Laparoscopic surgery to remove gallstones

With pains and colic in the right hypochondrium not far from the stomach, many of us came across, though not always paid attention to an unusual symptom, writing off the discomfort on the stomach ulcer, gastritis, neuralgia, liver problems, yes to anything, but not to problems with gall bladder. However, not everyone knows that it is in this place that the above-named organ is located, which can also become inflamed and sick. The cause of acute pain in the gallbladder is quite often the stones formed in the organ itself, and the restoration of its normal functioning is possible only after the removal of the stones. The operation for their extraction in most cases is carried out laparoscopically and is called laparoscopy of the gallbladder stones.

Where are the stones in the gallbladder?

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 fluid that actively participates in the digestion process, because it is with its help that the digestion of fats takes place. And bile helps to maintain a normal microflora in the body.

The bile produced in the liver gets into the gall bladder located near it, and from there it is already directed to the duodenum as needed, where it performs its basic 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. Hypodinamy and abuse of fried, fatty and spicy food, on the contrary, lead to stagnation of bile within the body.

Bile is a liquid that has a heterogeneous composition. As a consequence of stagnant phenomena, precipitation of individual components of this liquid can be observed. From this deposit, stones are formed , which can have different shapes and compositions.

Some stones are formed from cholesterol and its derivatives (cholesterol). Others (oxalate or calcareous) are calcium formations based on calcium salts. A third type of stone is called pigmented, because the main component is the pigment bilirubin. However, the most common are still stones that have a mixed composition.

The size of the concrements formed in the bowels of the gallbladder may also be different. Initially they have small dimensions (0.1 - 0.3 mm) and can easily enter the intestine along the bile ducts together with the liquid component. However, over time, the size of stones grows (stones can reach a diameter of 2-5 cm), and they can not leave the gallbladder independently, so you have to resort to effective and low-traumatic surgery, which is considered laparoscopy of gallstones.

Indications for the procedure

Stones in the gallbladder can not be called a rare phenomenon. Such deposits within the body can be found in 20 percent of the world's population. At the same time, women suffer from pathology more often than men. And the fault of all the female hormone estrogen, for reasons known to him only, inhibits the outflow of bile from the gallbladder.

The presence of stones in the gallbladder does not necessarily have to be accompanied by a pain syndrome. For a long time a person may not even suspect that bile in his body has a liquid and solid constituents, until at some moment there appear alarming symptoms in the form of bitterness in the mouth, pain in the right hypochondrium, amplifying during exercise and in the evening, and nausea after eating.

Acute pains (colic) appear when stones from the gall bladder try to escape through a special duct. If the stone has microscopic dimensions, it can exit almost painlessly. A large stone can not do this because of the limited diameter of the bile ducts. He stops at the very beginning of the duct or gets stuck along the way, thereby blocking the way 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 take into account that some stones have sharp angles and faces, the pain with their unsuccessful attempt to leave the gall bladder becomes simply unbearable.

The duration of colic can be different: 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 vomiting.

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

If such symptoms are detected, the doctors conduct a diagnostic test and, if the result is positive, confirming the diagnosis of cholelithiasis, think about the need for laparotomy or laparoscopy of gallstones.

Stones in the gallbladder can be found quite by accident, doing ultrasound of the abdominal cavity organs. But the fact that the stones in the gallbladder are already there does not mean that it's time to lie under the surgeon's knife. Small stones do not cause anxiety and can leave the body at any time without assistance, and larger stones in the absence of pain syndrome and severe symptoms of cholecystitis can be tried using medicines. To help come drugs that are also used for inflammation of the kidneys (pyelonephritis) and urolithiasis ("Urolesan", "Ursosan", "Ursofalk", etc.).

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

In the treatment of cholelithiasis in the presence of small stones, you can also use ultrasound, by which the stones are crushed into small parts that can independently leave the gallbladder and together with the chyme, and then the calves go outside.

To surgical treatment of cholelithiasis, doctors prefer to resort only if the stones in the gall bladder are large, at which drug therapy and ultrasound are considered ineffective, and give the person a painful sensation. In other words, indications for an operation to remove gall stones from the gallbladder by laparoscopy are:

• inefficiency of conservative and physiotherapy,
• the presence of small sharp stones that can injure the walls of the organ and cause even more of its inflammation,
• the 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 loss.

The fact is that you can remove stones from the gallbladder in two ways:

• Traditional (laparotomy), when the operation is performed with a scalpel without special equipment. The doctor evaluates the procedure of the operation visually, because through a rather large incision in the abdominal cavity he can see the internal organs and carry out manipulations to extract stones from the gall bladder or to remove the organ itself, which is practiced much more often.
• Laparoscopic. In this case, visual assessment of the organ and tracking of the manipulations performed with it is carried out using a special apparatus (laparoscope) resembling a probe (endoscope) with a flashlight and a camera at the end. With minicamera, the image is displayed on the monitor, where it is seen by medical personnel carrying out a surgical operation.

Of particular interest is the operation itself, in which the surgeon acts as an operator, without holding a surgical instrument. Laparoscopic access to the organs is carried out with the help of a laparoscope and 2 tube-manipulators (trocar). It is through these tubes that surgical instruments are delivered to the surgical site and surgical removal of stones or the gall bladder itself is performed.

We can say that the effectiveness of laparoscopy and laparotomy of the gallbladder does not differ much from each other. However, the first innovative method is considered preferable, since it has significantly fewer drawbacks.

Advantages of laparoscopic surgery can be considered:

• Minor traumatism of the skin and soft tissues at the site of surgery. With laparotomy, the doctor makes a long incision (sometimes up to 20 cm) so that it is convenient for him to 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 then remains in place of the suture. Laparoscopic intervention is limited to several punctures of no more than 0.5-2 cm, after healing of which there is practically no trace. Aesthetically, such point scars look much more attractive than the huge scars after laparotomy.
• Pain after laparoscopy is of lower intensity, easily suppressed by usual analgesics and subsided during the first 24 hours.
• The blood loss during laparoscopy is almost 10 times less than in laparotomy. The loss of about 40 ml of blood for a person is almost imperceptible.
• A person gets the opportunity to move and perform the simplest actions already in the first day after the operation after a few hours, necessary to move away from anesthesia and recover a little. The patient can quite serve himself, without resorting to the care of a nurse.
• Short term of stay in inpatient treatment. If the operation is successful, the patient can leave the hospital just a day after the operation. Usually such patients on inpatient treatment are not more than a week. A longer stay is indicated if there are some complications after the procedure.
• Rehabilitation after surgery does not take much time. The hospital can last up to 3 weeks, after which a person can again begin to perform his professional duties.
• Not a rare complication after laparotomy is a hernia. In the case of laparoscopy, the risk of postoperative hernia is incredibly small.
• Good cosmetic effect. Small, barely noticeable scars, especially on the female body, do not look as repulsive as the big crimson scars. Scars adorn only men, and even then, if it is not a question of postoperative traces, but of marks obtained in battle and which are evidence of courage, and not of disease.

Despite the comparative novelty, the laparoscopic method has already won the trust of doctors and patients and has become much more popular than traditional surgical intervention. The latter doctors resort to only if serious complications arose during the operation, which can be corrected only after obtaining full access to the organs.

[1], [2], [3]

Preparation

The patient receives a referral for laparoscopy after carrying out diagnostic tests for pain in the right hypochondrium. The final diagnosis in this case is ultrasound (ultrasound) of the abdominal organs, which, in addition to gallstones, can detect more dangerous tumors - polyps, considered to be 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 some preparation for the procedure.

Such training includes:

• Physical examination of the patient by a therapist or gastroenterologist with an update of the anamnesis, symptoms present, the time of pain, etc.

• Lab tests:
  1. general urine analysis,
  2. a general blood test, in which special attention is paid to the index of ESR,
  3. biochemical blood test (taking into account the content of various mineral components, bilirubin pigment, urea, protein, cholesterol, glucose, etc.)
  4. analysis to clarify the blood group and Rh factor,
  5. a test for clotting of blood (coagulogram),
  6. analysis for syphilis,
  7. virological tests for the presence of hepatitis and HIV infection.
• An electrocardiogram showing the state of the cardiovascular system.
• X-ray or ultrasound, which helps assess the condition of the gallbladder, its size and degree of filling with calculi.
• Fibrogastroduodenoscopy (FGDS) to clarify the state of the digestive system.
• Conclusion of a doctor with a final diagnosis.
• Referral for examination by a surgeon.

After the surgeon examines the examination data and examines the patient, it is determined with the method of carrying out and the type of operation (whether it is necessary to remove the gallbladder or you can restrict extraction of stones from it). After this, the patient receives instructions on how to better prepare for surgery in order to avoid the unpleasant consequences of general anesthesia. Under local anesthesia, laparoscopy of gallbladder stones is not carried out due to the fact that such anesthesia allows the patient to be conscious, which means that it is unlikely to completely relax and relax the abdominal muscles to facilitate access to the gallbladder.

Preparation is started the day before the surgery from the evening. After 18.00 doctors do not recommend eating, and after 22-24 hours and water. Since the evening, it is necessary to make a cleansing enema. In the morning on the eve of the operation, the cleansing procedure is repeated.

There is a certain group of drugs, the reception of which affects the blood coagulability. Anticoagulants, non-steroidal anti-inflammatory drugs (NSAIDs), vitamin E preparations contribute to the dilution of blood, which leads to large blood loss during the operation. Reception of similar medicines should be stopped even ten days before the planned date of the operation.

In 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 strongly attached to other organs by numerous spikes, or a large number of large stones that can not be removed by suction, laparoscopy of the gallbladder stones will be ineffective. And even removing such an organ with a laparoscopic method is very problematic. In this case, resort to laparotomy. The patient can initially be prepared for laparoscopy, but during the operation, after visualizing the tube organ, the laparoscope is removed and the operation is performed in the traditional way.

On the eve of the operation, the anesthetist conducts a conversation with the patient, specifying information on the tolerability of various types of anesthesia, as well as on the presence of diseases of the respiratory system. For example, with bronchial asthma, endotracheal anesthesia, in which the anesthetic enters the body through the respiratory system, is dangerous. In this case, the anesthetic is injected into the body by intravenous infusion.

On the eve of surgery in the evening or in the morning, the patient is prescribed sedation. In addition, the patient is already injected in the preoperative or directly on the operating table to relieve unnecessary excitement before surgery, fear of an artificial lung ventilation device used for anesthesia, fear of death, etc.

Restriction of the intake of liquid from the 10-12 hours of the night of the previous day is a certain trauma for him. Ideally, liquids and food should not be in the digestive tract, but the body must not suffer from dehydration. To fill the lack of fluid in the body immediately before the operation, infusion therapy is performed. Those. A catheter is inserted into the vein, to which the system (dropper) is connected, containing the necessary medicinal solutions, preventing dehydration and possible complications during the operation, and also providing qualitative anesthesia with ineffective injection of anesthesia through the respiratory tract.

Before the operation, a probe is inserted into the patient's stomach to pump liquid and gases out of it, thus it is possible to prevent vomiting and the ingestion of gastric contents into the respiratory system and to prevent the danger of asphyxiation. The probe remains inside the digestive tract during the entire operation. On top of him put on the mask of the apparatus of artificial ventilation, which is used even in the case of intravenous anesthesia.

The need for using an artificial respiration apparatus for laparoscopy of gallbladder stones is due to the fact that to facilitate the work of the surgeon and to prevent injuries to nearby organs, a gas is injected into the abdominal cavity, which compresses the diaphragm and compresses the lungs. Lungs under such conditions can not perform their functions, and without oxygen, the body will not last long and will not suffer an operation that can last from 40 to 90 minutes.

Which operation should I choose?

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

With the help of a laparoscope, two types of surgery 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 the simple removal of stones. The matter is that the gallbladder itself is not a vital organ, it is like a transitional point for bile emerging from the liver and intended for the digestive process, which is carried out in the duodenum. In principle, it is a bubble for storing bile, without which our body can perfectly manage.

Removal of stones from the gallbladder itself does not solve the problem of inflammation of the body and stone formation in general. Without changing the lifestyle and diet, it is impossible to stop the process of stone formation. And in people with a hereditary predisposition to cholelithiasis, even these measures are not always able to solve the problem of the formation of gallstones.

The above-described disadvantages of the operation to remove gallstones have made this procedure unpopular. To her, doctors resort mainly in those cases when it is necessary to remove single stones of large sizes, clogging the bile ducts, if cholelithiasis is not complicated by cholecystitis (inflammatory process in the gallbladder). Most often, doctors tend to remove the entire gallbladder and stones in its ducts.

[4], [5], [6]

Technique of the laparoscopy of gallstones

After the appropriate preparation for the operation has been carried out, the patient is attached to the lung ventilation apparatus and is susceptible to anesthesia, the surgeon can proceed directly to the operation. Regardless of whether the entire gallbladder is removed, or only the stones inside it, inside the abdominal cavity, a special needle injects sterile carbon dioxide, which increases the clearance between the abdominal organs, improves their visualization and prevents the possibility of damage to other organs during surgery .

After that, in the area directly above the navel, make a small incision of a semicircular shape, through which a laparoscope (tube with flashlight and camera) is inserted. Further in the area of the right hypochondrium in certain places, another 2 or 3 punctures are made, through which a corresponding number of trocar is injected. If a laparoscope is needed to visualize the progress of the operation, the remaining trocars are used to feed the instruments directly to the body and to control these tools using special mechanisms in the manipulator.

To begin with, the surgeon examines the condition of the gallbladder and tissues around it. If there is an inflammatory process in the abdominal cavity, the gallbladder may be surrounded by spikes, also causing discomfort in patients. These spikes must be removed.

Now let's see how the stones from the gallbladder are removed by laparoscopy. In the wall of the gallbladder, an incision is made, into which a special suction is inserted, through which the stones, together with the bile, are removed from the organ and its ducts. The place of the cut is covered with bioresorbable materials. The cavity of the peritoneum is necessarily washed with antiseptics to prevent complications in the form of peritonitis development, after which the instrument is removed and stitches are applied to the puncture sites.

A little different operation is performed to remove the gallbladder along with the stones in it. After releasing the organ from the adhesions, the surgeon assesses his condition, degree of overflow and tension. With strong gallbladder tension, it is recommended that an incision is made and partial evacuation of the organ content is carried out in order to avoid its rupture and the outflow of bile into the lumen of the abdominal cavity. After evacuating a certain volume of bile, the suction is removed, and a clamp is applied to the incision site.

Now it's time to find a bile duct and an artery, on which special clips are put (two for each vessel), after which a clipping from them is performed (a cut is made between the clips, the lumen of the artery must be carefully sewn).

Finally, it's time to free the gallbladder from a special deepening in the liver. You need to do this carefully, without haste. During this procedure, the cauterization of bleeding small vessels is periodically performed with the help of an electric current.

Remove the gallbladder with stones through a small hole in the navel, which does not spoil the appearance of the stomach. Any pathologically altered tissue found during surgery is subject to removal.

After removing the bladder, the surgeon again assesses the condition of the cut vessels and, if necessary, re-ignites them. After this, an antiseptic solution is injected into the abdominal cavity, which cleans and disinfects the internal organs. At the end of the procedure, the antiseptic is ejected again by suction.

To remove residual liquid in case the suction has not removed the entire solution, after removing the trocar, a drainage tube is inserted into one of the notches, which is removed after one or two days. The other notches are sewn or glued with medical tape.

Whatever the operation to remove gallstones from the gallbladder with a laparoscopic method, in case of serious difficulties the doctor resorts to a traditional solution of the problem.

Contraindications to the procedure

Laparoscopy of gall bladder stones, like any other serious intracavitary operation, requires a preliminary comprehensive diagnostic examination, including an examination of the patient's history and the information contained in the medical records (patient's medical record). This is not a simple reinsurance, but a necessity, because the operation has a number of contraindications. If you do not take them into account, you can cause serious damage to the patient's health.

It should be mentioned immediately that such a wide range of diagnostic studies is not accidental, because it helps to identify hidden pathologies that either do not allow laparoscopy or require prior treatment. All the tests prescribed before the operation should be normal. Otherwise, the doctor will first prescribe the treatment of the existing disease, and then, when the condition is normalized, the date of the operation will be determined.

In what cases can the doctor refuse the patient in the operation:

• with the development of an abscess in the region of the gallbladder,
• in the presence of exacerbation of severe diseases of the cardiovascular system, especially in the case of wearing a pacemaker,
• with decompensated pathologies of the respiratory system,
• when the anomaly of the location of the gallbladder, when it is located not next to the liver, but inside it,
• at the acute stage of pancreatitis,
• if you suspect a malignant process in the gallbladder,
• in the presence of severe cicatricial changes in the junction of the gallbladder, liver and intestine,
• in the presence of fistulas between the gallbladder and duodenum,
• with acute gangrenous or perforated cholecystitis, as a result of which bile or pus can flow into the abdominal cavity,
• with a "porcelain" gallbladder with deposition of calcium salts in its walls (removal of the organ is shown by the classical method, since there is a high probability of oncology).

Laparoscopic surgery on the gallbladder is not carried out in the third semester of pregnancy, with the development of mechanical jaundice caused by blockage of the bile ducts, impaired blood clotting due to the danger of bleeding. It is dangerous to carry out such operations if the diagnostic studies do not give a clear picture of the location of the organs. Laparoscopy can also be denied to patients who have had intracavitary operations in the past using the traditional method.

Some contraindications are associated with the anesthesia used during the operation. Others can be considered relative, because they concern only a certain method of conducting an operation. In the presence of such pathologies, the operation can be carried out in a traditional way. With regard to pregnancy, it is temporarily prescribed conservative treatment, and after childbirth, you can talk about the operation to remove the gallbladder. The restriction on pacemakers is associated with electromagnetic radiation, which can negatively affect the operation of the cardiac apparatus, and the functionality of the laparoscope.

[7], [8], [9], [10], [11]

Consequences after the procedure

Despite the fact that the laparoscopic method of surgery is considered to be the least traumatic and has fewer complications than the traditional approach to surgical removal of stones from the gallbladder, it is still impossible to completely avoid the discomfort after the operation. This is a pain syndrome, which, although it has a small intensity, but still requires the use of analgesics for the first 2 days (Tempalgin, Ketoral, etc.).

Usually after a couple of days the pain subsides and you can safely give up taking anesthetic medication. After a week, patients usually forget about pain and discomfort.

After the removal of the joints (approximately one week after the operation), patients can already safely live an active life. The pain syndrome can remind of itself only at physical exercises and a tension of muscles of the abdominal press. To prevent this from happening, you should take care at least for a month.

Sometimes pains appear if a person begins to stiffen during an act of defecation. It is better not to do this. If there are difficulties with the stool, the doctor will prescribe suitable laxatives, which will help to go off the toilet effortlessly.

If in the process of laparoscopy of gallstones it was decided to remove the bladder completely, a fairly frequent consequence of such surgery can be considered postcholecystectomy syndrome, caused by the transfer of bile directly into the 12-colon.

Symptoms of postcholecystectomy syndrome are: pain in epigastric medium intensity, attacks of nausea and vomiting, dyspeptic phenomena (bloating and rumbling in the abdomen, the appearance of heartburn and eructations with bitter aftertaste). Yellowness of the skin and fever are less common.

The above syndrome, alas, will accompany a person after an operation to remove the gallbladder throughout his life. Symptoms will occur periodically. When they appear, it is sufficient to adhere to the diet shown in liver diseases, take antispasmodics and antiemetics, drink a small amount of alkaline mineral water.

With regard to pain beyond the post-cholestocystectomy syndrome, they can indicate the development of various complications, especially if the intensity of pain gradually increases.

[12], [13], [14], [15]

Complications after the procedure

We have already mentioned that complications with laparoscopy of gallstones 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 on the eve of surgery can lead to bleeding during it). Other complications may arise as a result of the lack of competence of the medical staff or the banal inaccuracy of the surgeon.

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

To complications arising during intracavitary manipulation:

• improper injection of anesthesia can cause severe anaphylactic reactions,
• bleeding due to disruption of the integrity of the blood vessels along the abdominal wall;

Bleeding may occur if the papular artery that was cut was insufficiently clamped or poorly sewn;

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

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

What can happen after the operation of laparoscopy? Some complications can remind themselves not at the time of surgery, but after a while:

• damage to tissues inside the abdominal cavity due to bile on them from an inadequately sewn incision in the gallbladder;

In the case of removal of the gallbladder, bile may leak from the remainder of the bile duct or the bed of the liver,

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

An identical situation is observed when there is insufficient treatment of the abdominal cavity with antiseptics at the end of the operation, leaving some elements (blood, bile, etc.) that caused inflammation,

• reflux esophagitis, in which food from the stomach and duodenum, abundantly flavored with enzymes, is thrown back into the esophagus,
• omphalitis is a pathology characterized by inflammation of soft tissues in the navel, which can be caused by infection in the wound,
• a hernia is one of the most rare complications after laparoscopy, usually in people with excess weight or as a consequence of an urgent operation with a small preparatory period.

In general, complications after laparoscopy of gallbladder stones with sufficient competence of doctors are very rare, which is also a plus of this method.

[16], [17], [18], [19], [20]

Care after the procedure

At the end of the operation, narcosis is stopped, and the anesthesiologist tries to get the patient out of the state of artificial sleep. If the anesthesia was injected intravenously, the patient regains consciousness within one hour after the operation. An unpleasant consequence of general anesthesia is considered a high probability of dizziness, nausea and vomiting with an admixture of bile. You can stop such symptoms with the help of "Cerucal". In any case, after a short time, the effects of anesthesia disappear.

Laparoscopy of gallbladder stones, like any other surgical operation, can not exclude tissue damage. Places of incisions and stitching are still some time after leaving the action of anesthesia will remind themselves of pain. This is inevitable, but quite tolerable. At least, you can always stop pain with analgesics.

In rare cases, if perforation of the organ has occurred during the operation, and also in the case of acute cholecystitis, antibiotics may additionally be prescribed.

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

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

To feed patients begin on the second day after laparoscopy of stones of a cholic bubble. Food in this period should be easily assimilated, unstable, lean and unfriendly. You can try to eat weak vegetable broth, yoghurt or curdled milk, grated skim cottage cheese, chopped boiled dietary meat, soft varieties of fruit, etc.

Take food in 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 drink recommend a lot to make up for the volume of fluid in the body.

Starting from the third day you can switch to the usual food. The exceptions are:

• products promoting gas generation (black bread, peas, etc.),
• sharp spices (black and red hot peppers, onions, ginger, garlic), stimulating bile excretion.

In ready meals it is also not recommended to put a lot of salt and add spicy seasonings.

From this moment it is necessary to accustom itself to eat according to a diet number 5, appointed after removal of stones from a cholic bubble by a laparoscopy. With the help of this diet, it is possible to normalize liver function and minimize the risk of complications associated with the transfer of bile into the 12-colon between meals due to the lack of a vessel for storing it.

According to this diet, the food served to the table should be crushed. You can eat only warm dishes (not hot!), Prepared by boiling, baking or putting out various products.

The diet contains a certain list of prohibited foods, which from the diet will have to be eliminated altogether. Liquid and semi-liquid porridges, light soups without frying, low-fat dairy and sour-milk products, heat-treated vegetables (not fried), sweet fruits and berries, honey are also considered useful.

Strictly adhere to the diet number 5 patients will have for 3 or 4 months after surgery. Then in the diet, you can add some fresh vegetables. From now on, meat and fish are not necessarily comminuted. And only 2 years after the procedure for the removal of the gallbladder, you can, if desired, return to the usual diet.

The duration of the postoperative period varies from 1 to 1.5 weeks, during which physical activity remains limited due to the danger of seam divergence. It is forbidden to lift any weight and engage in physical labor or sports. It is shown wearing soft linen from natural fabrics to avoid irritating effect on the puncture sites located in the navel and right hypochondrium.

The end of the postoperative period is marked by the procedure for removing the stitches in the places of cuts on the skin. From that moment a person can live a normal life, perform light work, his state of health is normalized within the next 3-5 days. However, until complete recovery is still far away. It will be on the order of 5-6 months, until the body can fully recover after the operation, both psychologically and physically, while regaining its strength.

That the recovery period has passed smoothly and without complications it is necessary to adhere to some restrictions:

• refusal from an active sexual life for at least 2 weeks (ideally, you need to abstain for a month),
• proper nutrition with a sufficient amount of liquid, vegetables and fruits, preventing the development of constipation,
• return to sports can be only a month after surgery on the gallbladder, increasing the load gradually and constantly controlling their condition,
• heavy physical labor during the first month after the operation is also contraindicated; closing the sick leave, such a patient should be on light labor for another 1-2 weeks,
• as for the weights, then within the next 3 months the weight of the items lifted should be limited to 3 kilograms, within the next 3 months it is allowed to raise at a time not more than 5 kilograms,
• within 3-4 months after discharge from the hospital, the patient still must strictly adhere to the requirements of the therapeutic diet for liver and GI,
• so that the wounds on the body heal faster, the doctor can recommend special procedures for physiotherapeutic treatment, you can undergo such treatment one month after laparoscopy of the gall bladder stones or laparoscopic organ removal.
• for the fastest recovery after surgical intervention, doctors recommend taking vitamin preparations and vitamin-mineral complexes.

[21], [22]

Reviews about laparoscopy of the gallbladder

Laparoscopy of gallstones is an operation that has a lot of positive feedback, both from doctors and grateful patients. Both those and others note a low traumatic procedure and a very small rehabilitation period.

Many patients are attracted to the opportunity to self-service themselves after the operation, rather than feel incomplete, bedridden with a seriously ill patient. Pleases and a short duration of a surgical operation. True, somewhat embarrassing the need to find under the action of the device for artificial ventilation, but it prevents the development of various complications during surgery, which is also important.

There is a certain percentage of people who say that the traditional method of carrying out the operation casts greater fear on them than an operation for which one does not even have to open the peritoneum. Loss of blood with laparoscopy is much less than with laparotomy, and patients are not afraid to die from a large loss of blood.

It is clear that, like any surgical operation, laparoscopy has unpleasant moments, which patients do not hurry to forget about. For example, difficulty breathing during the next 2-3 days after surgery. This is due to the fact that for a full resorption of the gas bubble introduced before the operation to increase the abdominal cavity space, it takes at least 2 days. But this discomfort is easier to tolerate, if you understand that it was this moment that helped the doctor to perform the operation qualitatively, without damaging the nearby organs.

Another unpleasant nuance is a pain syndrome in the abdominal region within a few days after the operation. But the pain remains with traditional intracavitary intervention. And it lasts much longer, and the intensity of pain is significantly higher, taking into account the large (in some cases reaching 20 cm) wound on the abdomen, which also requires a considerable amount of time to heal.

And as for fasting during a couple of days, which is lamented by some of the patients who underwent an operation called "laparoscopy of gallstones," then such a purification procedure in many sources is even considered useful, since it helps the body to purify itself and restore its strength. Yes, and the digestive system will say "thank you" for this unscheduled vacation, which she had waited for many years, accumulating in her mountains slag and a toxin tank.