Laparoscopic surgery to remove gallstones from the gallbladder

Many of us have experienced pain and colic in the right hypochondrium near the stomach, although we have not always paid attention to this unusual symptom, attributing the discomfort to a stomach ulcer, gastritis, neuralgia, liver problems, or anything but problems with the gallbladder. However, not everyone knows that this is where the above-mentioned organ is located, which can also become inflamed and hurt. Acute pain in the gallbladder is often caused by stones that form in the organ itself, and its normal functioning can only be restored after the stones are removed. The operation to remove them is usually performed laparoscopically and is called laparoscopy of gallstones.

Where do gallstones come from?

The gallbladder is a small organ in the form of a sac with a capacity of 50 to 80 ml, which is a storage for bile. Bile is an aggressive liquid that actively participates in the digestion process, because it is with its help that fats are digested. Bile also helps maintain normal microflora in the body.

The bile produced in the liver enters the gallbladder located nearby, and from there, as needed, it is sent to the duodenum, where it performs its main function. If a person leads an active lifestyle and adheres to the principles of proper nutrition, the gallbladder functions normally and the fluid inside it is constantly renewed. Hypodynamia and abuse of fried, fatty and spicy foods, on the contrary, lead to stagnation of bile inside the organ.

Bile is a fluid with a heterogeneous composition. As a result of stagnation, individual components of this fluid can be observed to precipitate. Stones are formed from this sediment, which can have different shapes and compositions.

Some stones are formed from cholesterol and its derivatives (cholesterol). Others (oxalate or calcareous) are calcium formations, the basis of which are calcium salts. And the third type of stones is called pigment, because their main component is the pigment bilirubin. However, the most common are still stones with a mixed composition.

The size of the stones formed in the depths of the gallbladder can also vary. Initially, they are small in size (0.1 - 0.3 mm) and can easily exit into the intestines through the bile ducts along with the liquid component. However, over time, the size of the stones increases (stones can reach 2-5 cm in diameter), and they can no longer leave the gallbladder on their own, so it is necessary to resort to an effective and minimally invasive surgical intervention, which is considered to be laparoscopy of gallbladder stones.

Indications for the procedure

Gallstones are not a rare occurrence. Such deposits inside the body can be found in 20 percent of the world's population. Women suffer from the pathology more often than men. And the female hormone estrogen is to blame for everything, for reasons known only to it, inhibiting the outflow of bile from the gallbladder.

The presence of gallstones does not necessarily have to be accompanied by pain. For a long time, a person may not even suspect that the bile in his body has liquid and solid components, until at some point alarming symptoms appear in the form of bitterness in the mouth, pain in the right hypochondrium, increasing with exertion and in the evening, and nausea after eating.

Acute pain (colic) occurs when gallstones try to exit through a special duct. If the stone is microscopic in size, it can exit almost painlessly. A large stone is unable to do this due to the limited diameter of the bile ducts. It stops at the very beginning of the duct or gets stuck along the way, thereby blocking the path of bile. A new portion of bile, entering the organ, stretches its walls, provokes the development of a strong inflammatory process, which is accompanied by severe pain. And if you also consider that some stones have sharp corners and edges, then the pain from their unsuccessful attempt to leave the gallbladder becomes simply unbearable.

The duration of colic can vary: from 15 minutes to 6 hours. In most cases, patients note the appearance of this symptom in the evening or at night. Painful colic can be accompanied by bouts of vomiting.

The development of cholecystitis (inflammation of the gallbladder) against the background of the formation of stones in it leads to the appearance of systematic severe pain in the right hypochondrium, nausea and episodes of vomiting not associated with the consumption of poor-quality food. Painful sensations can radiate to the back, collarbone or stomach area and even to the right shoulder.

When such symptoms are detected, doctors conduct a diagnostic examination and, if the result is positive, confirming the diagnosis of gallstone disease, they consider the need for laparotomy or laparoscopy of gallstones.

Gallstones can be detected completely by accident during an ultrasound of the abdominal organs. But the fact that gallstones are already present does not mean that it is time to go under the surgeon's knife. Small stones do not cause any discomfort and can leave the organ at any time without outside help, and larger stones in the absence of pain and pronounced symptoms of cholecystitis can be tried to be crushed with medication. The drugs that are also used for kidney inflammation (pyelonephritis) and urolithiasis (Urolesan, Ursosan, Ursofalk, etc.) will come to the rescue.

This conservative treatment is called litholytic therapy. However, its effectiveness depends on the size of the stones. With large stones in the gallbladder, such treatment is rarely effective.

In the treatment of gallstone disease in the presence of small stones, ultrasound can also be used, with the help of which the stones are crushed into small parts that can independently leave the gallbladder and, together with the chyme and then the feces, come out.

Doctors prefer to resort to surgical treatment of cholelithiasis only if the gallstones are large, at which drug therapy and ultrasound are considered ineffective, and cause painful sensations to a person. In other words, indications for surgery to remove gallstones using laparoscopy are:

• ineffectiveness of conservative and physiotherapy,
• the presence of small sharp stones that can injure the walls of the organ and cause even more inflammation,
• development of mechanical jaundice and the presence of stones in the bile ducts,
• as well as the patient’s desire to get rid of gallstones and painful colic with the least amount of loss.

The fact is that there are two ways to remove stones from the gallbladder:

• Traditional (laparotomy), when the operation is performed using a scalpel without special equipment. The doctor evaluates the progress of the operation visually, because through a fairly large incision in the abdominal cavity he can see the internal organs and perform manipulations to remove stones from the gallbladder or remove the organ itself, which is practiced much more often.
• Laparoscopic. In this case, visual assessment of the organ and monitoring of the manipulations performed on it is carried out using a special device (laparoscope), resembling a probe (endoscope) with a flashlight and a camera at the end. The image from the mini-camera is displayed on a monitor, where it is seen by the medical staff performing the surgical operation.

The operation itself is also of interest, in which the surgeon acts as an operator, without holding a surgical instrument in his hands. Laparoscopic access to organs is carried out using a laparoscope and 2 manipulator tubes (trocars). It is through these tubes that surgical instruments are delivered to the site of the operation and the surgical removal of stones or the gallbladder itself is performed.

It can be said that the methods of laparoscopy and laparotomy of the gallbladder are not much different from each other in terms of efficiency. However, the first innovative method is considered more preferable, since it has significantly fewer disadvantages.

The advantages of laparoscopic surgery include:

• Low trauma to the skin and soft tissues at the site of the operation. During laparotomy, the doctor makes a fairly long incision (sometimes up to 20 cm) so that he can conveniently see the gallbladder and surrounding tissues and organs, and also to create sufficient freedom of movement during the operation. After the operation, the incision site is sutured, and a noticeable scar subsequently remains at the site of the suture. Laparoscopic intervention is limited to several punctures no more than 0.5-2 cm, after healing of which there is practically no trace left. Aesthetically, such pinpoint scars look much more attractive than huge scars after laparotomy.
• Pain after laparoscopy is less intense, is easily relieved by regular analgesics and subsides within the first day.
• Blood loss during laparoscopy is almost 10 times less than during laparotomy. The loss of about 40 ml of blood is practically unnoticeable for a person.
• A person gets the opportunity to move and perform simple actions already on the first day after the operation, after several hours, which are necessary to recover from the anesthesia and come to one's senses a little. The patient can fully serve himself without resorting to the help of a nurse.
• Short hospital stay. If the operation was successful, the patient can leave the hospital within 24 hours after the operation. Usually, such patients are hospitalized for no more than a week. A longer stay is indicated if some complications arise after the procedure.
• Rehabilitation after surgery does not take much time. Sick leave can last up to 3 weeks, after which the person can resume performing his professional duties.
• A hernia is not such a rare complication after laparotomy. In the case of laparoscopy, the risk of developing a postoperative hernia is incredibly small.
• Good cosmetic effect. Small, barely noticeable scars, especially on a woman's body, look less repulsive than large, crimson scars. Scars adorn only men, and even then, if we are not talking about post-operative marks, but about marks received in battle and are evidence of bravery, not illness.

Despite its relative novelty, the laparoscopic method has already managed to win the trust of doctors and patients and has become much more popular than traditional surgical intervention. Doctors resort to the latter only if serious complications arise during the operation, which can be corrected only by obtaining full access to the organs.

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Preparation

The patient receives a referral for laparoscopy after diagnostic tests for pain in the right hypochondrium. In this case, a final diagnosis can be made using ultrasound diagnostics (US) of the abdominal organs, which, in addition to gallstones, can also detect more dangerous neoplasms in the gallbladder – polyps, which are considered a precancerous condition.

Laparoscopy of the gallbladder, despite the small incisions on the body and a small number of complications, is still a serious surgical operation, and therefore requires certain preparation for the procedure.

Such preparation includes:

• Physical examination of the patient by a therapist or gastroenterologist with clarification of the anamnesis, existing symptoms, time of onset of pain, etc.

• Laboratory tests:
  1. general urine analysis,
  2. a general blood test, with particular attention paid to the ESR indicator,
  3. biochemical blood test (takes into account the content of various mineral components, bilirubin pigment, urea, protein, cholesterol, glucose, etc.),
  4. analysis to determine blood type and Rh factor,
  5. blood clotting test (coagulogram),
  6. test for syphilis,
  7. virological tests for the presence of hepatitis viruses and HIV infection.
• An electrocardiogram showing the state of the cardiovascular system.
• An X-ray or ultrasound helps to assess the condition of the gallbladder, its size and the degree of filling with stones.
• Fibrogastroduodenoscopy (FGDS) to clarify the state of the digestive system.
• A doctor's report with a final diagnosis.
• Referral for examination by a surgeon.

After the surgeon has studied the examination data and examined the patient, he decides on the method and type of surgery (whether to remove the gallbladder or to limit himself to extracting stones from it). After that, the patient receives instructions on how best to prepare for the surgery to avoid unpleasant consequences of general anesthesia. Laparoscopy of gallbladder stones is not performed under local anesthesia due to the fact that such anesthesia allows the patient to be conscious, which means that a person is unlikely to be able to completely relax and relax the abdominal muscles to facilitate access to the gallbladder.

Preparation begins the day before the operation in the evening. Doctors do not recommend eating after 6 p.m., and drinking water after 10-12 p.m. It is essential to do a cleansing enema in the evening. The cleansing procedure is repeated in the morning before the operation.

There is a group of drugs that affect blood clotting. Anticoagulants, nonsteroidal anti-inflammatory drugs (NSAIDs), vitamin E preparations contribute to blood thinning, which leads to significant blood loss during surgery. Such drugs should be stopped ten days before the planned date of surgery.

In a conversation with the surgeon, the patient learns about the likelihood of various complications during the operation. For example, in the case of severe inflammation, when the gallbladder is tightly attached to other organs by numerous adhesions, or a large number of large stones that cannot be removed by suction, laparoscopy of gallstones will be ineffective. And even removing such an organ by the laparoscopic method is very problematic. In this case, laparotomy is used. The patient can initially be prepared for laparoscopy, but during the operation, after visualization of the organ, the laparoscope is removed and the operation is performed in the traditional way.

On the eve of the operation, the anesthesiologist talks to the patient, clarifying information about the tolerance of various types of anesthesia, as well as the presence of respiratory diseases. For example, in case of bronchial asthma, endotracheal anesthesia, in which the anesthetic enters the body through the respiratory system, is dangerous to use. In this case, the anesthetic is administered to the body using intravenous infusion.

The day before the operation, the patient is prescribed sedatives in the evening or in the morning. Additionally, the patient is given an injection in the preoperative room or directly on the operating table to relieve excessive anxiety before the operation, fear of the artificial lung ventilation apparatus used for anesthesia, fear of a fatal outcome, etc.

The restriction of fluid intake from 10-12 o'clock at night the previous day is a certain trauma for the body. Ideally, there should be no fluid or food in the gastrointestinal tract, but the body should not suffer from dehydration. In order to replenish the lack of fluid in the body immediately before the operation, infusion therapy is carried out. That is, a catheter is inserted into the vein, to which a system (dropper) is connected containing the necessary medicinal solutions that prevent dehydration and possible complications during the operation, and also provide high-quality anesthesia if the administration of anesthesia through the respiratory tract is ineffective.

Before the operation, a tube is inserted into the patient's stomach to pump out liquid and gases, thus preventing vomiting and the entry of gastric contents into the respiratory system and preventing the risk of asphyxia. The tube remains inside the gastrointestinal tract during the entire operation. A mask of an artificial lung ventilation apparatus is put on top of it, which is used even in the case of intravenous anesthesia.

The need to use a respirator during laparoscopy of gallstones is due to the fact that in order to facilitate the surgeon's work and prevent injury to nearby organs, gas is pumped into the abdominal cavity, which, by compressing the diaphragm, also compresses the lungs. The lungs cannot perform their functions in such conditions, and without oxygen, the body will not withstand long and will not survive the operation, which can last from 40 to 90 minutes.

Which operation to choose?

The word "laparoscopy" consists of two parts. The first part of the word refers to an object - the abdomen, the second part implies an action - to see. In other words, using a laparoscope allows you to see the organs inside the abdomen without opening it. The surgeon sees an image sent by a camera on a computer monitor.

Using a laparoscope, two types of operations can be performed:

• laparoscopy (removal) of stones from the gallbladder and its ducts.
• removal of the gallbladder itself.

As practice shows, the effectiveness of the latter operation is much higher than simple removal of stones. The fact is that the gallbladder itself is not a vital organ, it is like a transit point for bile coming out of the liver and intended for the stage of the digestive process carried out in the duodenum. In principle, it is a bladder for storing bile, without which our body can do just fine.

Removing gallstones by itself does not solve the problem of inflammation of the organ and stone formation in general. Without changing your lifestyle and diet, it is impossible to stop the process of stone formation. And in people with a hereditary predisposition to gallstone disease, even these measures are not always able to solve the problem of gallstone formation.

The above-described disadvantages of gallstone removal surgery have made this procedure unpopular. Doctors resort to it mainly in cases where it is necessary to remove single large stones that block the bile ducts, if the gallstone disease is not complicated by cholecystitis (an inflammatory process in the gallbladder). Most often, doctors tend to remove the entire gallbladder and the stones in its ducts.

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Technique laparoscopy for gallstones.

After the appropriate preparation for the operation has been carried out, the patient is connected to a ventilator and is under anesthesia, the surgeon can proceed directly to the operation. Regardless of whether the entire gallbladder or only the stones inside it will be removed, sterile carbon dioxide is pumped into the abdominal cavity using a special needle, which increases the lumen between the abdominal organs, improves their visualization and prevents the likelihood of damage to other organs during surgery.

After this, a small semicircular incision is made in the area directly above the navel, through which a laparoscope (a tube with a flashlight and a camera) is inserted. Then, in the area of the right hypochondrium, 2 or 3 more punctures are made in certain places, through which the corresponding number of trocars are inserted. If the laparoscope is needed to visualize the progress of the operation, then the remaining trocars are used to deliver instruments directly to the organ and control these instruments using special mechanisms in the manipulator.

First, the surgeon examines the condition of the gallbladder and the tissues around it. If there is an inflammatory process in the abdominal cavity, the gallbladder may be surrounded by adhesions, which also cause discomfort to patients. These adhesions must be removed.

Now let's see how gallstones are removed using laparoscopy. An incision is made in the wall of the gallbladder, where a special suction device is inserted, with the help of which the stones together with the bile are removed from the organ and its ducts. The incision site is sutured with self-absorbable materials. The peritoneal cavity is necessarily washed with antiseptics to prevent complications in the form of peritonitis, after which the instrument is removed and stitches are applied to the puncture sites.

The operation to remove the gallbladder together with the stones in it is performed slightly differently. After freeing the organ from adhesions, the surgeon evaluates its condition, the degree of overflow and tension. If the gallbladder is very tense, it is recommended to make an incision and partially pump out the contents of the organ to avoid its rupture and the outpouring of bile into the lumen of the abdominal cavity. After pumping out a certain amount of bile, the suction device is removed and a clamp is applied to the incision site.

Now it is time to find the bile duct and artery, onto which special clips are placed (two for each vessel), after which the gallbladder is cut off from them (an incision is made between the clips, the lumen of the artery must be carefully sutured).

Finally, it is time to release the gallbladder from its special recess in the liver. This must be done carefully, without haste. During this procedure, the bleeding small vessels are periodically cauterized with electric current.

The gallbladder with stones is removed through a small opening in the navel area, which does not spoil the appearance of the abdomen. Any pathologically altered tissues found during the operation are subject to removal.

After the bladder is removed, the surgeon once again evaluates the condition of the severed vessels and, if necessary, cauterizes them again. After this, an antiseptic solution is introduced into the abdominal cavity, which washes and disinfects the internal organs. At the end of the procedure, the antiseptic is removed again using suction.

To remove any remaining fluid in case the suction did not remove all the solution, after removing the trocars, a drainage tube is inserted into one of the incisions, which is removed after one or two days. The remaining incisions are sutured or sealed with medical tape.

Whatever the operation for removing gallstones using the laparoscopic method, if serious difficulties arise, the doctor resorts to a traditional solution to the problem.

Contraindications to the procedure

Laparoscopy of gallstones, like any other serious intracavitary surgery, requires a preliminary comprehensive diagnostic examination, including studying the patient's medical history and information contained in medical documents (patient's medical record). This is not just a precaution, but a necessity, because the surgery has a number of contraindications. If they are not taken into account, serious harm can be caused to the patient's health.

It is worth mentioning right away that such a wide list of diagnostic tests is not accidental, because it helps to identify hidden pathologies that either do not allow resorting to laparoscopy or require preliminary treatment. All tests prescribed before the operation must be normal. Otherwise, the doctor will first prescribe treatment for the existing disease, and then, when the condition is normalized, will determine the date of the operation.

In what cases can a doctor refuse a patient an operation:

• when an abscess develops in the gallbladder area,
• in the presence of an exacerbation of severe cardiovascular diseases, especially in the case of wearing a pacemaker,
• in decompensated pathologies of the respiratory system,
• in case of an anomaly in the location of the gallbladder, when it is located not next to the liver, but inside it,
• in the acute stage of pancreatitis,
• if there is a suspicion of a malignant process in the gallbladder,
• in the presence of severe cicatricial changes in the area of the junction of the gallbladder, liver and intestines,
• in the presence of fistulas between the gallbladder and the duodenum,
• in acute gangrenous or perforative cholecystitis, which may result in bile or pus leaking into the abdominal cavity,
• in case of a “porcelain” gallbladder with calcium salt deposits in its walls (removal of the organ using the classical method is indicated, since there is a high probability of oncology).

Laparoscopic surgery on the gallbladder is not performed in the third trimester of pregnancy, in the development of mechanical jaundice caused by blockage of the bile ducts, or blood clotting disorders due to the risk of bleeding. It is dangerous to perform such operations if diagnostic studies do not provide a clear picture of the location of the organs. Laparoscopy may also be refused to those patients who have had intracavitary operations in the past using the traditional method.

Some contraindications are related to the anesthesia used during the operation. Others can be considered relative, since they concern only a certain method of performing the operation. In the presence of such pathologies, the operation can be performed in the traditional way. As for pregnancy, conservative treatment is temporarily prescribed, and after childbirth, we can talk about gallbladder removal surgery. The restriction concerning pacemakers is related to electromagnetic radiation, which can negatively affect both the work of the heart apparatus and the functionality of the laparoscope.

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Consequences after the procedure

Despite the fact that the laparoscopic method of surgery is considered the least traumatic and has fewer complications than the traditional approach to surgical removal of gallstones, it is still not possible to completely avoid discomfort after surgery. We are talking about pain syndrome, which, although of low intensity, still requires taking analgesics (Tempalgin, Ketoral, etc.) for the first 2 days.

Usually after a couple of days the pain subsides and you can safely stop taking painkillers. After a week, patients usually forget about the pain and discomfort.

After the stitches are removed (approximately a week after the operation), patients can calmly live an active life. The pain syndrome may remind of itself only during physical exertion and tension of the abdominal muscles. To prevent this from happening, you should take care of yourself for at least a month.

Sometimes pain occurs if a person begins to strain during the act of defecation. It is better not to do this. If there are difficulties with the passage of feces, the doctor will prescribe suitable laxatives that will help you go to the toilet without effort.

If during the laparoscopy of gallstones it was decided to remove the bladder completely, a fairly common consequence of such an operation can be considered postcholecystectomy syndrome, caused by the reflux of bile directly into the duodenum.

The symptoms of postcholecystectomy syndrome are: moderate-intensity epigastric pain, bouts of nausea and vomiting, dyspeptic symptoms (bloating and rumbling in the abdomen, heartburn and belching with a bitter taste). Less common are yellowing of the skin and fever.

The syndrome described above, unfortunately, will accompany a person after gallbladder removal surgery throughout his life. Symptoms will occur periodically. When they appear, it is enough to follow a diet indicated for liver diseases, take antispasmodics and antiemetics, and drink alkaline mineral water in small quantities.

As for pain sensations outside of attacks of postcholecystectomy syndrome, they may indicate the development of various complications, especially if the intensity of pain gradually increases.

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Complications after the procedure

We have already mentioned that complications during laparoscopic gallstone surgery are extremely rare. The reason for this may be insufficient preparation for the operation, which happens in cases of emergency procedures (for example, taking anticoagulants the day before surgery can lead to bleeding during the procedure). Other complications may arise as a result of insufficient competence of the medical staff or banal carelessness of the surgeon.

Complications can occur both during surgery and several days after it.

Complications that arise during intracavitary manipulations:

• Incorrect administration of anesthesia can cause severe anaphylactic reactions,
• bleeding due to damage to the integrity of blood vessels running along the abdominal wall;

Bleeding may occur if the cystic artery that was to be cut off is not clamped sufficiently or is poorly sutured;

Sometimes bleeding accompanies the release of the gallbladder from the liver bed,

• perforation of various organs located near the gallbladder, including the gallbladder itself (the reasons may vary),
• damage to nearby tissues.

What can happen after a laparoscopy? Some complications may make themselves known not at the time of the operation, but some time later:

• damage to tissues inside the abdominal cavity due to bile getting on them from a poorly sutured incision in the gallbladder;

If the gallbladder is removed, bile may leak from the remaining bile duct or liver bed,

• inflammation of the peritoneum (peritonitis) due to the contents of the gallbladder or other organs damaged during surgery entering the abdominal cavity;

An identical situation is observed when the abdominal cavity is not treated with antiseptics sufficiently at the end of the operation, as a result of which some elements (blood, bile, etc.) remain, causing inflammation.

• reflux esophagitis, in which food from the stomach and duodenum, richly flavored with enzymes, is thrown back into the esophagus,
• omphalitis is a pathology characterized by inflammation of the soft tissues in the navel area, which can be caused by infection entering the wound,
• Hernia is one of the rarest complications after laparoscopy, usually occurring in people who are overweight or as a result of an urgent operation with a short preparatory period.

In general, complications after laparoscopy of gallstones with sufficient competence of doctors are very rare, which is also an advantage of this method.

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Care after the procedure

At the end of the operation, the anesthesia is stopped and the anesthesiologist tries to bring the patient out of the artificial sleep. If the anesthesia was administered intravenously, the patient comes to within one hour after the operation. An unpleasant consequence of general anesthesia is a high probability of dizziness, nausea and vomiting with bile. Such symptoms can be relieved with the help of "Cerucal". In any case, after a short time, the effects of the anesthesia disappear.

Laparoscopy of gallstones, like any other surgical operation, cannot exclude tissue damage. The sites of incisions and suturing will remind you of themselves with painful sensations for some time after coming out of the anesthesia. This is inevitable, but quite bearable. At least, you can always relieve the pain with analgesics.

In rare cases, if an organ is perforated during surgery, or in the case of acute cholecystitis, antibiotics may also be prescribed.

Awakening the patient from anesthesia means only the end of medical manipulations, but not freedom of action for the patient. He will have to stay in bed for about 4-5 hours to avoid various complications. After this time, the doctor examines the patient and gives the "go-ahead" for the patient to try to turn over on his side, get out of bed, and walk. Patients are also allowed to sit and perform simple actions that do not require tension in the abdominal muscles. It is forbidden to perform active, sharp movements and lift weights.

As soon as the patient is allowed to get out of bed, he can drink purified or mineral water without gas. Patients are not allowed to eat on the first day after the operation.

Feeding of patients begins on the second day after laparoscopy of gallstones. Food during this period should be easily digestible, soft, low-fat and not spicy. You can try to eat weak vegetable broth, yogurt or sour milk, strained low-fat cottage cheese, boiled dietary meat chopped in a blender, soft fruits, etc.

You need to eat small portions, following the principle of fractional nutrition, prescribed for various diseases of the digestive system. You need to eat a little at least 5-6 times a day. But doctors recommend drinking a lot to replenish the volume of fluid in the body.

Starting from the third day, you can switch to your usual diet. The exceptions are:

• foods that promote gas formation (black bread, peas, etc.),
• hot spices (black and red hot pepper, onion, ginger, garlic), stimulating bile secretion.

It is also not recommended to add a lot of salt or spicy seasonings to prepared dishes.

From this point on, you need to accustom yourself to eating according to diet number 5, prescribed after the removal of gallstones by laparoscopy. With the help of this diet, you can normalize the functioning of the liver and minimize the risk of complications associated with the reflux of bile into the duodenum between meals due to the lack of a vessel for its storage.

According to this diet, food served at the table must be chopped. Only warm dishes (not hot!) can be consumed, prepared by boiling, baking or stewing various products.

The diet contains a specific list of prohibited products that must be excluded from the diet altogether. Liquid and semi-liquid porridges, light soups without frying, low-fat dairy and fermented milk products, heat-treated vegetables (not fried), sweet fruits and berries, honey are considered healthy.

Patients will have to strictly adhere to diet No. 5 for 3 or 4 months after the operation. Then, fresh vegetables can be added to the diet little by little. Meat and fish do not need to be chopped from this point on. And only 2 years after the gallbladder removal procedure can you return to your usual diet if you wish.

The duration of the postoperative period varies from 1 to 1.5 weeks, during which physical activity remains limited due to the risk of suture divergence. It is forbidden to lift any weights and engage in physical labor or sports. It is recommended to wear soft underwear made of natural fabrics to avoid irritating the puncture sites located in the navel and right hypochondrium.

The end of the postoperative period is marked by the procedure of removing the stitches in the places of incisions on the skin. From this moment on, a person can live a normal life, do light work, his health will normalize within the next 3-5 days. However, it is still a long way to complete recovery. It will take about 5-6 months until the body can fully recover from the operation, both psychologically and physically, while simultaneously restoring its strength.

To ensure that the recovery period goes smoothly and without complications, you will have to adhere to some restrictions:

• abstaining from active sexual activity for at least 2 weeks (ideally, you should abstain for a month),
• proper nutrition with sufficient amounts of liquid, vegetables and fruits, preventing the development of constipation,
• You can return to sports only a month after surgery on your gallbladder, increasing the load gradually and constantly monitoring your condition,
• heavy physical work is also contraindicated during the first month after surgery; after closing the sick leave, such a patient should do light work for another 1-2 weeks,
• as for heavy objects, during the next 3 months the weight of objects lifted should be limited to 3 kilograms, during the following 3 months it is allowed to lift no more than 5 kilograms at a time,
• for 3-4 months after discharge from the hospital, the patient must still strictly adhere to the requirements of a therapeutic diet for the health of the liver and gastrointestinal tract,
• To help wounds on the body heal faster, the doctor may recommend special physiotherapy procedures; such treatment can be performed a month after laparoscopy of gallstones or laparoscopic removal of the organ.
• For a quicker recovery after surgery, doctors recommend taking vitamin supplements and vitamin-mineral complexes.

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Gallbladder Laparoscopy Reviews

Laparoscopy of gallstones is an operation that has many positive reviews from both doctors and grateful patients. Both note the low trauma of the procedure and a very short rehabilitation period.

Many patients are attracted by the opportunity to take care of themselves after the operation, rather than feel inferior, bedridden and seriously ill. The short duration of the surgery is also pleasing. True, the need to be under the influence of a ventilator is somewhat disconcerting, but this prevents the development of various complications during the operation, which is also important.

There is a certain percentage of people who say that the traditional method of performing surgery is more frightening to them than an operation that does not even require opening the peritoneum. Blood loss during laparoscopy is much less than during laparotomy, and patients are not afraid of dying from massive blood loss.

It is clear that, like any surgical operation, laparoscopy has its unpleasant moments that patients are in no hurry to forget. For example, breathing difficulties during the next 2-3 days after the operation. This is due to the fact that it takes at least 2 days for the gas bubble introduced before the operation to increase the space of the abdominal cavity to completely dissolve. But this discomfort is easier to bear if you understand that it was this moment that helped the doctor perform the operation efficiently, without damaging nearby organs.

Another unpleasant nuance is the pain syndrome in the abdominal area for several days after the operation. But the pain remains even with traditional intracavitary intervention. Moreover, it lasts much longer, and the intensity of pain is significantly higher, given the large (in some cases reaching 20 cm) wound on the abdomen, which also takes quite a long time to heal.

As for fasting for a couple of days, which some patients who have undergone an operation called "gallstone laparoscopy" complain about, such a cleansing procedure is considered useful in many sources, since it helps the body cleanse itself and restore its strength. And the digestive system will say "thank you" for this unscheduled rest, which it has been waiting for many years, accumulating mountains of slag and cisterns of toxins.