the abdomen after surgery. Your doctor will prescribe pain medications to use at home. If you are taking pain pills 3 or 4 times a day, try taking them at the same time each day for 3 to 4 days. Try getting up and walking around if you have some abdominal pain. This may ease your pain.
- Pain at the incision area for 1 to 2 weeks. This pain should decrease every day. Press down on the area above the incision when you cough or sneeze to ease discomfort and protect your incision from tearing.
- Sore throat from breathing tube. Sucking on ice cubes or gargling can have a calming effect.
- Nausea and vomiting. Your doctor can prescribe medication if necessary.
- loose stool after meal. This can take 4 to 8 weeks.
- Bruises and hematomas around the wound. They will go by themselves.
- Redness of the skin around the wound. This is fine.
- A small amount of watery or dark bloody fluid from the incision. it normal phenomenon within a few days after the operation. The surgeon will probably leave 1 or 2 drainage tubes in the abdomen: one will help drain any fluid or blood that remains in the abdomen. The second tube will drain the bile during recovery. This tube will be removed by your surgeon after 2 to 4 weeks. Before removing it, a special X-ray study called a cholangiogram will be taken. You will receive care instructions for these tubes before you go home.

Activities after removal of the gallbladder (cholecystectomy)

You should be able to complete most of your regular activities within 4 to 8 weeks. Before:

Do not lift anything heavier than 4.5 - 7 kg until your doctor tells you to.
- Avoid strenuous activities. This includes heavy physical exercises, weightlifting, and other activities that make you pant or strain.
- Take regular short walks.

Wound care after surgery

Change the dressings over your surgical wound once a day, or sooner if it becomes dirty. Your doctor will tell you when you won't need to use bandages. Keep the wound clean by washing it with mild soap and water. You can also shower with bandages removed if your incisions have been closed with stitches, staples, or a special adhesive.

If the sutures were closed with suture strips or a patch skin suture Steri Strip, cover the incision with plastic wrap before showering for the first week. Do not try to wash these strips off, let them fall off on their own.

Diet after gallbladder removal (cholecystectomy)

You can return to normal eating habits almost immediately, but it is generally recommended to limit fatty or spicy foods and eat small meals often.

If you have hard stools:

Try to walk more and be more active, but don't overdo it.
-Try lowering the dosage of pain medications, some of them can cause constipation.
- You can use a mild laxative. But do not take any laxatives without consulting your doctor.
- Ask your doctor about high fiber foods.

Forecast after removal of the gallbladder(cholecystectomy)

Cholecystectomy can relieve pain and discomfort from gallstones. Conservative treatments, such as dietary changes, usually cannot stop the formation of gallstones, and symptoms may recur. Cholecystectomy is the only way prevent the formation of gallstones.

Some people experience mild diarrhea after a cholecystectomy, although this usually resolves with time. Most people do not experience digestive problems after cholecystectomy, as the gallbladder is not necessary for healthy digestion.

Complications and risks of cholecystectomy

Cholecystectomy carries a small risk of complications. The risk of complications depends on your general health and the reasons for the cholecystectomy. It could be:

Leakage of bile during surgery
- Bleeding
- Thrombosis of vessels in the area of operation
- Heart problems
- Infection
- Injuries to nearby organs such as the bile ducts, liver and small intestine
- Pancreatitis
- Pneumonia

Call your doctor or nurse if:

You have a fever and a temperature above 38°C.
- The wound is bleeding, red or warm to the touch.
- The edges of the surgical wound have thick edges, yellow, green or milky discharge from the drain.
- You have pain that is not relieved by pain medication.
- It's difficult to breathe.
- You have a cough that does not go away.
- You can't drink or eat.
- Your skin or the whites of your eyes turn yellow.
- Your stools are gray clay-colored.