Laparoscopy of the gallbladder: features and operation
Now laparoscopic surgery is widely used in practice. Their share up to 90% of all operations, including removal of the gall bladder if it contains stones. This is not surprising, because the laparoscopy is a highly effective, method malotravmaticheskih operations on organs of small pelvis and abdominal cavity. That is why when gallstones are mostly recommended laparoscopy. With this method of surgical intervention the body is exposed to minimal complications, besides the surgery itself and the recovery period is quite fast. What are the advantages and disadvantages of laparoscopy? What are the indications and contraindications for its implementation? What is the procedure and the recovery period after laparoscopy? Do I need a diet after surgery?
- Laparoscopy is performed through 4 punctures and no incision. Anterior abdominal wall is damaged slightly, then, as in abdominal surgery, the incision is performed.
- Pain after laparoscopy tolerant, are held during the day. After 2-3 hours after laparoscopy the patient is able to walk independently.
- Hospital stay 1 to 4 days, depending on the patient’s condition (body temperature and other indicators are normal).
- The risk of incisional hernia are minimal.
- The scars from punctures of small size, is almost invisible.
- The rehabilitation period is small, the ability to work is restored quickly.
To ensure sufficient review in the abdominal cavity is introduced carbon dioxide gas under pressure. If the patient has heart, vascular or respiratory system, it can impede breathing or cause malfunction of the cardiovascular system.
When performing laparoscopy is limited to the ability to diagnose the body.
Laparoscopy is not performed, when a high probability of altering the flow of operation for detecting abnormalities, is diagnosed when the body.
Laparoscopy gall bladder — sparing surgery, which can be used in cholelithiasis of all kinds, but the decision on its implementation is taken by the surgeon in each individual case. If there are contraindications and high risk, will be carried out abdominal surgery.
Indications for laparoscopy:
- calculous cholecystitis in chronic form;
- obstructive jaundice and stones in the ducts (in this case only deletes the stones in the ducts);
- the first days of an attack of acute cholecystitis;
- cholecystitis flowing without symptoms.
In some cases, the conduct is contraindicated?
The operation laparoscopic method is not carried out when:
- the presence of malignant tumors in the field of surgery;
- cholecystitis together with pancreatitis in the acute stage;
- congenital malformations of the bile ducts and bladder;
- fistulas of the colon, gall bladder, stomach, and duodenum;
- portal hypertension;
- pregnancy in the later stages;
- malfunctions of the heart, blood vessels and respiratory system Express;
- poor blood clotting;
- inflammation of the skin of the anterior abdominal wall;
- pancreatitis in acute and chronic form;
- the possibility of treatment of aggravation in the gallbladder by a conservative (surgery postponed);
- diseases accompanied by swelling;
- massive adhesions from previous operations in the abdominal cavity;
- severe obesity;
- hernia in the upper abdomen;
- obstructive jaundice previously migrated;
- the presence of stones in the liver and/or bile ducts.
Before performing a laparoscopy, the body is undergoing tests to rule out unforeseen complications:
- Ultrasound. Diagnostic ultrasound provides the opportunity to assess the state of the gallbladder (presence of calculi, their size) and adjacent organs: pancreas, liver. The disadvantage of ultrasonography is the poor visualization of stones in the final division of the common bile duct, concealed by the pancreas. Stones which came from gallbladder, most often stop it in this Department.
- MRI. This type of diagnostics will reliably detect the presence of stones and other pathological changes in all departments of the bile ducts.
- CT. Without such a diagnosis can not do in controversial situations. Computed tomography shows the status of the paravesical tissues and other organs of the abdominal cavity, as well as how to develop adhesions.
- Examination of the liver and pancreas.
- Examination of the heart, blood vessels and respiratory system to determine possible negative impacts of the operation on these systems.
Laparoscopy of the gallbladder: prepare to remove
Preparing for laparoscopic gallbladder includes activities:
- A week before the scheduled date of the operation to cancel the administration of drugs, blood coagulation (anticoagulants, nesteroidne anti-inflammatory drugs).
- During the day preceding the day of the operation, must be followed a diet that provides only a light meal.
- The last meal and fluid should be no later than midnight before the day of surgery.
- On the day of surgery morning need to take a shower.
- Doctor prescribe cleansing enema or special medications in the evening and in the morning on the day of surgery for bowel cleansing.
The progress of the operation
Laparoscopy gall bladder surgery can be of two types:
- removal of the gallbladder together with the stones;
- only removal of stones from the gallbladder.
Today, surgery to remove only stones in their gallbladder can be extremely rare. The explanation is the following: stones so much that he gallbladder pathologically changed so much that even after removal of the stones will not be able to function normally. In addition, the gall bladder will become inflamed, causing other diseases. If stones the size or a little small, the doctor may prescribe other methods of treatment without resorting to surgical intervention, although such sparing.
Therefore, laparoscopic gall bladder surgery is performed with removal of body together with the concretions.
Laparoscopy is performed by a surgeon under General anesthesia, which provides good relaxation of the abdominal muscles, and reliably suppresses the sensitivity of tissues and pain. Local anesthesia can not ensure this fully.
When the patient entered the anaesthetic, the anaesthetist removes the liquid and gases from the stomach of the patient by introduction of the probe. This procedure eliminates the possible gag reflex and the probability of getting stomach contents into the respiratory tract.
When the probe is installed, the patient put on the mask, and connected to a ventilator that provides breathing throughout the operation.
The operation begins with the surgeon makes a semicircular incision in the fold of the navel. Through it injected carbon dioxide to increase the volume of the abdominal cavity and extending organs. This is necessary in order to minimize the risk of injury of adjacent organs. Then, in this opening is introduced the trocar, equipped with a flashlight and camera.
In the right hypochondrium is introduced 2 or 3 of the trocar that will allow the surgeon to manipulate instruments to remove the organ.
First, the surgeon examines the location and condition of the gallbladder. If it is closed, the spikes are formed due to prolonged inflammatory process, first requires an incision to provide access to the body. After this requires a definition of its fullness and tension. With strong tension of the gall bladder first cut his wall and sucked some of the liquid. The bladder is clamped with a special clamp and stands out choledoch. Then it is cut and tissue is released from the cystic artery, which is followed by secretion of the gallbladder their liver bed.
In the process of gradual separation on all bleeding vessels prizhivayutsya current. Removal of the organ occurs through a puncture in the navel.
Using a laparoscope, the doctor carefully examines the abdominal cavity, there are no bleeding vessels, bile and other structures susceptible to pathological changes. Vessels prizhivayutsya, and all diseased tissue removed. In the abdominal cavity is injected antiseptic, which is then sucked.
The trocars are removed, the surgeon sews or just stick punctures. One of the punctures is inserted a chest drain to provide an outlet of antiseptic residues from the abdominal cavity. Removed after 1-2 days. If the bubble was not much inflamed, the drainage can not paste.
Removing a transition to lane operation, if the gallbladder is strongly linked with the tissues surrounding it, or have any other unforeseen circumstances. The surgeon removes the cannulas and makes a decision to do a regular laparotomy.
Postoperative period: precautions, diet
After laparoscopy for 4-6 hours, the patient must comply with bed rest. After this time you can sit on the bed, stand and even walk. During this period, the diet involves drinking water without gas.
You can eat the next day after laparoscopy. The diet should be strict. It should be light food (yogurt, chopped lean meat, low fat cottage cheese, low-fat broth, fruit). Diet prescribes frequent meals in small portions. Drink throughout the day after a laparoscopy should be plentiful. Over the next few days the diet must be diet (diet number 5), avoiding foods that stimulate flatulence and excretion of bile.
During the recovery period after laparoscopy the body can not load, lifting weights and performing heavy physical exercise. The rehabilitation period lasts 7 to 10 days.
In the first days after surgery can be pain at the puncture site, above the collarbone and in the right hypochondrium. The symptoms will pass in a few days. If pain will increase, you need to consult a doctor.
Possible complications of laparoscopy
Complications can occur during surgery:
- damage to blood vessels;
- bleeding from the cystic artery or the bed of the liver.
- damage to neighboring organs;
- puncture of the stomach, colon, duodenum, gallbladder;
This requires an immediate transition to laparotomy.
In the postoperative period, the body is susceptible to such complications:
- the expiration of bile into the abdominal cavity;
- inflammation okolofutbolnyh tissues;
In rare cases, laparoscopy may form a hernia.
Effects after laparoscopy
One of the most unpleasant consequences after an exploratory lap of the gallbladder are the emissions of the bile directly into the duodenum, occurring periodically, that manifest these symptoms: nausea, vomiting, pain and rumbling in the abdomen, diarrhea, flatulence, heartburn, belching, jaundice. In rare cases, the body can react in such a symptom, when the temperature rises. To completely get rid of these symptoms in the postoperative period. When they appear it is recommended diet number 5, and in severe pain to take antispasmodics. Relieve nausea and gag reflex in the postoperative period will help, alkaline mineral water.
If they followed the advice of a doctor and strict diet, the recovery process after surgery will be without complications. Well, if a diet becomes a way of life of the patient.