Gallstone disease has become one of the most common phenomena among abdominal pathologies today, and surgery to remove stones in the gallbladder is one of the methods to radically solve the problem.
Gallstone disease - what is it?
This is a disease associated with the formation of bile ducts and gall bladder stones (calculi). It develops for the following reasons:
- stagnation or change in the composition of bile;
- inflammatory processes;
- violation of bile secretion (dyskinesia).
The composition distinguishes three types of stones. Most often (in 80-90% of cases) cholesterol stones are found. Their formation is promoted by excess cholesterol in the composition of bile. In this case, crystals form due to the precipitation of excess cholesterol. If the motility of the gallbladder is impaired, then these formations do not enter the intestinal space, but remain inside it and begin to increase.
Pigment stones are formed due to increased decay of red blood cells - red blood cells. Most often, this can be observed with hemolytic anemia. There are also mixed formations. They are a combination of both forms. They include cholesterol, bilirubin and calcium.
Do I need an operation
Everyone who has been diagnosed with gallbladder stones sooner or later faces the question of whether surgery is needed or if conservative treatment is enough. It is worth mentioning that the stones themselves are not the basis for removing the gall bladder. If they do not manifest themselves in any way and do not affect the normal functioning of other organs, then you can not think about the operation. However, if there are pains in the gallbladder, a violation of the general condition, jaundice, then it is urgent to consult a surgeon. It is he who, after the examination, will decide whether surgery is needed, and which one. But it must be borne in mind that gallbladder cholecystitis implies an already begun inflammatory process. If the decision is postponed excessively, then the chances of fully recovering after surgery are drastically reduced. Even if there was a single attack, it is better to remove stones in the gall bladder.
Indications for surgery
When deciding on the need for surgical intervention, specialists usually take into account the following factors:
- the presence of stones (stones) of various sizes, occupying more than a third of the volume of the gallbladder;
- if the disease proceeds with frequent bouts of pain in the gallbladder (biliary colic), then the operation is carried out regardless of the size of the stones;
- if the stones are located both in the gallbladder and in the ducts;
- with a decrease in the ability of the gallbladder to contract or completely shut off;
- with the development of biliary pancreatitis;
- in violation of the integrity of the walls of the gallbladder;
- with blockage of the common hepatic duct.
There are international recommendations to determine the need for surgery for cholelithiasis. Summing up the points that are assigned to various diagnostic indicators, the doctor determines whether the operation is required, as well as relative and absolute indications for it.
Types of operations
As a rule, the formation of gallstones is not a quick matter. Of course, if you are unlucky, and an ambulance delivered you to a surgical hospital with an acute attack, which was diagnosed as cholecystitis of the gallbladder, then you have little choice. But in most cases, people who know about their problem, discuss with the doctor in advance all the details, determine the date of the planned surgical intervention.
In modern medicine, there are two methods for performing gallbladder removal (cholecystectomy):
- open cholecystectomy is a traditional method, which involves opening the abdominal cavity;
- laparoscopic cholecystectomy is a more modern technique, which is now preferred.
Open cholecystectomy
This surgery to remove gallstones is a classic surgical procedure. Through a wide incision in the midline of the abdomen, the abdominal cavity is examined, the gallbladder is removed and, if necessary, drainage (tube installation in order to ensure the outflow of the resulting exudate and other biological fluids).
Despite the advent of more modern and high-tech methods, open cholecystectomy continues to be relevant. This can be explained by the fact that some clinics do not have the equipment or specialists with the necessary qualifications for laparoscopic surgery. In addition, there are certain contraindications for them.
Gallbladder Laparoscopy
This is another type of surgery for gallstone disease. To date, this method is becoming more widespread due to its effectiveness, low trauma, and reduction of recovery time. The operation is performed using a laparoscope, a special device that allows access to the damaged organ with the help of several punctures of the abdominal wall through which manipulators and, in fact, the laparoscope are inserted. This method allows not only to remove the gallbladder without leaving postoperative scars, but in some cases to remove only stones, leaving the organ in place. A similar method is used not only for the treatment of gallstone disease, but also for the removal of appendicitis, the treatment of inguinal hernias, some gynecological diseases, as well as diagnostic operations. Despite the clear advantages of laparoscopic cholicystectomy, this method has its contraindications. These include:
- an abscess located in the area of operation;
- the last three months of pregnancy;
- severe cardiopulmonary pathology.
In addition, it must be borne in mind that during a laparoscopic operation, in case of the slightest difficulties in its course, surgeons proceed to open cholecystectomy. So ends about 5% of laparoscopic operations.
Preparation for surgery
Like any surgical intervention, the operation to remove stones in the gallbladder requires some preparation. In addition to a standard examination, which includes taking tests (general blood test and urinalysis, blood biochemistry, coagulogram - a study of blood coagulation, liver tests), it is necessary to do an abdominal ultrasound, ECG, chest x-ray, according to the indications of FGS and a colonoscopy, as well Get therapist’s opinion. In addition, preparation for a planned operation includes the abolition of drugs that affect blood coagulation. These include various anticoagulants, vitamin E, non-steroidal anti-inflammatory drugs. A few days before the operation, special attention is required to the diet for gallstone disease. The menu should not contain heavy dishes, and starting from midnight of the day when the operation is carried out, you should completely exclude food and drink. On the eve of the day for cleaning the intestines in the morning and evening, do cleansing enemas or take special medications. In the morning, take a shower using antibacterial soap.
Postoperative period
Today it’s hard to surprise anyone with a cholecystectomy. This operation to remove stones in the gallbladder has long been put "on stream", and is done about as often as appendectomy. Four hours after the completion of the operation, the patient is not allowed to drink and make sudden movements, the patient is allowed to turn in bed. Then you can start drinking small amounts of water without gas (1-2 sips, but not more than 500 ml). Six hours after laparoscopic surgery, the patient can get up. It is better to do this if someone from the medical staff or relatives is nearby, since after the body has been in a horizontal position for a long time and is under anesthesia, dizziness and fainting may occur when trying to get up. Already on the next day after surgery, the patient can freely move around the hospital.
After surgery, the diet for gallstone disease is of great importance. The next day menu may include liquid foods - oatmeal on the water, diet soups, dairy products. In the future, the diet can include boiled beef, chicken breast, baked apples or bananas. It must be remembered that in the first week after the operation, alcohol, strong tea or coffee, sugar, fried and fatty foods are prohibited.
Litholytic therapy
If surgical intervention is not possible due to severe somatic diseases or blood coagulation disorders, as well as in case of patient's refusal from surgery, litholytic therapy is performed. This is a method in which preparations containing bile acids are used to dissolve the stones formed. Starting it, you need to take into account that the duration of treatment can be from one to two years, and even if you manage to completely dissolve the stones in the gallbladder, this does not guarantee that they will not appear again. In addition, various complications of cholelithiasis may occur during treatment, including those requiring surgical intervention.
Criteria for litholytic therapy
Another limitation of litholytic therapy is certain requirements for the criteria of the disease:
- Stones in the gallbladder should be cholesterol, dimensions not exceeding 20 mm.
- The functions of the gallbladder are preserved, and the stones do not occupy more than half of its volume.
- The cystic and common bile duct must maintain their patency.
- More than two years have passed since the formation of stones.
- The history should include an uncomplicated course of the disease - mild pain, rare bouts of hepatic colic.
Treatment is carried out under the supervision of ultrasound once every 3-6 months. If after six months there is no improvement, then it is considered ineffective, and the question of surgical intervention is again raised. If litholytic therapy was successful, then in order to detect newly formed stones in the gallbladder in time, an ultrasound scan is done at least once every three months.