Operation to remove the gallbladder by laparoscopic means: life after and rehabilitation

To date, laparoscopic surgery has become ubiquitous and is widely used in the practice of surgeons. They have many advantages. Surgeons point to the high effectiveness of this method, emphasize the relative safety and low level of trauma. The method is ideally suited for operating in the abdominal region, the pelvis, allowing for manipulation quickly. Laparoscopy is used in about 70-90% of cases, and has become a regular part of daily practice.

Removal of the gallbladder: laparoscopy or a cavitary operation?

Sometimes you can get rid of cholelithiasis, only with the help of surgical intervention. Traditionally, they used cavitary operations, now, preference is given to laparoscopy.

To begin with, we give the definition of the concept of "laparoscopy": an operation aimed at removing the gallbladder or its separate part. To perform it, laparoscopic access is used.

To answer the question of which method is better to resort to, you can consider the essence of each of the operations.

Conventional abdominal surgery involves cutting the abdominal cavity. A hole is obtained, through which access to internal organs opens. The doctor spreads all the muscles, fibers, pushes the organs back to the diseased organ. With the help of surgical instruments, the doctor conducts the necessary actions.

That is, the doctor cuts the abdominal wall, cuts out the bladder, or removes stones, sutures the wound hole. Naturally, after such an operation, scars and scars can not be avoided. The main scar passes along the line of the cut.

When using the laparoscopic method to remove the gallbladder, a complete incision is not done. Modern high-tech equipment is used. Access to the operated organ occurs through a small incision. This is helped by a laparoscope, which can be represented as a tool, at the end of which is a mini-video camera, lighting devices. This equipment is inserted through the incision inside, and it displays the image on the computer screen. Then, through the remaining holes, small diameter tubules are introduced. Through them, manipulators (trocars) with tools are used, with the help of which the main actions are carried out. A doctor from outside directs these tools without penetrating the wound with his hands.

The puncture usually does not exceed 2 cm in diameter, respectively, the scar from it is small. This is important both from the aesthetic and from the medical point of view: the wound surface heals faster, the probability of infection is lower.

Thus, the meaning of both methods is the same, but the result is different. Most physicians tend to use laparoscopy instead of a cavitary operation. Its advantages can be judged by the following facts:

• the area of damage is insignificant, due to the fact that the surface is pierced and not cut;
• painful sensations are significantly reduced;
• the pain subsides faster: about a day later;
• short recovery period: minimal movements, any unsharp movements possible within 6 hours after the intervention;
• short term of in-patient follow-up;
• a person is quickly rehabilitated and is able to restore full working capacity in a short time;
• significantly lower the likelihood of complications, postoperative hernias, infection;
• scars easily resolve.

Indications for the procedure

There are certain indications to laparoscopy, in which its use is justified. It is recommended to resort to laparoscopy in the following cases:

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

[1], [2], [3], [4]

Preparation

The essence of preparation for the operation consists in preliminary consultation with a surgeon, an anesthesiologist, conducting preliminary laboratory and instrumental studies.

Begin preparation should be 2 weeks before the planned operation. It will be necessary to determine the concentration of bilirubin, glucose level, total blood protein, alkaline phosphatase.

You can not do without a coagulogram. For women, a vaginal smear on the microflora is additionally required. An electrocardiogram will also be required. To the operation of the patient is allowed if the analyzes comply with the norm indicators.

If the analyzes are not included in the framework of normal indicators, additional therapy is carried out to eliminate this shift and stabilize the studied parameters. Then they take the tests again.

Also, preliminary training implies the control of existing chronic diseases. Supportive drug therapy may be required.

Particularly careful preparation is carried out a few days before the operation. Observed recommended nutritional, drinking regimen, slag-free diet. Approximately from evening it is already impossible to eat food. Water can be drunk no later than 22-00. Do not eat or drink on the day of surgery. The day before surgery (in the evening), and in the morning, it is recommended to put an enema.

This is a standard training scheme, which is almost universal. It can vary somewhat in small limits. Everything depends on the characteristics of the body, on the physiological parameters, the features of the course of the disease. This the doctor will warn in advance.

Removal of stones from the gallbladder by laparoscopic method

Sometimes under laparoscopy means the need for laparoscopic operating techniques to remove the formed stones. However, this technique is almost not used because it is inexpedient. It will be more rational to remove the gallbladder completely, which helps to prevent its further permanent inflammation. With stones of small size and in a small amount, it is advisable to use other, non-surgical methods for their removal. For example, drug therapy is used.

[5]

Anesthesia in the removal of the gallbladder by laparoscopy

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

Sometimes the application of this method is impossible, for example, it can be extremely dangerous to asthmatics. Then anesthesia through the vein is allowed. General anesthesia is used. This gives the required level of anesthesia, tissues become less sensitive, muscles - more relaxed.

[6], [7], [8]

Technique of the gallbladder Removal

First, the person is injected into anesthesia. After the anesthesia has begun to act, it is necessary to remove the remnants of liquid and gas from the stomach. To do this, resort to the introduction of a gastric tube, which makes it possible to exclude the occasional occurrence of vomiting. Also, using a probe, you can avoid accidental ingestion of stomach contents in the respiratory tract. This can be dangerous, as it can cause blockage of the airways and end with suffocation, and as a result - a fatal outcome. The probe should not be removed from the esophagus until the operation is fully completed.

After installing the probe, resort to closing the oral and nasal cavity with a special mask. Then, a connection is made to the ventilator. This gives the person a chance to breathe. Without this procedure, you can not do, because a special gas is injected into the operated cavity. He puts pressure on the diaphragm, compresses the lungs, as a result they lose the ability to fully spread and provide the respiratory process.

At this preliminary preparation for the operation is over, the surgeon goes directly to the operation. An incision is made in the navel area. Then a sterile gas is pumped into the formed cavity. In most cases, carbon dioxide is used, which helps to open, expand the abdominal cavity, and increase its volume. Introduces trocar, at its end is a camera, a flashlight. Due to the action of gas, which expands the abdominal cavity, it is convenient to manage the instruments, the risk of damage to the walls, adjacent organs is significantly reduced.

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

A bladder is probed. If it is tense, immediately cut the walls, excess fluid is sucked. Then a clamp is applied. The doctor looks for choledoch, which acts as a connecting factor between the bladder and the duodenum. Then it is cut, and proceeds to search for the vesicle artery. After the artery is found, a clamp is also applied to it, a cut of the artery is made between the two clamps. The formed lumen of the artery is immediately sutured.

After the gallbladder has been separated from the duct and the vesicle artery, it is separated from the hepatic lobe. The bubble is separated without hurrying, neatly. In doing so, you should try not to hurt or damage the surrounding tissue. If the vessels begin to bleed, they are immediately cauterized with the help of an electric current. After the doctor has ascertained that the bladder is completely separated from surrounding tissues, it begins to be removed. Remove using manipulators, through a cut in the navel area.

It is too early to consider this operation complete. It is necessary to carefully check the cavity for the presence of bleeding vessels, bile, excess fluid, any palpable pathology. Vessels undergo coagulation, detect and remove tissues that have suffered changes. After that, the entire affected area is treated with an antiseptic solution, thoroughly washed. Excess liquids are aspirated.

Only now we can say that the operation is completed. Trocars are removed from the wound hole, the puncture site is sutured. In simple cases, if bleeding is not observed, it can simply be glued. A tube is inserted into the cavity, which will provide drainage. Through it, outflow of liquids, washing solutions, secreted bile is carried out. If there was no strong inflammation, and bile was released in small amounts, or did not stand out at all, then drainage can not be set.

There is always a possibility that in any operation it can go into a large cavitary operation. If something went wrong, there was some complication, or an unforeseen situation, the abdominal cavity is cut, trocars are removed and the necessary measures are taken. It can also be observed with a strong inflammation of the bladder, when it can not be removed through the trocar, or if bleeding occurs, or other damage.

How long does it take to remove the gallbladder?

The duration of the operation depends on how difficult the operation is, if there is a similar experience with the surgeon. Most operations are carried out on average within an hour. There is a minimal operation, which was carried out 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 the 27th week;
• organs in the abdominal cavity, which have an unclear and abnormal position;
• location of the gallbladder inside the liver, pancreatitis in the acute stage;
• jaundice, as a consequence of blockage of the bile ducts;
• malignant and benign neoplasms;

Remove the bladder is prohibited with abscesses, various types of cholecystitis. It is unsafe to perform an operation if a person has reduced blood clotting, there is a pacemaker. If there are fistulas, adhesions, pathological changes in scars, it is better to abstain from surgery as much as possible. Also, it is not possible to perform a repeat operation if one operation has already been performed by a laparoscopic method.

[9], [10], [11], [12], [13], [14]

Consequences after the procedure

The main consequence can be considered the release of bile, which occurs directly in the 12-colon. These feelings are very uncomfortable. This phenomenon is called postcholecystectomy syndrome. In this syndrome, a person may be disturbed for a long time by nausea and vomiting, other unpleasant sensations such as diarrhea, heartburn.

A person can regurgitate with bitterness, jaundice can be observed. All this can be accompanied by an increase in body temperature. It is very difficult to get rid of these consequences, and even impossible. Many people accompany these consequences throughout their lives.

Pain after removal of the gallbladder by laparoscopy

Severe pain occurs rarely. In most cases, they are mild, or weak, and can be easily stopped with pain medication. It is recommended to use non-narcotic drugs: Ketonal, Ketanov, Ketorol. Apply for well-being. If the pain has decreased, or disappeared, painkillers do not need to take more. If the pain does not decrease, but intensifies, consultation of the doctor is necessary, since this may indicate the presence of pathology.

After the seams are removed, the pain is usually not disturbed. However, from time to time pain can appear with sudden movements, with tension. Usually, if the pain in the long-term postoperative period continues to bother, it indicates a pathology.

[15], [16], [17], [18]

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 occurring immediately at the time of surgery, and those that occur some time after surgery. The course of the operation can be complicated by the perforation of the stomach, intestines, gall bladder, which is accompanied by bleeding, lymph flow into the lumen of surrounding organs. In the event of such damage, laparoscopy is urgently transferred to an open cavity operation.

In practice, there are cases in which the operation itself is successful, but after a while there are various pathologies, such as fever, peritonitis, hernia. This in most cases, is the result of tissue damage, removal of organs, in which bile flows from a poorly sewn canal, the liver bed. The cause may be inflammation, a low level of regeneration processes, infection.

Heat

The temperature can appear in inflammatory processes, the spread of infection. Also, the temperature can indicate bile stagnation. In such cases, the temperature rises within 14 days. As a rule, it keeps within the limits of 37,2-37,5 ° С. An increase in temperature may indicate a recovery process. In exceptional cases, the temperature can reach 38 ° C or higher. This can indicate an infection, purulent and inflammatory processes. You should immediately visit a doctor, determine the cause of such a pathology. Conduct ultrasound of the abdominal cavity, postoperative scar.

[19], [20]

Umbilical hernia

The risk of developing the umbilical hernia persists for a long time. The emergence of hernias is promoted by a high level of physical activity. 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 it is in this zone that a puncture is made.

Spikes

After laparoscopy there are spikes in the abdominal cavity area, in the area of suturing. They dramatically increase the risk of developing hernias. It is because of the formation of adhesions that intensive physical loads are not recommended.

Gases, flatulence

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

Belching

Belching after laparoscopy is quite common. It is associated with the formation of gases, a violation of digestion. You need dietary food.

[21], [22]

Liquid chair

After laparoscopy, diarrhea (diarrhea) is often observed, as a consequence of digestive disorders. This is also due to the peculiarities of the ejection of bile. To prevent it, you must follow a diet.

Care after the procedure

Once the operation is completed, the doctor gradually brings the person to consciousness: just stop giving anesthesia. The patient regains consciousness in the intensive care unit. Its state is controlled by the connected equipment. For the control are applied: a tonometer (control of arterial pressure), an electrocardiograph (control of the heart rhythm), a hematological analyzer (control of the basic parameters of the blood). Also, a catheter is connected to a person, which makes it possible to control the outflow of urine, its condition, indicators.

Rehabilitation is simple. First, there is a need for adherence to bed rest (6 hours). After this time has passed, you can make simple movements, for example, roll over in bed, sit down, get up. After that, you can gradually begin to get up, try to walk, look after yourself.

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

Recommendations and limitations after removal of the gallbladder by laparoscopy

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

Full rehabilitation implies that the person recovered both physically and mentally, and also accumulated the necessary reserve, which will allow a person to adapt to the conditions of ordinary life, stresses, stresses without complications, the occurrence of concomitant diseases.

The patient is discharged from the hospital, as a rule, on day 6.

Normal state of health, habitual work capacity is returned by about 10-15 days. For a more successful rehabilitation it is necessary to adhere to the basic rules of rehabilitation.

Approximately 14-30 days to observe sexual rest, adhere to proper nutrition, provide prevention of constipation. You can practice sports after a month. Heavy work should also be postponed for about a month.

Approximately 30 days maximum weight, which can be raised, should not exceed 3 kg. Approximately six months later, this limit should not exceed 5 kg.

After laparoscopy, rehabilitation therapy will be required, which will promote accelerated healing and healing processes. The course of rehabilitation may include physiotherapy, medication, and the intake of vitamin preparations.

[23], [24]

What to do with constipation after a laparoscopy of the gallbladder?

After surgery, constipation is often observed. They are a consequence of surgical intervention, can be a consequence after taking reconstitutive drugs. The cause is the 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 gall bladder in the postoperative period

Meals start from the second day. Eat simple, for the postoperative period. On this day, you will have to limit yourself to low-fat light broth, fruit, light curd, yoghurt.

Food is recommended to be taken in small amounts, with a high frequency: 5-7 receptions.

After three days, you can start eating everyday products. Rough products, fatty, fried dishes, spices, sauces are excluded. It is not recommended to use products made from rye flour, anything that contributes to the secretion of bile, gassing.

It is recommended to switch to food on the diet № 5.

Completely postoperative pain disappears after 24-96 hours. If during this period the pain does not pass, but on the contrary, it increases, it is necessary to consult a doctor. The underwear should be soft, should not press, rub the puncture site.

Drainage

Drainage is required in most cases. Its main goal is to ensure a reliable outflow of bile, liquid. Drainage prevents stagnation. If the formation of fluid has decreased, recovery processes have begun, drainage can be removed.

[25], [26], [27], [28], [29], [30]

Stitches

Stitches, in contrast to the operation of the cavity are small, compact. In diameter, they do not exceed 1.5-2 cm. The joints are removed as the incisions are healed. With a good healing, the sutures are removed as early as the second day, with a low rate of recovery processes, removal takes about 7-10 days. It all depends on the individual characteristics of the patient.

Scars

Scars after laparoscopy are minor, not exceeding 2 cm in size. After surgery, there are four scars. Heals quickly.

How much to lie after the operation to remove the gallbladder?

The patient should lie for 4-6 hours. Then you can go up, do slow movements. Quite often discharged from the hospital even on the day of surgery.

Medications after laparoscopy of the gallbladder

Sometimes you may need a course of antibiotic therapy (with an increased risk of infection, with inflammatory processes). Frequently used fluoroquinolones, conventional antibiotics. When the microflora is disturbed, probiotics, prebiotics are used. Well-proven drugs such as: linex, bifidum, bifidobacterin.

You may need multivitamins. Further, therapy is purely individual and depends on the existing violations and risks. When pain is used painkillers (ketanal, ketanov), with spasms - spasmolytics (no-shpa, duspatalin, mebeverin).

In the presence of concomitant diseases or complications, use etiological or symptomatic therapy. So, at a pancreatitis apply enzyme preparations, such as kreon, pancreatin, mikrazim.

With increased gas formation, such drugs as meto-spasmyl, espumizan can be useful.

To normalize the work of the sphincter and 12 duodenal ulcer, use motilium, debibrate, cerucal.

When using drugs, it is necessary to consult with a doctor, as self-medication can be dangerous.

How to take ursosan after laparoscopy of the gallbladder?

Ursosan refers to hepatoprotectors, which protect the liver from adverse effects. They take them for a long time, from 1 to 6 months. The active substance of this drug is ursodeoxycholic acid, which protects the mucous from the toxic effects of bile acids. Apply the drug to 300-500 mg, at night. The drug becomes vital, because the liver requires even greater protection from bile, which is released directly into the gut.

Mumiyeh

Mummy is quite an effective remedy, which is used for various diseases. This is the oldest alternative medicine, which stimulates the activity of the digestive organs. Mummy for the body is harmless. After the operation, the dosage of the drug is reduced by 3 times, compared with the standard dosage. To drink a mummy follows 21 day. The repeated course can be conducted after 60 days. The course provides 20 g of mummy, which is dissolved in 600 ml of water. Apply three times a day. The first week is applied to 1 tsp, the second - 2 tsp, the third week - 3 tsp each.

Hospital sheet after removal of the gallbladder by laparoscopy

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

Diet after an operation to remove the gallbladder

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 number 5. Portions should be small, crushed and warm, at least five times. Fried, fatty, sharp, smoked, pickled and salted dishes are excluded. Contraindicated seasonings, by-products, pastries and confectionery, alcohol, cocoa, coffee. The diet should include semi-liquid and liquid porridge, cereal soup. The main products can be filled with low-fat meat and fish products. You can add cereals, pasta, low-fat dairy products, non-acid berries and fruits, compotes, mousses, jellies. You can eat steamed and stewed vegetables.

[31]

Life after laparoscopy of the gallbladder

The only thing you can say life goes on. As a rule, a person ceases to be bothered by pain, the need for ongoing maintenance treatment for cholelithiasis and other pathologies. Postoperative pain, man's scars do not bother.

However, at the same time, the operation imposes certain restrictions and responsibilities on a person. It is necessary to understand that the gall bladder is now absent. Bile enters immediately into the intestine. Under normal conditions, the liver produces about 0.6-0.8 liters. Bile. After laparoscopy, bile is produced only as needed and is regulated by ingestion of food into it. This can cause certain difficulties and discomfort and you will have to accept this. Sometimes these consequences can not be avoided, and they will always accompany the person.

In most cases, with rare exceptions, a diet that is aimed at ensuring the normal functioning of the liver is important. In rare cases, it is enough to observe the diet 2 times a year: in the autumn and in the spring. Drinking alcohol is strictly prohibited. It is recommended to follow the diet of number 5.

Sports and exercise

Any kind of physical activity is prohibited for at least 4 weeks. If there are no complications, and the condition is normalized, you can gradually proceed to simple physical exercises. To begin with, special physical therapy is recommended. Then you can proceed to yoga, swimming, breathing exercises. These types of occupations are most suitable for people after laparoscopy, contribute to a complete recovery. About occupations by professional sports, participation in competitions, heavy and extreme kinds of sports it is possible to forget. The physical load should be moderate. Many professional athletes, were forced to move into the category of trainers. In general, only general developing, strengthening loads are recommended. If a person is engaged in any sport, he will definitely need to consult a sports doctor.

Gymnastics after laparoscopy of the gallbladder

After the laparoscopy, gymnastics is not contraindicated. Begin training should be at least after a period of 1 month. The load should be moderate, it must be constantly monitored, the pace should be increased gradually. Should include more restorative, breathing exercises. Intense loads should be avoided.

Intimate life

After the operation, it is necessary to refrain from sexual intimacy for about 1 month. In the absence of complications, normal state of health, sexual life can be safely renewed.

Bandage

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

[32]

Pregnancy 

The operation is not a contraindication to pregnancy. It is possible to cease to be protected, as soon as well-being has adjusted, and the organism has started to be restored.

Bath after laparoscopy of the gallbladder

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

[33], [34]

Reviews

Marina, 26 years old: "All my life I lived in fear of surgeons and operating units. And one day an operation was required. I was very afraid. But the doctor got a good, friendly. He reassured me, said that such operations today are not a problem. There is a method in which one does not even have to make a full incision - just pierce the place of operation in four places. Through these punctures, an operation is performed. It calmed down a little. The doctor assured me that everything will go well. He said that many patients are discharged home even on the day of the operation.

We started training. The doctor immediately appointed tests, conducted an examination. There were no contraindications. On the day of surgery, I remember how I was held in the operating room ...

Then I remember only that I woke up in the ward. Immediately the pain manifested itself, then began to vomit, vomiting began. The doctor came, examined, said that everything is normal, this is the consequences of anesthesia. Soon the condition will be normalized. At first I did not even believe it.

But the next day the pain really stopped worrying. I felt perfectly normal. Went, but did not want to eat. The whole day muscles ached, as if after an intense workout on fitness.

On the third day, drainage was removed. She was hungry. She began to eat. I was discharged only on the sixth day. I was already looking forward to discharge, because the condition was absolutely normal, did not even understand what I was doing in the hospital.

Karina, 41 years old.

About 21 years have passed since I had an operation to remove the gallbladder with laparoscopy. Then I first heard about the fact that the operation can be done without incisions. Was very surprised. At the same time, it was incredibly scary.

But everything went well. On the first day there was a strong weakness, there were pains in the place where they made punctures. When sneezing and coughing, the pain increased sharply. Approximately on the third day I felt well, as if the operation did not.

Approximately the first year and a half strictly adhered to a diet. As soon as I stop to follow a diet - aching pain begins. Only after a year and a half began to gradually add various products.

20 years have passed, I live normally, I enjoy life. Has already got used, has built up own food ration. I know exactly what products can cause bloating or pain, I try to exclude them. I know how much to eat. This is the only restriction that eventually ceases to be a restriction, but passes into a way of life. I am engaged in dancing, yoga.