Laparoscopic gallbladder surgery: life after and rehabilitation

Today, laparoscopic surgeries have become widespread and are widely used in the practice of surgeons. They have many advantages. Surgeons point to the high efficiency of this method, emphasize its relative safety and low level of trauma. The method is ideally suited for operations in the abdomen and pelvis, and allows for quick manipulations. Laparoscopy is used in approximately 70-90% of cases, and has become a common part of everyday practice.

Gallbladder removal: laparoscopy or open surgery?

Sometimes, the only way to get rid of gallstone disease is through surgery. Traditionally, abdominal surgeries were used, but now, preference is given to laparoscopy.

To begin with, let us define the term "laparoscopy": an operation aimed at removing the gallbladder or its individual part. It is performed using a laparoscopic approach.

The answer to the question of which method is better to resort to can be found by examining the essence of each of the operations.

A regular abdominal operation involves an incision in the abdominal cavity. An opening is made, through which access to the internal organs is opened. The doctor uses his hands to push apart all the muscles, fibers, move the organs, and get to the diseased organ. Using surgical instruments, the doctor performs the necessary actions.

That is, the doctor cuts the abdominal wall, cuts out the bladder, or removes stones, and sutures the wound. Naturally, after such an operation, scars and marks cannot be avoided. The main scar runs along the incision line.

When using the laparoscopic method to remove the gallbladder, a full incision is not made. Modern high-tech equipment is used. Access to the organ being operated on occurs through a small incision. A laparoscope helps with this, which can be imagined as an instrument with a mini-video camera and lighting devices at the end. This equipment is inserted through the incision, and it displays the image on the computer screen. Then, small-diameter tubes are inserted through the remaining holes. Manipulators (trocars) with instruments are passed through them, with the help of which the main actions are performed. The doctor controls these instruments from the outside, without penetrating the wound with his hands.

The puncture is usually no more than 2 cm in diameter, so the scar is small. This is important from both an aesthetic and medical point of view: the wound surface heals faster, and the risk of infection is lower.

Thus, the meaning of both methods is the same, but the result is different. Most doctors are inclined to use laparoscopy instead of abdominal surgery. Its advantages can be judged by the following facts:

• the area of damage is insignificant, due to the fact that the surface is punctured rather than cut;
• pain sensations are significantly reduced;
• the pain subsides faster: after about a day;
• short recovery period: minimal movement, any gentle movements are possible 6 hours after the intervention;
• short period of inpatient observation;
• the person quickly recovers and is able to restore full working capacity in a short time;
• the likelihood of complications, postoperative hernias, and infection is significantly lower;
• scars are easily absorbed.

Indications for the procedure

There are certain indications for laparoscopy, in which its use is justified. Laparoscopy is recommended in the following cases:

• when a person is diagnosed with chronic calculous and non-calculous cholecystitis;
• in the formation of polyps and cholesterosis;
• late stages of the inflammatory process in acute cholecystitis;
• in asymptomatic cholecystolithiasis.

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Preparation

The essence of preparation for surgery consists of a preliminary consultation with a surgeon, anesthesiologist, and preliminary laboratory and instrumental studies.

Preparation should begin 2 weeks before the planned operation. It will require determination of bilirubin concentration, glucose level, total blood protein, alkaline phosphatase.

You can't do without a coagulogram. Women will also need a vaginal smear for microflora. An electrocardiogram will also be required. The patient is allowed to undergo surgery if the test results are within the normal range.

If the tests are not within the normal range, additional therapy is administered to eliminate this shift and stabilize the parameters being studied. Then the tests are repeated.

Preliminary preparation also includes monitoring of existing chronic diseases. Supportive drug therapy may be required.

Preparation is especially thorough several days before the operation. The recommended nutritional and drinking regimen, and a slag-free diet are followed. From about the evening, you can no longer eat food. You can drink water no later than 10 p.m. On the day of the operation, you also cannot eat or drink. The day before the operation (in the evening) and in the morning, it is recommended to do an enema.

This is a standard preparation scheme, which is almost universal. It may vary slightly within small limits. Everything depends on the characteristics of the body's condition, physiological indicators, and the characteristics of the course of the disease. The doctor will warn you about this in advance.

Laparoscopic removal of gallstones

Sometimes laparoscopy means the need for laparoscopic surgical technique to remove formed stones. However, this technique is almost never used due to its inappropriateness. It would be more rational to completely remove the gallbladder, which allows preventing its further constant inflammation. If the stones are small in size and in small quantities, it is advisable to use other, non-surgical methods of their removal. For example, drug therapy is used.

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Anesthesia for laparoscopic gallbladder removal

The operation is most justified using the general endotracheal method, with the connection of an artificial lung ventilation device. This is the only method of anesthesia used during such an operation. This is gas anesthesia, used in the form of a special tube. Through this tube, a gas mixture is supplied.

Sometimes this method cannot be used, for example, it can be extremely dangerous for asthmatics. Then the introduction of anesthesia through a vein is allowed. General anesthesia is used. This provides the required level of pain relief, the tissues become less sensitive, the muscles - more relaxed.

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Technique gallbladder removal

First, the person is put under anesthesia. After the anesthesia has taken effect, it is necessary to remove the remaining liquid and gas from the stomach. To do this, a gastric tube is inserted, which makes it possible to exclude the accidental occurrence of vomiting. Also, with the help of the tube, it is possible to avoid the accidental entry of stomach contents into the respiratory tract. This can be dangerous, since it can cause blockage of the respiratory tract and end in suffocation, and as a result - death. The tube cannot be removed from the esophagus until the operation is completely completed.

After installing the probe, they resort to closing the mouth and nasal cavity with a special mask. Then they connect to the artificial lung ventilation device. This gives the person the opportunity to breathe. This procedure is impossible to do without, since a special gas is used, pumped into the cavity being operated on. It puts pressure on the diaphragm, compresses the lungs, as a result of which they lose the ability to fully straighten and ensure the breathing process.

At this point, the preliminary preparation for the operation is complete, and the surgeon proceeds directly to the operation. An incision is made in the navel area. Then sterile gas is pumped into the resulting cavity. In most cases, carbon dioxide is used, which helps to open and straighten the abdominal cavity, increasing its volume. A trocar is inserted, with a camera and a flashlight at its end. Thanks to the action of the gas, which expands the abdominal cavity, it is convenient to control the instruments, and the risk of damage to the walls and adjacent organs is significantly reduced.

Then the doctor carefully examines the organs. Pay attention to the location and appearance. If adhesions are found, which indicate the presence of an inflammatory process, they are dissected.

The bladder is palpated. If it is tense, an incision is made immediately in the walls, excess fluid is sucked out. Then a clamp is applied. The doctor finds the common bile duct, which acts as a connecting factor between the bladder and the duodenum. Then it is cut, and they move on to finding the cystic artery. After the artery is found, a clamp is also applied to it, an incision is made between the two clamps. The resulting lumen of the artery is immediately sutured.

After the gallbladder has been separated from the duct and cystic artery, it is separated from the liver bed. The bladder is separated slowly and carefully. At the same time, one must try not to touch or damage the surrounding tissues. If the vessels begin to bleed, they are immediately cauterized with an electric current. After the doctor has made sure that the bladder is completely separated from the surrounding tissues, it is removed. It is removed using manipulators, through an incision in the navel area.

At this point, it is too early to consider the operation complete. It is necessary to carefully check the cavity for bleeding vessels, bile, excess fluid, and any noticeable pathologies. The vessels are coagulated, and the tissues that have suffered changes are detected and removed. After this, the entire affected area is treated with an antiseptic solution and thoroughly washed. Excess fluid is sucked out.

Only now can we say that the operation is complete. Trocars are removed from the wound opening, the puncture site is sutured. In simple cases, if there is no bleeding, it can simply be sealed. A tube is inserted into the cavity, which will provide drainage. Through it, liquids, washing solutions, and secreted bile are drained out. If there was no severe inflammation, and bile was secreted in small quantities, or was not secreted at all, then drainage may not be installed.

There is always a possibility that any operation can turn into an extensive abdominal operation. If something goes wrong, some complication or unforeseen situation arises, the abdominal cavity is cut, the trocars are removed and the necessary measures are taken. This can also be observed with severe inflammation of the bladder, when it cannot be removed through the trocar, or if bleeding or other damage occurs.

How long does gallbladder removal surgery take?

The duration of the operation depends on how complicated the operation is, whether the surgeon has similar experience. Most operations are performed on average within an hour. The minimum operation is known to have been performed in 40 minutes, and the maximum – in 90 minutes.

Contraindications to the procedure

Laparoscopy is not suitable for all patients. Contraindications include:

• severe decompensated diseases;
• pregnancy, starting from 27 weeks;
• organs in the abdominal cavity that have an unclear and abnormal position;
• location of the gallbladder inside the liver, pancreatitis in the acute stage;
• jaundice as a result of blockage of the bile ducts;
• malignant and benign neoplasms;

Removing the bladder is prohibited in case of abscesses, various types of cholecystitis. It is unsafe to perform the operation if a person has reduced blood clotting, a pacemaker. If there are fistulas, adhesions, pathological changes in scars, it is better to refrain from the operation if possible. Also, a second operation cannot be performed if one operation has already been performed laparoscopically.

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Consequences after the procedure

The main consequence can be considered the release of bile, which occurs directly into the duodenum. These sensations cause severe discomfort. This phenomenon is called postcholecystectomy syndrome. With this syndrome, a person may be bothered by nausea and vomiting for a long time, other unpleasant sensations such as diarrhea, heartburn.

A person may belch bitterly, jaundice may be observed. All this may be accompanied by an increase in body temperature. It is very difficult, and even impossible, to get rid of these consequences. Many people have these consequences throughout their lives.

Pain after gallbladder removal by laparoscopy

Severe pains are rare. In most cases, they are moderate or weak and can be easily relieved with painkillers. It is recommended to use non-narcotic drugs: Ketonal, Ketanov, Ketorol. They are used according to how you feel. If the pains have decreased or disappeared, you do not need to take painkillers anymore. If the pains do not decrease, but increase, you need to consult a doctor, as this may indicate the presence of pathology.

After the stitches are removed, the pain usually does not bother. However, pain may periodically appear with sudden movements, with tension. Usually, if pain continues to bother in the remote postoperative period, this indicates a pathology.

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Complications after the procedure

Complications do not occur often. But sometimes you have to deal with them. In general, all complications can be classified into 2 categories: those that occur immediately at the time of the operation, and those that occur some time after the operation. The course of the operation can be complicated by perforation of the stomach, intestines, gall bladder, which is accompanied by bleeding, effusion of lymph into the lumen of the surrounding organs. If such damage occurs, laparoscopy urgently turns into an open abdominal operation.

In practice, there are cases in which the operation itself is successful, but after some time various pathologies arise, such as high temperature, peritonitis, hernia. In most cases, this is a consequence of tissue damage, organ removal, in which bile flows out of a poorly sutured canal, the liver bed. The cause may be inflammation, low level of regenerative processes, infection.

High temperature

Temperature may appear during inflammatory processes, spread of infection. Temperature may also indicate bile stasis. In such cases, the temperature rises for 14 days. As a rule, it is kept within 37.2-37.5 ° C. An increase in temperature may indicate recovery processes. In exceptional cases, the temperature can reach 38 ° C and above. This may indicate infection, purulent and inflammatory processes. You should immediately visit a doctor to determine the cause of such pathology. An ultrasound of the abdominal cavity and postoperative scar is performed.

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Umbilical hernia

The risk of developing an umbilical hernia persists for a long time. The occurrence of hernias is facilitated by a high level of physical activity. The restoration of the aponeurosis, which holds the entire abdominal wall, occurs within 9 months. At this time, there is still a risk of developing an umbilical hernia. Hernias develop mainly in the navel area, since this is the area where the puncture is made.

Adhesions

After laparoscopy, adhesions appear in the abdominal cavity, in the area where the sutures are applied. They dramatically increase the risk of hernias. It is because of the formation of adhesions that intense physical activity is not recommended.

Gases, flatulence

After the operation, intense gas formation is observed. First of all, the cause of such disorders is irritation of the intestinal walls by mucus, pathological changes in the ducts, and general digestive disorders.

Belching

Belching after laparoscopy is quite common. It is associated with gas formation, digestive disorders. Dietary nutrition is necessary.

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Loose stools

After laparoscopy, diarrhea is quite common as a result of digestive disorders. This is also due to the peculiarities of bile release. To prevent this, it is necessary to follow a diet.

Care after the procedure

Once the operation is completed, the doctor gradually brings the person to consciousness: they simply stop giving anesthesia. The patient regains consciousness in the intensive care unit. His condition is monitored using connected equipment. The following are used for monitoring: a tonometer (monitoring blood pressure), an electrocardiograph (monitoring heart rate), a hematology analyzer (monitoring the main blood parameters). A catheter is also connected to the person, which makes it possible to monitor the outflow of urine, its condition, and parameters.

Rehabilitation is simple. At first, there is a need to stay in bed (6 hours). After this time has passed, you can make simple movements, such as turning over in bed, sitting up, getting up. After that, you can gradually start getting up, trying to walk, and taking care of yourself.

In some exceptional cases, a person is discharged on the first day. However, in general, it is necessary to observe the recovery stage, which lasts 3 days.

Recommendations and restrictions after gallbladder removal by laparoscopy

The recovery process is quite fast. Complications are rare. It can be said that a person has fully rehabilitated only if he has recovered both physically and mentally. Full rehabilitation implies not only physical aspects of recovery, but also psychological ones. This takes about 6 months. But do not think that this entire period of time is limited and that his life will cease to be full.

Full rehabilitation means that a person has recovered both physically and mentally, and has also accumulated the necessary reserves that will allow a person to adapt to the conditions of ordinary life, workloads, stress without complications, the occurrence of concomitant diseases.

The patient is usually discharged from the hospital on the 6th day.

Normal health and usual working capacity return approximately on the 10-15th day. For more successful rehabilitation, it is necessary to adhere to the basic rules of rehabilitation.

For about 14-30 days, observe sexual rest, stick to a healthy diet, and ensure constipation prevention. You can do sports after a month. Heavy work should also be postponed for about a month.

For about 30 days, the maximum weight that can be lifted should not exceed 3 kg. After about six months, this limit should not exceed 5 kg.

After laparoscopy, rehabilitation therapy will be required, which will promote accelerated recovery and healing processes. The rehabilitation course may include physiotherapy, medication, and vitamin supplements.

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What to do if you have constipation after laparoscopy of the gallbladder?

Constipation is often observed after surgery. It is a consequence of surgical intervention, and can be a consequence of taking restorative drugs. The reason is difficult digestion of food, the spread of bile. It is recommended to take laxatives. Unfortunately, this problem does not go away with time.

Rehabilitation after laparoscopy of the gallbladder in the postoperative period

Nutrition begins on the second day. Eat simple food, for the postoperative period. On this day, you will have to limit yourself to low-fat light broth, fruits, light cottage cheese, yogurt.

It is recommended to eat food in small quantities, with high frequency: 5-7 meals.

After three days, you can start eating everyday foods. Coarse foods, fatty, fried foods, spices, sauces are excluded. It is not recommended to eat products made from rye flour, anything that promotes the release of bile, gas formation.

It is recommended to switch to therapeutic diet No. 5.

Postoperative pain completely disappears after 24-96 hours. If the pain does not go away during this period, but rather intensifies, a doctor's consultation is necessary. Underwear should be soft, should not press, should not rub the puncture site.

Drainage

In most cases, drainage is required. Its main purpose is to ensure reliable outflow of bile and fluid. Drainage prevents stagnation. If fluid formation has decreased and recovery processes have begun, drainage can be removed.

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Seams

The sutures, unlike those used in abdominal surgery, are small and compact. They do not exceed 1.5-2 cm in diameter. The sutures are removed as the incisions heal. If the healing is good, the sutures are removed on the second day; if the recovery process is slow, they are removed approximately on the 7th-10th day. Everything depends on the individual characteristics of the patient.

Scars

Scars after laparoscopy are insignificant, do not exceed 2 cm in size. After the operation, four scars remain. They heal quickly.

How long should you lie down after gallbladder removal surgery?

The patient must lie down for a 4-6 hour period. Then you can get up and make slow movements. Quite often they are discharged from the hospital even on the day of the operation.

Medications after laparoscopy of the gallbladder

Sometimes a course of antibiotic therapy may be needed (with an increased risk of infection, with inflammatory processes). Fluoroquinolones and conventional antibiotics are often used. Probiotics and prebiotics are used in case of microflora disorders. Such drugs as Linex, Bifidum, Bifidobacterin have proven themselves well.

Multivitamins may be needed. Further therapy is strictly individual and depends on the existing disorders and risks. For pain, painkillers are used (ketanal, ketanov), for spasms - antispasmodics (no-shpa, duspatalin, mebeverine).

In the presence of concomitant diseases or complications, etiological or symptomatic therapy is used. Thus, in case of pancreatitis, enzyme preparations such as Creon, Pancreatin, Micrazim are used.

In case of increased gas formation, medications such as meteospasmil and espumisan may be useful.

To normalize the functioning of the sphincter and duodenum, motilium, debridate, and cerucal are used.

When using medications, it is essential to consult a doctor, as self-medication can be dangerous.

How to take Ursosan after laparoscopy of the gallbladder?

Ursosan is a hepatoprotector that protects the liver from adverse effects. They are taken for a long time, from 1 to 6 months. The active ingredient of this drug is ursodeoxycholic acid, which protects the mucous membranes from the toxic effects of bile acids. The drug is used at 300-500 mg, at night. The drug becomes vital, since the liver requires even greater protection from bile, which is secreted directly into the intestine.

Mumiyo

Mumiyo is a fairly effective remedy used for various diseases. This is an ancient folk medicine remedy that stimulates the digestive organs well. Mumiyo is harmless to the body. After surgery, the dosage of the drug is reduced by 3 times compared to the standard dosage. Mumiyo should be taken for 21 days. A repeat course can be carried out after 60 days. The course is 20 g of mumiyo, which is dissolved in 600 ml of water. Apply three times a day. The first week, apply 1 teaspoon, the second - 2 teaspoons, the third week - 3 teaspoons.

Sick leave after gallbladder removal by laparoscopy

The entire period that the patient spends in the hospital is included in the sick leave. Additionally, 10-12 days are given for rehabilitation. Usually, the patient is discharged from the hospital on about 3-7 days. In total, the sick leave is 13-19 days. If complications arise, this period is extended.

Diet after gallbladder removal surgery

After the operation, it is important to follow a diet, adhere to the postoperative diet, and after this period, switch to dietary nutrition according to diet No. 5. Portions should be small, chopped and warm, eat at least five times a day. Fried, fatty, spicy, smoked, pickled and salted dishes are excluded. Contraindicated are seasonings, offal, baked goods and confectionery, alcohol, cocoa, coffee. The diet should include semi-liquid and liquid porridges, cereal soups. The main products can be seasoned with low-fat meat and fish products. You can add cereals, pasta, low-fat dairy products, non-acidic berries and fruits, compotes, mousses, jelly. You can eat steamed and stewed vegetables.

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Life after gallbladder laparoscopy

The only thing that can be said is that life goes on. As a rule, a person stops being bothered by pain, the need for constant maintenance treatment for gallstone disease and other pathologies. Postoperative pain and scars do not bother a person.

However, the operation also imposes some restrictions and responsibilities on the person. It is important to understand that the gallbladder is now absent. Bile goes straight to the intestines. Under normal conditions, the liver produces approximately 0.6-0.8 liters of bile. After laparoscopy, bile is produced only as needed and is regulated by the food entering it. This can cause certain difficulties and discomfort, and you will have to put up with it. Sometimes these consequences cannot be avoided, and they will always accompany a person.

In most cases, with rare exceptions, a diet aimed at ensuring normal liver function is important. In rare cases, it is enough to follow a diet twice a year: in autumn and spring. Alcohol consumption is strictly prohibited. It is recommended to follow therapeutic diet No. 5.

Sports and physical activity

Any kind of physical activity is prohibited for at least 4 weeks. If there are no complications and the condition is normalizing, you can gradually move on to simple physical exercises. Special therapeutic physical training is recommended for a start. Then you can move on to yoga, swimming, breathing exercises. These types of activities are most suitable for people after laparoscopy, they contribute to full recovery. You can forget about professional sports, participation in competitions, heavy and extreme sports. Physical activity should be moderate. Many professional athletes were forced to become trainers. In general, only general developmental, strengthening loads are recommended. If a person is involved in any sport, he will definitely need to consult a sports doctor.

Gymnastics after laparoscopy of the gallbladder

Gymnastics is not contraindicated after laparoscopy. You should start training at least after a period of 1 month. The load should be moderate, it should be constantly monitored, the pace should be increased gradually. More recovery and breathing exercises should be included. Intensive loads should be avoided.

Intimate life

After the operation, it is necessary to abstain from sexual intercourse for about 1 month. If there are no complications and you feel normal, you can safely resume sexual activity.

Bandage

After any surgery, it is necessary to wear a bandage. It is required for a period of approximately 60-90 days. When wearing a bandage, the likelihood of a hernia, which may occur after surgery, is reduced.

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Pregnancy

The operation is not a contraindication to pregnancy. You can stop using contraception as soon as you feel better and your body begins to recover.

Bath after laparoscopy of the gallbladder

After the operation, the bath is not contraindicated. It is recommended to start visiting the bath after the recovery period, approximately 30 days later. Naturally, drinking alcohol in the bath is prohibited. The bath should be of a purely health-improving nature.

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Reviews

Marina, 26: “I have lived my whole life in fear of surgeons and operating rooms. And then one day I needed an operation. I was very afraid. But the doctor was good and friendly. He calmed me down and said that such operations are not a problem today. There is a method that does not even require making a full incision – it is enough to puncture the operation site in four places. The operation is performed through these punctures. This calmed me down a little. The doctor assured me that everything would go well. He said that many patients are even discharged home on the day of the operation.

We started preparing. The doctor immediately prescribed tests and conducted an examination. There were no contraindications. On the day of the operation, I remember how I was led into the operating room…

Then I only remember waking up in a ward. The pain immediately made itself known, then I started feeling nauseous, and vomiting began. The doctor came, examined me, and said that everything was fine, that it was the effects of the anesthesia. My condition would soon return to normal. At first I couldn't even believe it.

But the next day the pain really stopped bothering me. I felt absolutely normal. I walked, but I didn't feel like eating at all. My muscles ached all day, as if after an intense workout at the gym.

On the third day, the drainage was removed. I got hungry. I started eating. I was discharged only on the sixth day. I was already looking forward to being discharged, since my condition was absolutely normal, I didn’t even understand what I was doing in the hospital.

Karina, 41 years old.

It's been about 21 years since I had my gallbladder removed using laparoscopy. That was the first time I heard that the surgery could be done without incisions. I was very surprised. At the same time, I was incredibly scared.

But everything went well. On the first day I felt very weak, there was pain in the place where the punctures were made. When I sneezed and coughed the pain increased sharply. Around the third day I felt good, as if the operation had not been done.

For about the first year and a half I strictly followed the diet. As soon as I stop following the diet, the aching pain begins. Only after a year and a half I began to gradually add various products.

20 years have passed, I live normally, I enjoy life. I have already got used to it, I have built my own diet. I know exactly which products can cause bloating or pain, I try to exclude them. I know in what quantities to eat. This is the only restriction, which over time ceases to be a restriction, but becomes a way of life. I do dancing, yoga.