Currently, up to 90% of all surgical interventions account for laparoscopic surgery. 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, gallbladder laparoscopy is well tolerated by most patients. In addition, it is allowed to begin to carry out daily activities within a few days.
Description of the method, its advantages
By the term “gallbladder laparoscopy” is meant 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 tool.
Standard gallbladder surgery involves cutting soft tissues. Thanks to this, the doctor can visualize the organ and perform manipulations with the help of tools. After the operation is completed, the specialist sutures the tissue. Subsequently, a visible scar will form at the site of the incision, which can only be removed with the help of cosmetic procedures, for example, laser resurfacing.
Laparoscopy 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) in them. The image from the instruments gets on the screen, so that the doctor can visualize the internal organs and carry out 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 organ completely or remove calculi from it. According to medical reviews, laparoscopy of gallstones is currently less common. 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 laparoscopic surgery, stones in the gallbladder subsequently rarely form, that is, the risk of relapse is minimized. But at the same time, the inflammatory process can affect other organs. In other words, based on medical reviews, during surgery (laparoscopy), gallstones can be removed. But it is preferable to excise the organ completely.
Indications
The gallbladder, which enters the biliary system, is considered an important organ. It is a reservoir for secretions produced by the liver. In addition, in his cavity, bile is brought to the necessary concentration. After this, hepatic secretion enters the intestine when ingested in the last food. It is bile that stimulates the pancreas, breaks down heavy fats and fights bacteria.
However, in the presence of serious organ diseases, its removal is indicated. Excision of the gallbladder is carried out in the presence of the following pathologies:
- Choledocholithiasis.
- Acute cholecystitis.
- Severe cholelithiasis.
- Chronic cholecystitis calculous form.
- Pancreatitis
In addition, according to medical reviews, laparoscopy (surgery to remove the gallbladder) is performed if there are contraindications to the implementation of traditional surgical intervention. In some cases, it is necessary in the development of other pathologies, the course of which is associated with a greater risk of complications.
Contraindications
Like any other operation, laparoscopy has several limitations. It is not performed in 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.
- Obstructive jaundice.
- Anatomically incorrect location of internal organs, including intrahepatic location of the bladder.
- Malignant neoplasms in the organ.
- Significant cicatricial changes in soft tissues.
- Blood clotting disorders.
- Fistulas between the intestines and bile ducts.
- "Porcelain" cholecystitis.
In addition, according to medical reviews, gallbladder removal by laparoscopy is not performed in women in the third trimester of pregnancy and in those who underwent traditional surgical intervention in the abdominal organs in the past. The presence of a pacemaker is also a contraindication.
Preparation
About 2 weeks before the planned operation, the patient must undergo a comprehensive examination. According to reviews, preparation for laparoscopy of the gallbladder does not take much time.
The patient needs to undergo the following studies:
- Blood and urine tests (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 group and Rh factor.
- Electrocardiogram.
- A blood test to rule out hepatitis B and C, syphilis and HIV infection.
- Women additionally need to pass a smear from the vagina to the flora.
The patient is allowed to undergo surgery only if the results of his analyzes are within normal limits. If they deviate up or down, appropriate treatment is indicated. In this case, the operation is postponed until the indicators normalize. Reviews of laparoscopy of the gallbladder in most cases are positive due to the fact that doctors promptly identify contraindications, thereby minimizing the risk of unwanted effects of the intervention.
In the presence of chronic pathologies, consultations of specialized specialists are required. Each of them should draw up a treatment regimen in such a way that by the time the operation is performed, the inflammatory processes are stopped, the foci of pathologies are sanitized, etc.
Immediately before laparoscopy (the night before), the last meal should take place before 18.00 hours. It is allowed to drink clean still water until 22 hours. After that, it is forbidden to consume any products and liquids.
On the day before the operation, you need to put a cleansing enema. This is necessary for a full bowel cleansing before the intervention. In addition, an enema must be delivered several hours before the removal of the organ.
Judging by medical reviews, surgery (laparoscopy of the gallbladder) does not require specific preparatory measures. However, if the attending specialist has additional recommendations, it is necessary to listen to them.
Operation Algorithm
Laparoscopic resection of the gallbladder is performed under general anesthesia. This is due to the need to reduce the sensitivity of soft tissues, stop painful sensations 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. Algorithm for laparoscopy:
- An anesthetist inserts a probe 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 ingestion of the contents of the stomach with the subsequent development of asphyxia disappears. The probe remains in the stomach during surgery.
- The patient is connected to a mechanical ventilation system, covering his mouth and nose with a mask. Throughout the operation, respiratory function will be supported by the apparatus. Mechanical ventilation is a must. This is due to the fact that the gas, which is pumped into the abdominal cavity during laparoscopy, strongly presses on the diaphragm. She, in turn, compresses the lungs. As a result, a person cannot breathe independently.
- In the crease of the navel, the surgeon makes a small incision in a semicircular shape. In order to increase the abdominal cavity and smooth out the internal organs, a specialist pumps in sterile gas (most often carbon dioxide). Through an incision, the doctor inserts a trocar inside, equipped with a flashlight and a video camera. Due to the presence of gas in the abdominal cavity, the surgeon is able to freely operate the trocar, without touching and without injuring nearby organs.
- On the line of the right hypochondrium, the doctor makes 2 more incisions. Through them, manipulators are introduced, with the help of which the gall bladder will be removed.
- After immersing the instruments in the body, the surgeon evaluates the appearance and location of the gallbladder. It so happens that against the background of the inflammatory process of a chronic nature, the organ is blocked by commissures. If the latter are found, their dissection is initially performed.
- The doctor assesses 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 a small amount of accumulated fluid.
- The doctor puts a clamp on the gallbladder. After that, he secretes bile duct from the soft tissues. Then the last one is cut. After that, the doctor isolates the cystic artery from the tissues and imposes healed on it. Between them, the surgeon makes an incision. Then he sews the vascular lumen.
- After the organ is released from the common bile duct and cystic artery, the doctor removes it from the liver 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 by a puncture made in the navel.
- The doctor examines the abdominal cavity in order to detect bleeding vessels, liver secretion and other pathologically altered tissues. The latter, when identified, are deleted. The vessels are coagulated.
- The doctor introduces an antiseptic into the abdominal cavity and rinses the operated area. After completion of this manipulation, the fluid is pumped out.
At this stage, laparoscopic surgery is considered complete. The doctor removes the trocar and manipulators, after which he sutures the incisions or simply seals them with an ordinary plaster. In some cases, one puncture remains open. A drainage tube is inserted into it. It is necessary in order to remove the remains of an 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 the traditional open surgery.
According to reviews, the 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 the organ is similar to the above. The patient is injected with an anesthetic drug, liquid and accumulated gases are pumped out of his stomach, and the operated person is connected to an artificial lung ventilation apparatus. After that, a trocar and manipulators are inserted into previously made incisions in the abdominal cavity.
If adhesions are found, the latter are dissected. Then the doctor cuts the wall of the gallbladder. After that, a special suction is removed into the body, which removes calculi. Then the gallbladder wall is sutured, the abdominal cavity is treated with an antiseptic. The final step is to remove the tools and overlay the seams. 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 about a possible change in technique.
Features of the postoperative period
Based on the reviews, laparoscopy of the gallbladder has become a familiar and often 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 prescriptions in order to prevent the development of complications.
Immediately after completion of the operation, the anesthetist closes the gas mixture into the human body. 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. Allowed only to drink clean still water.
Judging by medical reviews, after laparoscopy of the gallbladder, hunger in patients appears only after a day. On the second day after the operation, it is allowed to eat soft food, giving priority to broths, yoghurts, fruits. In this case, the portions should be small. Also on the second day you need to drink a large amount of water. On the third day, it is allowed to return to the usual diet, excluding from it only products that contribute to increased 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. The pain can be localized in the puncture zone, above the collarbone, as well as 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 the doctor about it, as in this case it can be a sign of complications.
Judging by the reviews, after removal of the gallbladder with laparoscopy, you can begin to carry out the usual activities in full volume after 7-10 days. Until this time, it is necessary to wear soft underwear that does not irritate the wounds, and exclude physical activity. On day 7 or 10, you must come to a medical institution where the doctor will remove the stitches from the punctures.
According to reviews, after surgery (laparoscopy of the gallbladder) 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.
Full 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 sex in the first month after surgery. At the same time, it is not recommended to subject the body to physical activity.
Power Features
Based on medical reviews, a diet after removal of the gallbladder by laparoscopy is a key point. Correction of the diet is necessary in order to ensure the normal functioning of the liver. Diet should be followed in the first 2 years after removal of the gallbladder.
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.
From the diet it is necessary to exclude:
- high fat foods;
- canned food;
- smoked meats;
- pickles;
- offal;
- mushrooms;
- raw vegetables;
- peas;
- fresh bread;
- confectionery;
- chocolate;
- alcohol-containing drinks;
- coffee;
- cocoa.
The menu must include:
- lean meat and fish;
- cereals;
- soups on a weak broth;
- vegetables (stewed or steamed);
- lactic acid products;
- fruits and berries;
- bread (yesterday);
- honey.
You can fill dishes with both butter and vegetable oil. After 2 years, the diet must be gradually expanded, returning to previous gastronomic habits. Judging by the reviews, laparoscopy of the gallbladder is an operation that is easy to transfer. But it takes a lot of strong-willed efforts to follow a diet for such a long time.
Possible consequences
Reviews about the removal of the gallbladder by laparoscopy in most cases are positive. However, against the background of the release of bile into the human duodenum throughout life, pain, nausea, heartburn, flatulence and diarrhea can periodically disturb.
With the frequent occurrence of these unpleasant symptoms, it is necessary to strictly follow the postoperative diet. Expressed 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 state or private medical institution. In the first case, you need a medical insurance policy.
Judging by the reviews, the operation is well tolerated by most patients. Within a few days, they can begin daily activities. If all the prescriptions of the doctor are observed, the general state of health is not disturbed, complications do not develop.
Finally
The term "laparoscopy of the gallbladder" in surgery refers to the removal of an entire organ or stones that have accumulated in it. The operation requires careful preparation. In the absence of contraindications to the patient, an organ is removed. At the same time, strict bed rest is only necessary for the first few hours after surgery. In the absence of complications, a person is prescribed after 3-7 days.