Laparoscopic cholecystectomy is considered a new step in the treatment of gallstones. Many experts say with confidence that this technology is a significant step forward for the entire surgery. Only a few years of technology development have already allowed it to gain popularity in many European powers. Laparoscopic cholecystectomy is common in both Asian and American clinics. Today, doctors have access to the experience gained in many thousands of surgical interventions. As can be seen from practice, the operation equally helps with the chronic course of the disease, and with cholecystitis in a calculous form. In our country, such an intervention was first carried out in 1991.
General view
Doctors highlighted the numerous advantages of laparoscopic cholecystectomy over the traditional method of surgical intervention. The classical form is called "laparotomy" and involves the dissection of the abdominal wall in front, which suggests a long recovery. The new method allows to shorten the rehabilitation period, it is necessary to spend significantly less time in the hospital, recovering from treatment.
Compared with laparotomy, the technique under consideration gives complications much less frequently. Clinical trials show that patients return to their working condition faster. The cosmetic aspect is also important, since the modern method of intervention leaves only barely noticeable scars.
The operation of laparoscopic cholecystectomy by many doctors is estimated almost as a piece of jewelry. The intervention is complex, and only a highly qualified surgeon who knows the anatomical features of this area of the human body, as well as the topography of the internal organs, can cope with it. It is necessary to be able to carry out manipulations with high-precision tools, focusing on the image transmitted to the screen. Such skills require long-term training, long-term training.
When is it necessary?
Indications for laparoscopic cholecystectomy are exactly the same as for a classical surgical procedure. The main task of the doctor is to efficiently, without consequences for the patient, remove the gallbladder, if pathology is not possible to effectively eliminate by conservative methods.
Most often, surgery is prescribed if calculous cholecystitis in a chronic form is diagnosed. Experts pay attention: neither the degree of severity of the disease, nor the number of formations, nor the duration of the pathology affect the choice in favor of the traditional or more modern method.
In addition to the specified diagnosis, laparoscopic cholecystectomy is necessary for acute cholecystitis. With this disease, treatment should be carried out in the first two days of the attack. An event is prescribed if polyps in the gall bladder, cholesterosis are established, cholecystolithiasis without symptoms is detected. Particularly difficult is the case, not accompanied by symptoms. Doctors pay attention: surgical intervention is absolutely necessary, since the lack of manifestation of stones does not protect against complications in the future. There is a risk that, over time, small neoplasms will move into the ducts of the bladder for bile, and cause a bedsore of the cystic wall. Both small and large stones are considered to be equally dangerous, therefore, the identification of this aspect always becomes the basis for referral to surgical intervention.
Sometimes you can’t
Contraindications to the removal of the gallbladder are divided into local and general. Common conditions include the condition and pathology of the patient, which do not allow surgical intervention. Doctors, evaluating the condition of the patient, may come to the conclusion that such an event can cause serious complications, so they will suggest looking for alternative methods to alleviate the course of the disease. Dangerous situations are:
- heart, vascular diseases;
- impaired lung function;
- clotting problems that cannot be corrected with medications;
- peritonitis (general, diffuse);
- excess weight (2-3rd degree);
- gestation (late).
Among the local contraindications for gallbladder removal, it should be noted:
- acute pancreatitis;
- obstructive jaundice;
- malignant neoplasms in the gallbladder;
- cicatricial changes, infiltrative, found on the neck of the bladder, ligaments;
- intrahepatic gall bladder;
- surgical interventions in the upper abdominal cavity.
Proper preparation is the key to success
If surgical intervention is necessary, the patient is assigned a full examination in order to determine the individual characteristics of the body. Preparation for laparoscopic cholecystectomy is generally similar to the measures taken when planning a traditional form of intervention. First, the patient is sent for ultrasound, according to the results of which they can decide on additional measures of instrumental clarification of the condition.
Before laparoscopic cholecystectomy, you will have to take blood tests, studies of other body fluids are possible. A set of specific tests is determined by the attending physician taking into account the individual characteristics of the patient.
Step by step: how is it done?
Several consecutive mandatory stages of laparoscopic cholecystectomy are distinguished. First, the abdominal cavity is filled with a special gas - nitric oxide, or carbon dioxide, after which the tools are introduced directly for work. The first step is the revision of the internal organs, after which the object of intervention, the gall bladder, is isolated from the adhesions. The doctor determines the location of the cystic duct, the artery that feeds the organ, crosses, bandages the necessary areas, and then selects the organ from the liver bed and removes it from the cavity. The final point is an examination of all organs in order to summarize, monitor the patient's condition. This completes the operation.
Troubles: are they possible?
In medicine, complications after laparoscopic cholecystectomy are known. In some cases, urgent surgical intervention is required to alleviate the patient's condition. Known complications that appeared already at the stage of the primary event, as well as identified during rehabilitation after surgery.
Operation Complete: What's Next?
The postoperative period with laparoscopic cholecystectomy is easy to proceed, since the intervention itself is quite insignificant. In comparison with the classical methods of surgery, rehabilitation is quite easy, and the pain syndrome practically does not bother the patient.
In most cases, right after the event, you can completely abandon pain medication or reduce their intake to the minimum dose. The primary activation of the patient occurs a couple of hours after the completion of the intervention, and the free regime is permissible on the second day after the event. The patient is prescribed on the third or fourth day. Before discharge, it is necessary to carefully examine the patient in order to prevent complications.
Since the postoperative period with laparoscopic cholecystectomy is easy, it requires a relatively short time period for recovery, after a week or two the patient can return to work. The specific terms are determined by the profession of a person, the physical load that he is faced with while performing official duties.
Anatomical features
The relevance of such surgery is due to the importance of the gallbladder for the human body. The organ belongs to the digestive system, located slightly below the liver. Its activity is important for the normal processing of food: bile generated by cells through the liver is sent through the ducts to the bladder. When food enters the body, bile passes into the intestine, where it actively participates in the processes of splitting fatty compounds, and also initiates the activity of enzyme structures.
Diseases of the gallbladder, as well as stones in this organ, are a serious problem for a person, worsen the general condition of the body and can be life threatening to the patient. With a number of pathologies, emergency laparoscopic cholecystectomy is necessary - such an intervention is carried out within the first two days from the moment of an acute attack, but only if the disease is diagnosed. During the operation, the doctor removes the diseased organ.
Features and diagnoses
It is possible to suspect that a laparoscopic cholecystectomy is necessary, if a person suffers from nausea, from time to time it hurts on the right under the ribs, and after entering the body there is a feeling of discomfort. With such manifestations, it is reasonable to visit a doctor to formulate an accurate diagnosis. The doctor prescribes an ultrasound scan to clarify the condition. Stones are not always found, the reason may be in polyps, oncology.
It is known that women aged 50 years and older belong to the risk group for the formation of stones. The predisposition is more significant if excess weight is observed, diabetes is established, or other metabolic problems are known. Statistics show that laparoscopic cholecystectomy in 60% of cases is prescribed to patients in whom the disease proceeded without symptoms or rarely showed colic, and the pain attack lasted from a quarter to six hours, and sensations were transmitted to the shoulder on the right, in the stomach and between the shoulder blades. More likely this is possible in the evening, at night. The patient suffers from vomiting. If the diagnosis is confirmed, the patient is prescribed scheduled surgical intervention.
Important features: what to look for?
Currently, laparoscopic cholecystectomy is one of the most sparing techniques available to qualified surgeons. It allows you to solve the problem of stone formation by the radical method, when crushing, removing such elements does not give a positive effect. Since the appearance of objects is due to metabolic problems, new and new specimens will form over time. Only radical intervention can solve the problem once and for all. As can be seen from medical statistics, the removal of only stones by modern doctors is practiced in extremely rare cases, more often the patient is recommended to sign up for a laparoscopic cholecystectomy. The cost of such an intervention varies quite a lot - from ten to one hundred thousand rubles. True, doctors assure that it is worth its price: the method is effective, safe, and the period of disability with laparoscopic cholecystectomy is only a few days in a hospital, not more than two weeks until complete discharge.
The intervention involves the creation of only two-centimeter sections, while the traditional technique is carried out with sections that exceed this value ten times. Consequently, the risk of hernia after the intervention is minimized. The traditional technique is especially difficult for patients of loose physique, since the recovery processes will require long time intervals, but the method under consideration does not differ in such weakness. During the intervention described method create four minor incisions, the healing of which takes place almost without pain.
Let's check everything!
If a laparoscopic cholecystectomy is planned, the doctor usually prescribes a comprehensive examination to determine the patient’s health status. Above were indicated basic analyzes, studies. In addition to them, the doctor may order a test for infection with syphilis, hepatitis, HIV. Doctors will find out what the patient’s blood type is, the Rh factor. In most cases, the patient is additionally sent for fluorography, an analysis to assess blood coagulability, and urine is taken for general examination. The therapist and dentist formulate their conclusions. Only after their positive decisions can you choose the day for the operation.
When the initial stage of collecting information about the patient's condition is completed, the patient is determined in the ward. A surgeon comes here to visually examine the patient, verify information from the tests, interview the patient and clarify his well-being. A professional will tell you what risks the operation is associated with, what kind of rehabilitation will be for laparoscopic cholecystectomy, and what limitations will have to face in the future.
Technical points
Already ten days before the operation, restrictions on taking medications are imposed. This applies to drugs that reduce blood coagulation, such as aspirin. You can not use vitamin E as food. Restrictions are imposed on stopping inflammatory processes non-steroidal medicines. After choosing the optimal date, time of the surgical intervention, the clinic staff will introduce the patient to the course of how to prepare for the event. As a rule, a ban on food is imposed from six in the evening before the intervention of the day. After midnight, do not drink, including water. In the morning, the patient is given an enema to cleanse the body.
Immediately before surgery, the patient is immersed in sleep. A prerequisite is general anesthesia. In order to have access to the image of all internal organs, gas is introduced through a needle, a video camera, used tools. The largest incision created will be used to remove the diseased organ. During the operation, there is a risk of detecting an acute inflammatory process. It is not possible to cope with it, using gentle methods of intervention, it will be necessary to urgently change the format and complete the intervention in a laparotomy way. This will require the tension of the bubble, the presence of numerous adhesions, as well as the growth of nearby organs. Before starting the operation, the patient is informed about this possibility of developing the situation.
Operation completed: first impressions
As the intervention is completed, the patient is sent to the ward, where he awakens - usually within the first hour after the operation is completed. There is a possibility of nausea, dyspepsia. With such manifestations, it is necessary to use Cerucal. A few hours later, pain can be disturbing. The intensity of sensations varies, a lot depends on the specific case. Doctors prescribe analgesics to relieve the syndrome. With very severe pain, the use of narcotic compounds is possible. If there are indications for this, infusion therapy is prescribed. If the organ is sealed during surgery, a course of antimicrobial agents is prescribed.
Nutrition after laparoscopic cholecystectomy is possibly limited. On the first day after the intervention, eating is prohibited in principle. On the second day, the patient is bandaged, drainage is removed in the absence of discharge. On the second day, you can start feeding the patient. A return to the usual daily routine (walking, eating food) occurs on the second or third day after the intervention. At first, you need to eat fractionally, eat strictly dietary foods.
I want to go home!
Usually, discharge occurs within the first week of the operation, although sometimes the patient is recommended to stay in the hospital for a longer period. Before discharge, a blood test is taken, urine is checked. If the indicators are normal, there is no heat, the patient does not feel severe pain, and the wounds gradually heal, you can send him for aftercare. At home, you will also have to strictly observe dietary restrictions after laparoscopic cholecystectomy, so as not to create an additional load on the body.
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