Laparoscopy of the gallbladder: preparation,removal that after surgery

Update: December 2018

The gallbladder is one of the most important digestive organs.
system under the liver whose role is to
concentration and accumulation of bile, which produces the liver. Bile
plays a crucial role in the digestive process, it is from the liver
penetrates the gallbladder through the bile ducts.

When a person takes food, from the accumulated in the gallbladder
bile, through the ducts excreted into the duodenum, it
breaks down fats, activates enzymes. With the development of various
gallbladder diseases, stone formation, in many cases
recommended removal of the gallbladder by various methods, among
the most benign is laparoscopic removal
gallbladder. The main technologies owned by modern
surgeons operating various forms of cholecystitis are as follows:

  • Open laparoscopic cholecystectomy – OLHA from
    mini-access, while using the tools “Mini –
    assistant”
  • LCE – Video laparoscopic cholecystectomy
  • THC – Traditional cholecystectomy, which is produced from
    oblique or median laparotomy access, if indicated
    interference is made on ducts

Who shows gallbladder laparoscopy?

To date, it can be performed for all types and
complications of gallstone disease, but each specific
the clinical case is thoroughly examined and with risks
and contraindications resort to abdominal operations.
Laparoscopic cholecystectomy is indicated:

  • With acute cholecystitis during an attack in the first 2 days
  • With chronic calculous cholecystitis
  • The presence of obstructive jaundice and stones in the ducts, with
    This shows a laparoscopic choledocholithotomy, which removes only
    stones from the bile ducts.
  • Stone carrying – that is, asymptomatic cholecystolithiasis.

It is very important to diagnose cholecystitis in time and
the presence of gallstones, the most simple and affordable
a study is an ultrasound of the abdominal organs, especially if
constantly or periodically a person is worried about pain in the right
hypochondrium, discomfort after eating, nausea, etc. (see
Cholecystitis symptoms and treatment). In addition to gallstones ultrasound
can reveal polyps or polyposis of the gallbladder that is threatened
oncological condition, as polyps of internal organs
considered prenatal conditions.

The tendency to stone formation occurs most often in women
over 50 years old, especially in the presence of obesity, diabetes mellitus
women, other metabolic disorders (see diet with stones in
gall). Причем, у  60-80% пациентов холецистит протекает
asymptomatic or sometimes manifested as biliary colic – an attack
acute pain from 15 minutes to 6 hours when the duct overlaps
stone, with pain may radiate to the right shoulder, to the area
the stomach, between the shoulder blades, usually happens at night or in the evening,
accompanied by vomiting. When the diagnosis of calculous is established
cholecystitis should be addressed
плановой холецистэктомии.

What is the operation for diseases of the gallbladder
sparing?

Given that the occurrence of gallstones at
chronic calculous cholecystitis is directly related to the violation
patient’s metabolic rate, mechanical disposal of them, i.e.
removal or crushing does not lead to cure, and stone formation
happens again.

Therefore, laparoscopy to remove gallbladder stones today
practically not performed, but to treat calculous cholecystitis
taken only by the radical method – removal of the gallbladder –
cholecystectomy. Most often it is produced as laparoscopy.
gall, the price of which varies by region and
specific clinic from 9 thousand to 90 thousand rubles and is considered
most modern, progressive, more sparing operation.

What are the advantages of LCE laparoscopic cholecystectomy over?
open cavity cholecystectomy:

  •  The risk of the development of postoperative hernia is reduced,
    since small cuts no more than 2 cm reduce the risk to
    the minimum.
  • With an open operation, the length of the incision can reach 20 cm and
    healing, especially when loose constitution, can be very
    long, with LCE, the incisions are 0.5 -2 cm, there are only 4 of them and
    healing is much faster.
  • For the same reasons, postoperative pain after laparoscopy
    significantly less.
  • Hospital stay is also reduced from 2 to 5 days.

Are there any contraindications for laparoscopic
cholecystectomy?

And even with a lot of advantages over other operations,
laparoscopic cholecystectomy, like any surgical
interventions have contraindications – this is primarily the presence
past surgical interventions in the abdominal cavity, on the stomach,
spleen, liver with injuries and wounds, as well as during operations on
intestines. The presence of adhesions or increments to the internal abdominal wall
organs during laparoscopic surgery increase the risk of injury
of these organs when inserted into the abdominal cavity of instruments.

Also in diseases of the lungs and respiratory failure,
such an operation may also be contraindicated because
pumping gas into the abdominal cavity during bile laparoscopy
bladder, the diaphragm is displaced, and the muscle that separates the abdominal
organs from the chest organs, shifted upwards, which creates
additional breathing problems.

Also contraindications include:

  • significant pulmonary disorders
  • general and diffuse peritonitis
  • uncorrected bleeding disorders
  • Grade 2-3 obesity
  • Late pregnancy

In addition to these major contraindications, there are also other
undesirable factors that can be identified during the examination
patient and then use gallbladder removal open
by.

Preoperative preparation

Preoperative examination of the patient should include the following
analyzes and procedures:

  • Clinical analysis of urine, blood, the importance of ESR
  • Биохимическое исследование крови, включающее АсаТ, К, Na,
    Cl, AlaT, bilirubin, urea, alkaline phosphatase, total protein,
    total cholesterol, protein fractions, glucose, fibrinogen,
    creatinine.
  • Hepatitis, HIV, syphilis, blood type tests,
    rhesus factor
  • ECG, fluorography, endoscopy
  • Coagulogram
  • Conclusion of the dentist and therapist

After the patient enters the ward, the surgeon examines
patient, evaluates the results of all tests, all the benefits and
risks of laparoscopy, and offers the best option in each
specific clinical case. As a rule, after 6 pm
on the eve of the operation, eating is not recommended, you can not drink
after midnight, evening and morning cleansing enema is performed.
But taking such medicines as anticoagulants,
Aspirin, NSAIDs and Vitamin E should be stopped 10 days before
intended operation.

How is the operation?

Laparoscopic cholecystectomy is performed under
endotracheal anesthesia (general). To facilitate the visualization of all
abdominal organs, the surgeon with a special needle introduces
gas into the abdominal cavity. Special 4 incisions are special
tools and video camera.

To carry out the removal of the gallbladder during laparoscopy
it is necessary to cut off the arteries and cystic duct, so on them
metal clips are specially superimposed. Through one of
gallbladder extraction occurs from the largest incisions,
thin drainage is laid to the gall bed, on the wound
stitched over.

When a strong inflammatory
process, when the voltage of the gallbladder, the growth of the surrounding
organs or multiple adhesions – complete laparoscopic surgery
method in such cases fails because the risk is high
damage to nearby organs.

Then the surgeons go to open abdominal surgery, so
each patient is warned before laparoscopy of the gallbladder
about the possibility of such an emergency option.

Local contraindications to such an operation are usually identified.
before surgery, but may show up during laparoscopic
inspection and surgery:

  • Intrahepatic Gallbladder
  • Acute pancreatitis or obstructive jaundice
  • Oncological process in the gallbladder
  • Significant cicatricial – infiltrative changes in
    hepatoduodenal link and gall neck

Postoperative period

Immediately after the laparoscopic operation of the gallbladder, the patient
delivered to the ward, within an hour the patient usually wakes up,
sometimes dyspeptic disorders like
nausea, the reception of Cerucal stops it. Usually after a few
hours, pains of varying intensity begin to occur, which
necessarily relieve anesthetics, even
narcotic analgesics.

  • Infusion therapy is indicated only if indicated.
  • Antibiotics are prescribed when the body is dehermetized during
    LCE or acute inflammation of the gallbladder.
  • Nothing is allowed to eat on the first day after laparoscopy
    the next day the ligation is performed and if the patient does not have
    drainage discharge, it is removed.
  • Feeding begins on day 2. Gradually patient over 2-3
    days begins to return to normal walking, begins to take
    food fractional, little by little, only diet food.
  • In the hospital, the patient is usually 1-7 days, which
    determined by the nature of the operation and the characteristics of the clinical
    case.

In the absence of bad tests, temperature, severe pain,
non-healing wounds, the patient can go home up to 7 days. Then
he comes already for discharge, removal of sutures, recommendations for
diet food and obtaining a sick-list. Usually,
a couple of weeks after surgery, the patient returns to his usual
lifestyle, including sports and light physical labor.

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