What is elective gallbladder surgery? Laparotomy of the gallbladder postoperative period

Because the hepatic angle of the colon often closes the descending part of the duodenum and the head of the pancreas; it is mobilized by cutting the peritoneal ligaments cranial to the hepatic angle. After this, the colon is retracted in a caudal direction using a Mikulicz pad. The stomach is moved medially using the same pad.

On infundibular part of the gallbladder apply a Kelly clamp, and then pull it cranially and laterally. The serosa covering the porta hepatis is dissected and the portal structures are then identified (Fig. 2). The cystic duct is usually easily found first. It is bandaged with silk ligature No. 2/0. Double ligation of the cystic duct prevents the migration of gallstones through the cystic duct into the common bile duct, which is possible during manipulation of the gallbladder.

Preparation of Callot's triangle allows you to identify the cystic artery, which can arise from the common hepatic artery or (more often) from the right hepatic artery. Their anatomy is extremely variable, so dissection in this area should be carried out carefully, carefully identifying the cystic duct and artery along its entire length, so as not to injure abnormal structures. The right hepatic artery often accompanies the cystic duct and/or gallbladder before bending back toward the liver parenchyma. Therefore, over a distance of 1-2 cm it can easily be confused with the cystic artery.

Dissect arteries it is necessary so that the place where the cystic artery enters the gallbladder is clearly visible. The cystic artery often reaches just above the cystic duct, in a perpendicular direction. Let us again emphasize that the artery running parallel to the cystic duct is most likely the right hepatic one.

Anatomy of the cystic duct may also cause confusion for the surgeon. The cystic duct usually drains into the common bile duct, but it may drain into the right hepatic duct or into one of the two segmental ducts of the right lobe of the liver. In addition, it can form very low, behind the duodenum and rise parallel to the common bile duct into the porta hepatis, only then deviating to the right towards the gallbladder.

This area should be prepared with all care, completely, in order to be confident in her anatomy- only in this case there will be no injury to important structures at the gates of the liver. If the anatomical features of the place where the cystic duct enters the common bile duct remain unclear, the surgeon should stop dissection in this area and begin mobilizing the gallbladder from the fundus. Once the gallbladder is mobilized from its bed on the liver, the anatomy of the cystic duct region will become clear. Sometimes early cholangiography, performed by injecting contrast directly into the gallbladder or ducts, helps. Opinions remain controversial as to whether cholangiography should be performed at every cholecystectomy.

After implementation laparoscopic cholecystectomy, in which routine cholangiography is more complex and time-consuming, the arguments in its favor have become less significant. Nowadays, many surgeons believe that cholangiography should be performed only in selected cases. Nevertheless, everyone agrees that when the anatomy of the biliary tract is unclear, cholangiography is necessary.

After anatomy of the cystic artery becomes clear, it is bandaged with three silk ligatures No. 2/0 and crossed. We again want to emphasize that it is unacceptable to ligate and cross this vessel if there is no complete confidence that it is the cystic artery. Mobilizing the fundus of the gallbladder and retracting it from top to bottom before dividing the cystic artery usually helps to understand the anatomy.

When cystic artery will be divided, the gallbladder will be mobilized from its bed on the liver. I prefer to mobilize it from the top down. The serosa is incised at a distance of 3-4 mm from the liver and then lifted with a graceful clamp. Using an electric knife, the serous membrane is cut from top to bottom along the circumference of the entire gallbladder. Then the bubble is removed from its bed using a coagulator, sharp (scissors) or blunt dissection. It must be remembered that small abnormal ducts can flow into the bladder directly from the liver. They need to be clamped and ligated or bandaged with stitching.

If cystic artery was bandaged before mobilization of the gallbladder, mobilization proceeds almost bloodlessly. Any bleeding can be easily stopped with an electric knife or argon plasma coagulator.

After complete mobilization of the gallbladder from its bed the anatomy usually becomes clear, and if the cystic artery has not yet been ligated, its ligation becomes possible. If the surgeon wishes to perform intraoperative cholangiography, after mobilization of the gallbladder it is the turn of this procedure.

Most patients with a normally functioning liver, in the absence of clear indications for cholangiography, the latter is not needed. However, in some cases intraoperative cholangiography cannot be avoided. If a patient has a history of cholangitis or pancreatitis, and multiple small stones are found in the gallbladder, many surgeons are inclined to perform cholangiography. If the common bile duct is dilated and there is a clear history of choledocholithiasis, cholangiography is also necessary.

After Cystic duct ligation near the neck of the gallbladder, distal to the ligature on the cystic duct (approximately 1 cm from the point where the cystic duct enters the common bile duct), a small hole is formed. A cholangiography catheter is inserted through the hole and secured with a No. 2/0 silk ligature tightened around the distal part of the duct containing the catheter. After obtaining adequate cholangiograms, the cholangiocatheter is removed, two clamps are applied to the duct, and then crossed between them. The gallbladder is removed from the surgical field.

Cystic duct stump ligated with silk No. 2/0. Many surgeons, like us, continue to use silk. Others believe that a silk ligature can become a source of gallstone formation, so they use a synthetic absorbable thread. You can also use clips. The latter are routinely used in laparoscopic cholecystectomy. The right outer quadrant is thoroughly washed with saline solution with antibiotics or an antiseptic (for example, an aqueous solution of chlorhexidine), final hemostasis is carried out in the bladder bed using an electric knife or an argon plasma coagulator, and the abdominal cavity is closed.

Majority surgeons drainage is not installed after conventional cholecystectomy. However, if this operation was performed due to acute cholecystitis, or if there was bile leakage from the liver bed, it is reasonable to install a closed suction silicone drainage*.

*If there is any doubt about the possible development of complications (inflammation with exudation, bile leakage, bleeding, even capillary), external drainage of the subhepatic space is required.

In many research It has been proven that after cholecystectomy there is no need for drainage. The only argument in favor of leaving drainage in the subhepatic space is unpredictable bile leakage from a small, inconspicuous bile duct in the gallbladder bed. The drainage tube allows you to do without percutaneous drainage in the event of the formation of a bile duct or abscess. Although the likelihood of such complications is small, in our opinion, the discomfort from the drainage tube is better than the threat of subhepatic abscess or biliary peritonitis after surgery for acute cholecystitis, or leakage of bile from the bladder bed.

If there is no discharge through the drainage within 48 hours, it can be removed, often even in a day hospital. There is virtually nothing wrong with draining the surgical site after an elective cholecystectomy.

Today, laparoscopic operations are not at all new to our society. In surgical treatment, laparoscopy of the gallbladder accounts for 50-90% of all such cases. In the article, we will take a closer look at the very concept of such an operation, how it is carried out, and why it is beneficial for human health.

What it is?

Laparoscopy is a highly effective, safe and low-traumatic method of surgical intervention on internal organs. For this reason, treating gallstone disease with this method has long become a common daily operation.

What is this treatment? In everyday life, this means surgical therapy, during which the severed gallbladder is removed from a person along with the stones formed in it, using an important device - a laparoscope.

Today, practically no operations are carried out so that the organ can be preserved and only numerous gallstones can be removed. If the stones are single, then other methods of removing them are used, such as:

Dissolution using medications;
Crushing using laser equipment;
Shock wave litholripsia.

During these treatments, the dissolved stones are eliminated from the body naturally.

To better understand what laparoscopic treatment of the gallbladder is, you should first become familiar with how this therapy differs from laparotomy. Let's get acquainted with the basic principles.

Laparoscopy

This type of surgical treatment is performed using auxiliary instruments:

Apparatus – laparoscope;
Manipulators in the form of trocars.

What is a laparoscope? This is a kind of device with a built-in flashlight for illuminating the work area and a video camera. The surgeon inserts the camera into the patient’s abdominal space, having first made a small incision (1 cm) in it.

During the operation, all his manipulations are visible on the screen thanks to a video camera. This helps the doctor monitor his actions. The advantage here is that there is no direct contact with the diseased organ being removed, but only visual contact.

The surgeon controls the instruments necessary for the operation using trocars. These are nothing more than hollow tubes, which are also inserted through punctures into the abdominal space. They are necessary to deliver the required instrument to the organ to be removed. The tubes have manipulator devices, with their help the doctor is able to move the instrument inside the abdomen.

In short, the doctor carries out the entire process of laparoscopic surgery using only three tubes:

A video camera is inserted into the first tube to display the image on the screen;
The other two tubes are needed to work through them with a surgical instrument.

All stages of both surgical interventions and their essence are completely identical.

Laparotomy

This is the most common abdominal operation, which the surgeon performs by making a large and deep incision in the abdominal cavity (its front part) using a scalpel. Through the incision, the doctor inserts instruments and removes the patient's diseased organ.

Laparotomy means the following: “lapar” means the stomach, and “tomy” means cutting.

Indications and contraindications for laparoscopy

In medical practice, gallbladder diseases are quite common. There are many reasons for this, for example:

Unfavorable environmental data;
Frequent stressful conditions;
A person consumes fatty foods in abundance, and even of poor quality.

All this, in turn, leads to the development of various pathologies, and as a result, gallstone disease develops. If the presence of this disease does not in any way affect the functionality of the human body, then conservative treatment can be prescribed.

Let's consider what indications for laparoscopy may be, and in which cases this type of treatment is not indicated for the patient.

Indications	Contraindications
An inflammatory process is observed in the gallbladder, during which stones are formed.	Intervention is not performed if pus formation is detected in the area of the cut-off bladder.
Chronic cholecystitis without stone formation.	Severe pathologies of the respiratory or cardiovascular system.
A polypous growth of size was found in the gallbladder<10мм.	Third trimester of pregnancy.
An excessive amount of cholesterol is deposited on the walls of the bladder space.	The presence of previously performed laparoscopic interventions on organs located in the abdominal space.
Cholecystitis in the acute stage, where the attack lasts more than 1-3 days.	The gallbladder has an intrahepatic location.
Multiple presence of stones in the gallbladder.	The patient has pancreatitis in an acute stage.
The presence of various pathologies leading to the development of adverse side effects	Obstructive jaundice, resulting from poor patency of the bile ducts.
	Poor blood clotting ability.
	Presence of a pacemaker.
	Near the bubble there is a flaw or hole of unknown origin.

Preparing for surgery

Before surgery, which will be carried out according to plan, the patient should submit the necessary tests to the laboratory:

Blood - general and biochemical analysis, for the presence of various types of jaundice, AIDS, blood type, Rh;
Urine fluid;
Coagulogram;
Electrocardiogram;
Women are given a vaginal smear.

If the test results are completely normal, then the patient can be operated on. If unacceptable deviations are detected, you will first have to undergo medical therapy to normalize the condition.

Expert opinion

Shoshorin Yuri

General practitioner, site expert

The day before surgery, you should stop eating any food from 18:00, and stop drinking liquids from 22:00. Late in the evening, the medical staff on duty gives the patient an enema to cleanse the intestines. Today it is practiced to take a strong laxative, but it is not indicated for everyone.

How is the operation performed?

Before the laparoscopic procedure to remove the gallbladder begins, anesthesia is administered to relieve pain and tissue sensitivity. In addition, anesthesia causes the abdominal muscle tissue to relax.

After administering anesthesia, the anesthesiologist inserts a probe through the patient's mouth to remove gases and remaining fluid from the stomach. This will help prevent an accidental gag reflex to prevent asphyxia. The probe is removed after the operation.

As soon as the probe is installed, a mask is placed on the lower part of the patient's face for artificial ventilation of the lungs. A person breathes through it during surgery. During laparoscopy, ventilation is simply necessary, since gas smoke is supplied into the abdominal space. It presses on the diaphragm, pressing against the lungs.

After all these preparatory procedures, the nurse treats the desired area with an antiseptic, and then the surgeon and assistants begin the surgical procedure. 3 incisions are made - one near the navel and two on the sides of the right hypochondrium. Carbon dioxide is pumped in to straighten the internal organs so that they do not interfere with the surgical process.

A laparoscope, illuminated video camera and other important trocars are inserted through the incisions. Inside the abdominal space, the surgeon manipulates them in the right directions, as a result of which he removes the gallbladder that is unsuitable for normal functioning. Removal occurs through a cosmetic incision made near the navel.

At the end of the surgical process, the blood vessels are coagulated, and an antiseptic solution is injected into the abdominal cavity. With its help, disinfection is carried out, after which it is sucked out. The trocars are removed, and the doctor sutures the incisions.

Using the laparoscopic approach, cholecystectomy can also be performed. During this procedure, the patient is given general anesthesia, and artificial ventilation of the lungs is mandatory by connecting to a machine.

Another name for anesthesia is “gas exposure.” Anesthesia is given to the patient using a machine through a special tube through which he breathes during surgery.

The exception to administering such anesthesia is if the patient has bronchial asthma. In this case, endotracheal anesthesia is replaced with general intravenous anesthesia.

Consequences

After laparoscopic surgery, as after any surgical intervention, unpleasant consequences may occur that cause severe discomfort. The main problem is the release of bile that goes directly into the duodenum. This process in medicine is called “subsequent cholecystectomy syndrome.”

With this diagnosis, the patient may experience the following symptoms:

Gag reflex and nausea;
In some cases, there is an increase in temperature;
Pain and rumbling in the abdomen;
Stomach upset and flatulence;
Bitterness when belching, heartburn;
Jaundice.

Expert opinion

Shoshorin Yuri

General practitioner, site expert

Unfortunately, some patients, even after laparoscopic surgery, may experience these symptoms throughout their later lives. It is almost impossible to completely get rid of them.

Possible complications

Any unforeseen situations or complications may arise both during surgery and after the operation.

The following complications may occur during laparoscopy of the gallbladder:

On the abdominal wall, the doctor can damage blood vessels;
The stomach, gallbladder and other nearby internal organs may be punctured or damaged by the laparoscope;
Bleeding may begin from the liver bed or gallbladder artery.

Complications of a more complex nature are eliminated with another operation - laparotomy.

Due to the removal of the organ and nearby tissues, the patient may also experience some complications.

If, after removing the gallbladder, its stump was poorly sutured, bile could enter the abdominal cavity;
Peritonitis;
The tissue around the navel could become inflamed.

In very extreme cases, 5-7% of patients may experience a hernia after laparoscopy. Most often this happens in people with large body weight. Or this complication occurs in those patients who underwent emergency surgery and were not planned in advance.

Advantages and disadvantages

Let's consider what advantages the laparoscopic method of gallbladder removal has.

Laparoscopy is a closed technique, and thanks to this, the interaction of internal organs and tissues is completely eliminated during the operation. There is also no risk of contracting infections.
This operation requires small incisions to be made. This in turn reduces the traumatic process of the operation.
After laparoscopy, no scars are formed, so the abdomen will not be cosmetically damaged.
Short postoperative period, no more than 3 days.
Those who cannot miss work can start it in a week.

With all its advantages, such surgical intervention also has a number of disadvantages. Let's get to know them.

If the patient has chronic diseases of the cardiovascular or respiratory system, then laparoscopy is not indicated for him. Because carbon dioxide is injected into the abdominal cavity during surgery, there is a risk of compression of the lungs or heart. This can lead to increased pressure in the venous system, and there may be complications in the functioning of the heart. Or there will be strong pressure on the diaphragm, making breathing difficult.
Diagnostic manipulations and possibilities during the operation are somewhat limited.
Laparoscopy cannot be performed if the patient’s situation is too advanced. In these cases, unexpected pathologies may occur in the gallbladder, and additional surgical adjustments will be required.

If at least one of these points is present, a traditional laparotomy is performed.

List of permitted and prohibited products

You can eat	It is forbidden to eat
You can include lean meat in your diet, such as veal, chicken, as well as turkey and rabbit meat.	Exclude meat and dairy products with high fat content.
Sea fish or river predators, such as hake, pollock, perch or pike.	Fried foods should not be consumed.
Porridge is cooked from cereals until semi-liquid.	Smoked products are prohibited. Any offal.
Boil low-fat infusions and make soups from them; you can also add vegetables, pasta or cereals.	Spicy dishes, pickles and marinades.
Vegetables can either be stewed, boiled, or steamed.	Rye bread or fresh baked goods, any baked goods.
It is allowed to eat white bread, but yesterday's bread, not fresh.	Black coffee, chocolate, cocoa.
Boil compotes, prepare jelly only from non-acidic varieties of fruits or berries.	Alcohol.
Honey.	Mushrooms in any form are not recommended.
Low calorie dairy products.	Raw vegetables.

Allowed products are subjected to heat treatment - boiled, steamed or baked in the oven.

This is a minimally invasive surgical intervention aimed at removing the gallbladder using endovideosurgical techniques. Laparoscopic cholecystectomy is the international standard for the treatment of gallbladder pathology requiring its removal.

Indications for surgical treatment

Possible complications if treatment is not timely.
1. Gallstone disease: chronic calculous cholecystitis, acute calculous cholecystitis or exacerbation of chronic cholecystitis.
The presence of stones in the cavity of the gallbladder can lead to a number of serious complications such as:

Bedsore of the gallbladder wall (a large stone that is constantly in one place can cause perforation of the bladder, which will lead to the contents of the gallbladder entering the abdominal cavity) - in most medical centers an open operation (open or classic cholecystectomy) will be performed with an incision of 10 -15cm.
An acute attack of biliary colic (in the presence of an obstruction to the outflow of bile through the cystic duct), in the case of the presence of a stone, this will be the obstacle.
An acute attack can lead to the development of a phlegmonous (festering) gallbladder. This is followed by a transition to a gangrenous gallbladder (the gallbladder tissue becomes necrotic); ultimately, everything will lead to diffuse peritonitis and emergency surgery, where there is no talk of a cosmetic effect and the percentage of deaths remains high.
During an acute attack, a stone can enter the main bile duct and block the exit of all bile into the intestines (the liver produces 2-3 liters per day), and this will lead to rapidly progressing jaundice. If the necessary medical interventions are not performed within a few days, liver failure may develop and, as a result, death. In this case, first, endoscopic Retrograde CholangioPancreatoGraphy (ERCP) is performed (an attempt to eliminate the blockage of the site where bile exits into the intestine with a stone); if this procedure does not produce a positive effect, a laparotomy is performed with a reconstructive operation lasting 4-6 hours.

The presence of stones in the gall bladder is an indication for surgical treatment.
2. Chronic acalculous cholecystitis - with this type of cholecystitis, the patient can be observed for a long time, emergency indications for surgical intervention for this type of cholecystitis are rare, there are cases when the patient does not have time to be discharged from the surgical hospital, but the attack resumes. In this situation, the patient’s quality of life deteriorates greatly. In such cases, surgical treatment is recommended.
3. Gallbladder polyps - it is important to distinguish between true (parenchymal polyps) and cholesterol polyps. Cholesterol polyps (cholesterosis of the gallbladder) are small in size, do not have blood flow, can be in large numbers, as a rule, they are the result of an error in diet and are not an indication for surgical treatment. It is recommended to perform an ultrasound of the abdominal organs once every 6 months, since polyps can dissolve or form cholesterol stones. If there are negative dynamics and all the recommendations of the attending physician are followed, removal of the gallbladder is indicated.
4. Parenchymal polyps (they have blood flow and are part of the mucous membrane) are a common pathology that requires dynamic observation and assessment of the growth of the polyp over time (first identified requires ultrasound monitoring after 3 months, then once every six months), if within a year the polyp has increased by 0.5 cm, or its total size is more than 1 cm, this is an indication for surgical treatment, since the chance of malignancy (degeneration of a benign polyp into a malignant one) of gallbladder polyps is high.
5. Oncological diseases are a 100% indication for surgical treatment, and cholecystectomy can also be part of major surgical interventions (for example, for cancer of the large duodenal papilla).
During laparoscopy of the gallbladder, in all of the above cases, the entire gallbladder is removed (preserving the organ not performing its function will lead to relapse of the disease).

Preparation for laparoscopic cholecystotomy surgery

Before surgery, before hospitalization or directly in the hospital, the patient must undergo a number of laboratory tests:

general blood analysis,
general urine analysis,
blood chemistry,
coagulogram,
blood type
Rh factor

Laboratory test results are valid for 10 days. It is necessary to undergo FibroesophagoGastroDuodenoScopy (FEGDS) to exclude acute pathology of the esophagus, stomach, duodenum, since surgery is stressful for the body and can lead to exacerbation and bleeding (it is advisable to perform this procedure 1 month before surgery or earlier). The day before the operation, the patient is examined by an anesthesiologist.

Modern medicine works according to Fast Track standards, this is a multimodal strategy for the active treatment of patients requiring surgical intervention. This strategy includes a set of measures before surgery, during surgery and after surgery (the approach described below is based on these protocols).

Eating solid food is prohibited 6 hours before surgery, and liquid food 2 hours before surgery.

Before the operation, the patient is shown elastic compression (2 classes) of the legs of both lower extremities; this measure is aimed at preventing thrombosis. For the same purpose, the patient is prescribed low molecular weight heparins (fagmin, fraxiparin, etc.) in the evening before surgery.

In the morning, 1 hour before surgery, the patient is given premedication, which includes a broad-spectrum antibiotic and sedatives. The surgical field is shaved (if necessary).

Laparoscopic cholecystectomy is performed under endotracheal anesthesia (the patient breathes using an artificial respiration apparatus). This type of anesthesia is preferable, since during the operation a pressure of 14 mm is created in the patient’s abdominal cavity. rt. Art., which creates pressure on the diaphragm and problems with spontaneous breathing may occur.

Progress of the operation

After processing the surgical field, a 1-1.5 cm incision is made above the navel where a 10 mm optical trocar is installed (a video camera is inserted through it), then a 1 cm incision is made in the epigastric region (under the xiphoid process), a 10 mm trocar is placed for the manipulator, a 5 mm incision is made in the right hypochondrium and They install another manipulator.

There are several options and methods for installing trocars, the presented option provides 3 ports, classic laparoscopy of the gallbladder is performed through 4 incisions. In our medical center it is performed through 2 incisions. If you take a more expensive option, you can use a single port, in which surgery is performed through 1 incision above the navel (about 2 cm).

There is also the option of performing laparoscopic cholecystectomy using a robotic surgeon; the operating surgeon is located at the control panel and not at the operating table. It is worth noting that this is more convenient for the surgeon, but it makes no difference to the patient (only much more expensive).

But there are patients for whom laparoscopy is contraindicated (severe concomitant pathology, severe heart failure, severe adhesions in the surgical area, advanced forms of acute cholecystitis) and open cholecystectomy becomes the operation of choice.

Open surgery is much inferior to laparoscopy:

high level of trauma;
poor cosmetic effect;
long period of rehabilitation;
high risk of postoperative complications (wound suppuration, postoperative hernia, etc.);
the operation time increases significantly.

Regardless of the number of ports, the technique for performing the operation is the same. The division of the operation into stages in this article is solely to simplify the understanding of the procedure being performed.

Stage 1

Revision of the abdominal cavity - a visual assessment of the condition of the abdominal organs is performed (large and small intestines, greater omentum, gall bladder, visible part of the stomach, uterus, ovaries, the presence of adhesions, hernia defects).

Stage 2

Mobilization of the gallbladder, if necessary, most often due to adhesions in the gallbladder area.

Stage 3

Clipping of the cystic duct, gallbladder artery. This is the most difficult and critical stage, since important anatomical structures pass near this place and damage to them will lead to serious complications.

Stage 4

Isolation of the gallbladder from its bed is performed by monopolar coagulation. At this stage, there is a possibility of damage to the integrity of the gallbladder; the bile is removed by vacuum suction and no problems arise in the postoperative period; this is a normal and quite common situation. After its removal, the bladder bed is additionally coagulated (if necessary).

Stage 6

The next stage is a revision of the operation site and the trocar insertion site. If necessary, hemostasis is performed (stopping bleeding, most often capillary); for insurance, the surgeon can leave a drainage tube at the operation site (if complications develop: bleeding or bile leakage, it will allow you to quickly respond and take the necessary measures). Removing instruments and suturing postoperative wounds.

Surgery time can vary greatly, but averages from 20 to 60 minutes.

Postoperative period

The patient awakens directly on the operating table under the supervision of an anesthesiologist, then the patient is transferred to the intensive care unit and remains there for the first few hours after the operation and only then is transferred to the ward of the surgical department (each medical institution has its own rules and therefore the stage with resuscitation may not be be).

On the first day after the operation, the patient is allowed to drink only water in small sips (nausea and vomiting may occur), 4 hours after the operation the patient can be put on his feet under the supervision of a doctor, the patient can go independently for minor needs.

The next day, a control ultrasound of the abdominal organs is performed, bandages are changed, and postoperative wounds are inspected. During all procedures, the patient walks independently under the supervision of a nurse; when the patient actively moves, elastic compression can be removed from the legs. The patient's diet consists of mucous decoctions, not fatty broths. And the next day, after dressing and receiving dietary recommendations (a link to dietary recommendations after the operation has not yet been written), the patient is discharged for outpatient treatment under the supervision of a surgeon.

Hospitalization is 3 days, temporary disability (sick leave) is on average about 15 days (individually). The sutures are removed on the 10th postoperative day by a surgeon.

According to international statistics, 95% of operated patients do not experience the slightest discomfort from the absence of a gallbladder (statistics were collected from patients 2 months after surgical treatment).

Removal of the gallbladder, or cholecystectomy, is a simple surgical intervention, with a favorable outcome the patient must be discharged after 5-6 days. Surgery can be prescribed for a number of pathologies that can cause harm to the patient’s body.

The appointment of abdominal surgery to remove the gallbladder is carried out by the doctor after reviewing the patient’s test results. Main indications for cholecystectomy:

Gallstone disease. Pathology accompanied by the formation of gallstones.
Choledocholithiasis. In this disease, stones are present in the bile ducts.
Cholecystitis. Inflammatory processes accompanied by acute pain in the gallbladder and surrounding areas.
Pancreatitis. Inflammatory course in the pancreas of various etiologies.

Important! A relative indication for surgery is the presence of chronic cholecystitis in the patient, in which stones form in the gallbladder and its ducts.

Preparatory activities

Before the operation begins, the patient must prepare for surgery. Colon lavage is a mandatory procedure, which is carried out in two ways:

Enema. Esmarch's mug is filled with a certain amount of warm liquid. The tip is inserted into the patient's anus, and the liquid is slowly introduced into the rectum.
Taking medications. If there are any contraindications to administering an enema to a patient, the patient is given special medications with a laxative effect. One such medicine is Fortrans.

5-6 hours before the planned intervention, the patient should take a solution that allows the intestines to be completely freed from fecal residues. In the last 12 hours before cholecystectomy, the patient is prohibited from eating. Drinking is strictly prohibited 4-5 hours before the intervention.

The patient must inform the doctor about all medications used recently. This will prevent possible allergic reactions of the body to anesthesia in advance.

Types of operations and their advantages

Surgery can be performed in two ways. These include:

laparoscopy,
laparotomy.

Laparoscopy of the gallbladder involves complete or partial removal of the internal organ using a laparoscope and a manipulator. Today, this method is the most popular due to the almost complete absence of scars. The laparoscope is a long rod equipped with a small video camera and a lighting device (flashlight). The device is inserted into the abdominal cavity through a small puncture. On the monitor, the surgeon sees the internal organs and is guided by the image on the screen.

The role of a scalpel is performed by a trocar - a hollow tube. It has several special devices with which the doctor cuts the organ, applies a clamp or cauterizes the blood vessels. All surgical interventions are performed using 3 instruments. After laparoscopy, small scars with a diameter of 1.5-2 cm remain on the patient’s body.

Laparotomy is a “traditional operation” that requires cutting into the patient's abdomen. The incision is made using a scalpel; the presence of other tools (for example, a clamp) is required. The surgeon sees the internal organs with his own eyes, without a monitor. After the operation, a noticeable scar is left on the patient's abdomen.

On a note! Both operations are performed using the same technique. The rules and stages are the same in both cases. Both surgeries are performed under general anesthesia.

The first day after the intervention

In the first 24-48 hours, the patient is in the intensive care unit. Visits during this period are prohibited, the patient is in a state of sleep. At the same time, anti-inflammatory solutions and antibiotics are injected into the patient’s vein. After 6-10 hours (depending on the individual characteristics of the patient), consciousness begins to return.

The patient is prohibited from getting up and sitting on the bed. The first 12 postoperative hours must be spent in a horizontal position. Medical staff are obliged to provide a vessel upon the patient’s first request.

The first feeding is allowed no earlier than 24 hours after surgery. If there is a threat to health, the patient is not able to eat on his own, he is injected with a maintenance solution into a vein. For patients in serious condition and who are conscious, food is administered through a tube (a tube through which food enters directly into the stomach).

The patient's diet in the first 24 hours after surgery includes warm, easily digestible broth. The liquid should not be greasy; viscous oatmeal porridges cooked in water are allowed. Cereals serve as building materials for cells and contain amino acids and vitamins that are beneficial for a weak body. Fiber in porridge normalizes intestinal motility.

Important! Products that contribute to excessive gas formation (mineral water, carbonated drinks, bread and dairy products) are prohibited.

3-4 days after surgery

If there are no complications after surgery, the patient is transferred to a regular ward after 72 hours. The patient can get up and go to the toilet independently, provided that the abdominal cavity is supported by a bandage. Movement should be slow.

The diet is gradually expanding. It is allowed to eat low-fat fish, which include pollock, pike perch and hake. Within reasonable limits, you can eat poultry, rabbit or veal. Food must be boiled or steamed. Fish and meat must be present in the diet - they contain a large amount of proteins, from which connective tissue is formed.

The lack of vitamins is eliminated with the help of drinks made from fruits and berries. A decoction of rose hips and juniper, compotes of raisins and apples restore the balance of minerals and vitamins in the body. You can eat fresh herbs, especially parsley.

Pastries, chocolate and other sweets should be temporarily excluded from the diet. Products contain large amounts of glucose, which slows down the recovery processes in the body.

Rehabilitation

The recovery process takes a long time. The body needs to completely rebuild. During the rehabilitation period, it is necessary to strictly adhere to all instructions of the attending physician. A set of measures to speed up recovery:

On a note! The activities relate to the post-hospital period. Conducted after discharge.

Video - Cholecystectomy gallbladder removal

Lifestyle after surgery

The correct actions of the patient after discharge directly affect his future life. The liver produces bile continuously, so in the absence of a gallbladder it is necessary to ensure its outflow. The movement of bile should be unimpeded; stagnation should not be allowed. There are several methods to normalize the flow of bile:

Proper eating. Correcting portions and meal times allows you to avoid stagnation. This stimulates the movement of bile into the intestines.
Dosing of physical activity. Insufficient physical activity leads to slow bowel movements.
Taking medications. Antispasmodics prescribed by a specialist must be taken regularly. This will eliminate the spasm and expand the lumens of the bile ducts.
Mechanical obstacles. The patient should not sit for a long time. Tight clothes and belts cannot be worn.

On a note! Compliance with these measures will avoid complications and prevent bile from accumulating in the body..

Regime and diet

After removal of the gallbladder, the diet needs to be adjusted. Portions should be fractional, food intake should be regular. The daily dose should be divided into 6-7 doses, the interval between which should be 3-4 hours. It is recommended to avoid weight gain.

The quality of food directly affects the functioning of the liver. Nutrition should be complete and balanced; a number of products must be removed from the diet:

fatty and smoked foods;
fried and salty foods;
baked goods and sweets;
canned foods;
alcoholic drinks;
strong tea and coffee.

The food consumed must be fresh. If possible, it is recommended to cook in portions. In the first 30 days after surgery, food should be pureed or mashed. Fresh vegetables and fruits should not be eaten raw.

From the second month, the consumption of raw vegetables and fruits, preferably soft ones (bananas, seedless berries, peaches), is allowed. Vegetables and meat in soups and main courses should be finely chopped.

After cholecystectomy, bile collects in the duodenum and is excreted in small portions. An average increase in flow of up to 10 times is observed. Bile becomes more liquid, the intestines are not able to perform a bactericidal function, so the risk of developing dysbiosis increases sharply.

Symptoms indicating complications:

pain in the abdomen, radiating to the back;
feeling of heaviness in the right side of the ribs;
itching of the skin;
gagging;
bitterness in the mouth;
bowel dysfunction (diarrhea, constipation);
bloating;
minor colic in the liver;
yellowness of the epidermis.

Against the background of irregular flow of bile secretions into the intestines, inflammatory processes may develop. Lipids are poorly broken down, and the digestion process slows down. After cholecystectomy, concomitant diseases of the gastrointestinal tract may appear, which include:

stomach ulcer,
pancreatitis,
gastritis.

The treatment is carried out comprehensively, the drugs are prescribed by a gastroenterologist after collecting an anamnesis and the patient passing all the necessary tests.

If you follow the doctor's instructions after abdominal surgery to remove the gallbladder, the rehabilitation period takes 3-6 months, after which the body is completely restored. The postoperative patient needs to adjust his daily routine and diet. Excessive physical activity is unacceptable, but insufficient activity can lead to stagnation of bile.

Video - Open surgery for gallstone disease: indications, contraindications, complications

Hundreds of suppliers bring hepatitis C medicines from India to Russia, but only M-PHARMA will help you buy sofosbuvir and daclatasvir, and professional consultants will answer any of your questions throughout the entire therapy.

Today's surgical practice is unthinkable without laparoscopic operations. In many cases, they replace traditional operations and are not so traumatic for the human body.

They are especially good because rehabilitation after removal of the gallbladder by laparoscopy does not last long and has no complications. The person recovers easily and returns to his usual way of life.

Surgeons often treat cholelithiasis exclusively by surgery.

Previously, technically complex and difficult abdominal operations were used, after which the patient had a long recovery and could not walk for a long time.

These days they have been replaced by innovative laparoscopy.

Technique for laparoscopic removal of gallbladder

Removal of the gallbladder using a laparoscope is performed without a skin incision, using high-tech equipment.

The laparoscope provides access to the diseased organ through a small incision. Instrumental trocars, a mini-video camera, lighting, and air tubes are inserted into it.

This is the equipment necessary to carry out a tactically complex operation, when the surgeon does not insert his hands into an open cavity, but works with an instrument.

At the same time, he observes his actions in full detail on a computer monitor. This is how a laparoscopic operation occurs - removal of the gallbladder.

In the abdominal cavity, the surgeon makes a puncture with a diameter of no more than 2 cm; it leaves an almost invisible scar. This is significant for health - the wound heals easily, the likelihood of infection is low, the patient gets back on his feet faster, and the rehabilitation period begins.

Advantages of laparoscopic surgery:

small puncture area;
reduction in pain;
shorter recovery period.

In preparation for surgery, the patient undergoes extensive laboratory and instrumental examination and must consult with an anesthesiologist.

Recovery after surgery is easy

The main complication that occurs in the postoperative period after removal of the gallbladder with a laparoscope is the reflux of bile directly from the ducts directly into the duodenum.

This is called in medical language postcholecystectomy syndrome; it gives a person unpleasant and uncomfortable sensations.

The patient may be bothered for a long time by:

diarrhea or constipation;
heartburn;
belching with bitterness;
icteric phenomena;
temperature increase.

These consequences remain with the patient for the rest of his life, and he will have to regularly take maintenance medications.

When the gallbladder is removed, the postoperative period takes a short time.

The patient can get up as soon as he recovers from anesthesia, approximately 6 hours after completion of the operation.

Movements are limited and correct, but nevertheless you can and should move. There is practically no severe pain after surgery.

Moderate or mild pain is relieved with non-narcotic painkillers:

Ketonal;
Ketanov;
Ketorol.

They are used according to the patient's well-being. When pain decreases, medications are discontinued. There are practically no complications after laparoscopy, and the patient immediately begins recovery after removal of the gallbladder.

The course of the rehabilitation period is complicated by an increase in temperature and the development of hernia formations at the site of surgical intervention.

This depends on the regenerative capabilities of each person’s body, or possible infection of surgical wounds.

Discharge from the hospital occurs after a week. In rare situations, they are discharged on the first day, or 3 days later, when the main recovery is completed.

Rehabilitation after cholecystectomy in stages

Of course, today the patient is raised to his feet 6 hours after the end of laparoscopy. However, rehabilitation after laparoscopy of the gallbladder continues for a considerable time.

It conventionally divides some stages:

early; lasts 2 days while the patient is still under anesthesia and surgery. During this time the patient is in the hospital. The recovery stage is conventionally called stationary;
late; lasts 3-6 days after surgery. The patient is in the hospital, his breathing begins to function completely independently, he begins to work in new physiological conditions of the gastrointestinal tract;
the outpatient recovery stage lasts 1-3 months; during this time, digestion and breathing begin to work normally, human activity increases;
stage of sanatorium-resort rehabilitation; It is recommended no earlier than 6 months after laparoscopy.

Inpatient recovery is based on breathing exercises; eating on a strict diet; carrying out exercise therapy to restore normal well-being.

At this time, the person takes medications: enzymes, antispasmodics. Inpatient recovery is divided into 3 stages:

intensive therapy;
general mode;
discharge for outpatient observation.

Intensive therapy lasts until the person is removed from the influence of anesthesia, this is about 2 hours.

At this time, the staff conducts antibacterial therapy, administers antibiotics, and treats wounds.

When the temperature is normal, the patient is adequate, the intensive stage is completed, the patient is recommended to switch to the general regimen.

The main goal of the general regime is to include the operated bile ducts in the functioning of the gastrointestinal tract. To do this, you need to eat according to a diet and move with the permission of the surgeon.

This will prevent the formation of adhesions. If there are no complications, bed rest lasts only a few hours.

In the hospital, the patient undergoes laboratory and instrumental examination, his temperature is monitored, and medications are prescribed to him.

The results of the control examination help the doctor see the patient’s clinical condition and foresee the possibility of complications.

If complications are not observed, the patient no longer requires constant medical supervision, and he is recommended to be discharged for outpatient follow-up treatment.

Outpatient rehabilitation includes dynamic observation by leading doctors and a follow-up examination.

To do this, immediately after discharge you should come to an appointment with your local surgeon and register with him.

The doctor’s task is to monitor the progress of recovery, remove stitches, and make new appointments. The duration of this stage depends on the general well-being of the patient, 2 weeks - a month.

It is necessary to visit the surgeon in a timely manner so as not to miss the onset of complications. Only a specialist can see and prevent them.

At home, you need to organize meals according to diet No. 5. You should visit the exercise therapy room, where, with an instructor, you can do therapeutic exercises with a gradual increase in the load on the abdominal press, increasing the time of measured walking.

The patient continues to take medications: the antireflux drug Motilium and the antisecretory drug Omeprazole are prescribed.

In the sanatorium, rehabilitation is aimed at the final restoration of human health. As a rule, sanatorium treatment includes baths, physiotherapy, diet therapy, and exercise therapy.

To correct energy metabolism, the doctor at the sanatorium prescribes Mildronate and Riboxin. To correct adaptation, electrophoresis with succinic acid is prescribed.

Patients usually recover fairly quickly. Nevertheless, rehabilitation after laparoscopy of the gallbladder is completely completed when the patient recovers both physically and mentally.

All psychological aspects of recovery are taken into account and require about six months to complete.

All this time the person lives an ordinary, full life. During this time, the necessary reserve is accumulated for complete adaptation to normal life, workloads, and everyday stress.

Prerequisite: absence of concomitant diseases.

Normal work ability is usually restored 2 weeks after surgery. More successful rehabilitation lasts a little longer and has its own rules.

Rehabilitation conditions:

sexual rest – 1 month;
proper nutrition;
prevention of constipation;
playing sports – after 1 month;
hard work - after 1 month;
lifting weights 5 kg – six months after surgery;
continued treatment with a physiotherapist;
wear a bandage for 2 months;
Continue taking medications as recommended by your doctor.

The postoperative period is often accompanied by constipation. With proper nutrition you can gradually get rid of them.

But the tendency to constipation will remain for life. To do this, you will have to constantly have mild laxatives on hand, or switch to traditional medicine recipes.

This is the most rational nutrition that a patient needs during rehabilitation after laparoscopy of the gallbladder, and in general for the rest of his life.

You can gradually move away from the strict requirements of table No. 5, but only for a short time, and return to a strict diet again.

After laparoscopy of the gallbladder, the patient will necessarily take medications for a long time, if not his entire life.

Immediately after the operation, a course of antibiotics is administered to prevent infection and the development of inflammation.

These are usually fluoroquinolones, traditional antibiotic drugs. Signs of microflora disturbance require the use of pro- or prebiotics.

Linex, Bifidum, Bifidobacterin work well here. If there are spasms in the operated area, it is recommended to take antispasmodics: No-shpu, Duspatalin, Mebeverine.

If concomitant diseases are diagnosed, etiological therapy is used. The absence of a gallbladder requires taking enzymes - Creon, Pancreatin, Micrazim.

When a person is bothered by the accumulation of gases, it is corrected with Meteospasmil, Espumisan. To normalize the functions of the duodenum, it is recommended to take Motilium, Debridat, Cerucal.

Any use of medications requires consultation with the attending physician. You need to get a consultation and a specific prescription, and then purchase the medicine from the pharmacy chain.

This rule necessarily applies to taking hepatoprotectors recommended to protect the liver. Their reception is long, from 1 month to six months.

The active component, ursodeoxycholic acid, protects the mucous membranes of the liver from the toxic effects of bile.

The drugs are vital because the liver requires reliable protection from bile acids released directly into the intestines.

Laparoscopy gives a start to a new life

Rehabilitation after removal of the gallbladder by laparoscopy leads to a complete absence of pain. To do this, rehabilitation must follow all the rules.

A person needs to understand responsibility for his own health. The absence of a gallbladder made serious adjustments to the functioning of the liver and intestines.

Bile is not released directly into the intestines. This causes discomfort in intestinal functions, which you must learn to live with.

These consequences cannot be avoided after removal of the gallbladder. It is important to follow a diet aimed at normal liver function.

When the condition normalizes, you can gradually begin physical therapy, under the guidance of a physical therapy instructor.

Swimming and breathing exercises are allowed. For people in the postoperative period, recovering from gallbladder removal, the most gentle types of physical exercise with moderate load are suitable.

Gymnastics classes are allowed only one month after discharge from the hospital. The load should be adjusted at a moderate pace, including recovery exercises.

Human behavior plays a big role in proper rehabilitation. The surgeon will not be able to talk about a favorable recovery if the patient does not follow his requirements and recommendations.

Another person thinks in the sense that laparoscopic removal of the gallbladder is not a complicated operation, and after it the postoperative period itself will pass without complications.

But one should take into account the fact that serious changes have been made to the gastrointestinal tract system, and both the digestive system and the entire body must adapt to a new state for them.

Bile production is restored during the stationary stage. But here an undesirable situation is when bile is not excreted in full, but is retained in the ducts.

She needs to ensure easy passage into the intestines. This can be achieved:

a properly organized diet, when portions of food are designed to encourage bile to leave the liver and flow through the ducts to the intestines;
physical exercises that provide the body with the necessary motility of the ducts and intestines;
taking antispasmodics to eliminate painful spasms, widening the passages in the ducts.

Digestive complications associated with difficulties in bowel movement are possible.

The postoperative period for patients with a removed gallbladder is a time of careful monitoring of their well-being.

To avoid constipation, you should consume fermented milk products daily; drink mild laxatives; Don't get carried away with enemas.

If diarrhea often occurs after laparoscopy, you should eat cooked vegetables and fruits, include porridge in your diet, take Lactobacterin, Bifidumbacterin. All medications are taken only as prescribed by a doctor.

Belching and bitterness in the mouth may be bothersome. When the doctor says that there are no complications, you need to monitor your diet, which foods cause such dyspeptic disorders, and regulate digestion with the composition of your diet.

Human physical activity helps move bile, but the load should only be feasible.

The duration and intensity of daily walking walks should be increased carefully, day by day; if desired and feeling well, you can switch to jogging, but do not use intense running.

Swimming is useful as a gentle form of muscle activation. At the same time, metabolic processes throughout the body are improved.

During the first year after laparoscopic removal of the gallbladder, you should not lift or carry heavy things or bags. Their weight should be limited to three kilograms.

Within a year after laparoscopic removal of the gallbladder, the body fully adapts to the changed operating mode, bile secretion is released in the required quantity, due to proper nutrition, and has the necessary consistency.

Against this background, digestive processes are normalized. A person who has undergone planned and effective rehabilitation moves into a group of healthy people.