The “gold standard” for the treatment of gallstone disease (if the stones cannot be dissolved with medications) is laparoscopic cholecystectomy. This operation is one of the least traumatic, so recovery after it is as fast as possible. How is gallbladder removal performed and do you need to prepare specially for it? Read more about this.
Where do the gallstones come from? The gallbladder is a small reservoir that stores bile. Where do stones come from in the gallbladder and how to prevent their formation? We answer this question in our article.
What it is?
Laparoscopy is a highly effective, safe and low-traumatic method of surgical intervention on internal organs. For this reason, treating gallstone disease with this method has long become a common daily operation.
What is this treatment? In everyday life, this means surgical therapy, during which the severed gallbladder is removed from a person along with the stones formed in it, using an important device - a laparoscope.
Today, practically no operations are carried out so that the organ can be preserved and only numerous gallstones can be removed. If the stones are single, then other methods of removing them are used, such as:
- Dissolution using medications;
- Crushing using laser equipment;
- Shock wave litholripsia.
During these treatments, the dissolved stones are eliminated from the body naturally.
To better understand what laparoscopic treatment of the gallbladder is, you should first become familiar with how this therapy differs from laparotomy. Let's get acquainted with the basic principles.
Recovery period
Based on reviews from people who have undergone surgery, laparoscopy does not bring much discomfort. At first, they are bothered by mild pain, which quickly passes. It is impossible to completely cure a diseased gallbladder, so removal is the best solution.
Antibacterial therapy is carried out only in case of violation of the tightness of the organ. The work of intestinal motility is normalized within a day. Immediately after this, you can eat.
The rehabilitation period ends in 14-15 days. The patient is discharged 4-5 days after his stay in the clinic.
General recommendations:
- there is no need to bring down low-grade postoperative temperature;
- completely eliminate alcohol;
- avoid strenuous exercise and heavy lifting during the first few weeks of recovery;
- You can resume sexual life in a month;
- treat stitches daily and use ointments to resolve scars;
- switch to dietary nutrition.
Following the doctor's recommendations will help reduce the duration of the rehabilitation process.
Laparoscopy
This type of surgical treatment is performed using auxiliary instruments:
- Apparatus – laparoscope;
- Manipulators in the form of trocars.
What is a laparoscope? This is a kind of device with a built-in flashlight for illuminating the work area and a video camera. The surgeon inserts the camera into the patient’s abdominal space, having first made a small incision (1 cm) in it.
During the operation, all his manipulations are visible on the screen thanks to a video camera. This helps the doctor monitor his actions. The advantage here is that there is no direct contact with the diseased organ being removed, but only visual contact.
The surgeon controls the instruments necessary for the operation using trocars. These are nothing more than hollow tubes, which are also inserted through punctures into the abdominal space. They are necessary to deliver the required instrument to the organ to be removed. The tubes have manipulator devices, with their help the doctor is able to move the instrument inside the abdomen.
In short, the doctor carries out the entire process of laparoscopic surgery using only three tubes:
- A video camera is inserted into the first tube to display the image on the screen;
- The other two tubes are needed to work through them with a surgical instrument.
All stages of both surgical interventions and their essence are completely identical.
Third day after surgery
If everything is in order, the patient is discharged home and rehabilitation begins after discharge from the hospital. If necessary, a sick leave certificate is issued for the duration of your stay in the hospital plus three days - usually after surgery using laparoscopy this is enough. If the patient’s work involves physical activity, the sick leave must be extended at the clinic.
If there are concomitant diseases that require medical supervision, or complications arise, you will have to be discharged later after stone removal by laparoscopy - in this case, the doctor determines the specific timing individually.
You can take a shower at home. Transparent stickers on wounds do not need to be peeled off; they are waterproof; white ones are best removed. Under no circumstances should the area of postoperative wounds be treated with shower gels or rubbed with a washcloth. Having carefully blotted them (without rubbing!) with a towel, they need to be lubricated with brilliant green or betadine solution, or a 5% iodine solution (the main thing is not to get carried away: too much lubrication with alcohol solutions can cause a burn).
Then, until the end of the week, rehabilitation after stone removal goes on as usual, without requiring special measures.
Indications and contraindications for laparoscopy
In medical practice, gallbladder diseases are quite common. There are many reasons for this, for example:
- Unfavorable environmental data;
- Frequent stressful conditions;
- A person consumes fatty foods in abundance, and even of poor quality.
All this, in turn, leads to the development of various pathologies, and as a result, gallstone disease develops. If the presence of this disease does not in any way affect the functionality of the human body, then conservative treatment can be prescribed.
Let's consider what indications for laparoscopy may be, and in which cases this type of treatment is not indicated for the patient.
| Indications | Contraindications |
| An inflammatory process is observed in the gallbladder, during which stones are formed. | Intervention is not performed if pus formation is detected in the area of the cut-off bladder. |
| Chronic cholecystitis without stone formation. | Severe pathologies of the respiratory or cardiovascular system. |
| A polypous growth <10 mm in size was discovered in the gallbladder. | Third trimester of pregnancy. |
| An excessive amount of cholesterol is deposited on the walls of the bladder space. | The presence of previously performed laparoscopic interventions on organs located in the abdominal space. |
| Cholecystitis in the acute stage, where the attack lasts more than 1-3 days. | The gallbladder has an intrahepatic location. |
| Multiple presence of stones in the gallbladder. | The patient has pancreatitis in an acute stage. |
| The presence of various pathologies leading to the development of adverse side effects | Obstructive jaundice, resulting from poor patency of the bile ducts. |
| Poor blood clotting ability. | |
| Presence of a pacemaker. | |
| Near the bubble there is a flaw or hole of unknown origin. |
Anatomical features of the gallbladder
The human gallbladder is located on the lower surface of the liver, has the shape of an oval sac and is filled with bile. In its narrow part it passes into the excretory cystic duct, where the sphincter is located, which is responsible for the flow of bile back and forth. The cystic bile duct joins the hepatic duct at the porta hepatis, where they form the common bile duct, which joins the pancreatic duct and opens through the sphincter of Oddi into the duodenum.
The length of the gallbladder of an adult is 8-14 cm, width - 3-5 cm. The organ has a bottom, body and neck. The main function of the gallbladder is the accumulation of bile and its gradual supply to the duodenum.
Preparing for surgery
Before surgery, which will be carried out according to plan, the patient should submit the necessary tests to the laboratory:
- Blood - general and biochemical analysis, for the presence of various types of jaundice, AIDS, blood type, Rh;
- Urine fluid;
- Coagulogram;
- Electrocardiogram;
- Women are given a vaginal smear.
If the test results are completely normal, then the patient can be operated on. If unacceptable deviations are detected, you will first have to undergo medical therapy to normalize the condition.
Expert opinion
Shoshorin Yuri
General practitioner, site expert
The day before surgery, you should stop eating any food from 18:00, and stop drinking liquids from 22:00. Late in the evening, the medical staff on duty gives the patient an enema to cleanse the intestines. Today it is practiced to take a strong laxative, but it is not indicated for everyone.
Reviews of doctors providing the service – Cholecystectomy
Hello.
I would like to share my impressions after 3 brilliantly performed operations by the surgeons of the Multidisciplinary Clinic of CELT Dr. Bronshtein, Yuri Anatolyevich Prokhorov and the chief surgeon of CELT, Oleg Emmanuilovich Lutsevich, and express my gratitude to them from the bottom of my heart for the wonderful... Read full review Alexander Markovich A
07.08.2020
Hello. I would like to share my impressions after 3 brilliantly performed operations by the surgeons of the CELT Multidisciplinary Clinic Dr. Bronshtein, Yuri Anatolyevich Prokhorov and the chief surgeon of CELT, Oleg Emmanuilovich Lutsevich, and express my gratitude to them from the bottom of my heart for the wonderful... Read full review
Alexander Markovich A
07.08.2020
How is the operation performed?
Before the laparoscopic procedure to remove the gallbladder begins, anesthesia is administered to relieve pain and tissue sensitivity. In addition, anesthesia causes the abdominal muscle tissue to relax.
After administering anesthesia, the anesthesiologist inserts a probe through the patient's mouth to remove gases and remaining fluid from the stomach. This will help prevent an accidental gag reflex to prevent asphyxia. The probe is removed after the operation.
As soon as the probe is installed, a mask is placed on the lower part of the patient's face for artificial ventilation of the lungs. A person breathes through it during surgery. During laparoscopy, ventilation is simply necessary, since gas smoke is supplied into the abdominal space. It presses on the diaphragm, pressing against the lungs.
After all these preparatory procedures, the nurse treats the desired area with an antiseptic, and then the surgeon and assistants begin the surgical procedure. 3 incisions are made - one near the navel and two on the sides of the right hypochondrium. Carbon dioxide is pumped in to straighten the internal organs so that they do not interfere with the surgical process.
A laparoscope, illuminated video camera and other important trocars are inserted through the incisions. Inside the abdominal space, the surgeon manipulates them in the right directions, as a result of which he removes the gallbladder that is unsuitable for normal functioning. Removal occurs through a cosmetic incision made near the navel.
At the end of the surgical process, the blood vessels are coagulated, and an antiseptic solution is injected into the abdominal cavity. With its help, disinfection is carried out, after which it is sucked out. The trocars are removed, and the doctor sutures the incisions.
Using the laparoscopic approach, cholecystectomy can also be performed. During this procedure, the patient is given general anesthesia, and artificial ventilation of the lungs is mandatory by connecting to a machine.
Another name for anesthesia is “gas exposure.” Anesthesia is given to the patient using a machine through a special tube through which he breathes during surgery.
The exception to administering such anesthesia is if the patient has bronchial asthma. In this case, endotracheal anesthesia is replaced with general intravenous anesthesia.
Life of a patient after gallbladder removal
Rehabilitation after surgery is generally quick. A person fully recovers after about half a year, taking into account the mental aspects of the rehabilitation period.
General normalization of well-being occurs within 2-3 weeks after the procedure, but the patient must strictly adhere to all rehabilitation requirements. The first month after bladder laparoscopy, sports training should be avoided. For the first six months, lifting weights is prohibited. Strict diet No. 5 is indicated for 3-4 months.
If necessary, to speed up the process of tissue restoration and wound healing, the doctor may recommend physiotherapy.
Diet after gallbladder removal has some restrictions. For the first 3-4 months, the patient strictly follows table No. 5, after which raw vegetables, as well as unchopped fish and meat, can be introduced into his diet.
This stage lasts 2 years, after which the patient is gradually allowed to eat previously prohibited foods, but in moderation.
Consequences
After laparoscopic surgery, as after any surgical intervention, unpleasant consequences may occur that cause severe discomfort. The main problem is the release of bile that goes directly into the duodenum. This process in medicine is called “subsequent cholecystectomy syndrome.”
With this diagnosis, the patient may experience the following symptoms:
- Gag reflex and nausea;
- In some cases, there is an increase in temperature;
- Pain and rumbling in the abdomen;
- Stomach upset and flatulence;
- Bitterness when belching, heartburn;
- Jaundice.
Expert opinion
Shoshorin Yuri
General practitioner, site expert
Unfortunately, some patients, even after laparoscopic surgery, may experience these symptoms throughout their later lives. It is almost impossible to completely get rid of them.
Advantages of laparoscopic intervention over laparotomy
General abdominal surgery is prescribed mainly in cases where it is not possible to solve the patient’s problem using laparoscopy.
Laparoscopy is the more preferable method of invasive treatment because:
- during its implementation, a slight violation of the integrity of the tissues of the anterior abdominal wall is required, usually three or four punctures up to 20 millimeters long;
- pain after laparoscopy subside within 24 hours, provided that the operation was performed professionally;
- the patient can walk and move 4-6 hours after the end of the procedure (we are not talking about physical activity or complex movements);
- hospital stay after laparoscopy lasts from 1 to 10 days;
- the rehabilitation period lasts significantly less than after laparotomy;
- scars remaining from punctures are hardly noticeable;
- the risk of a postoperative hernia is minimal.
Possible complications
Any unforeseen situations or complications may arise both during surgery and after the operation.
The following complications may occur during laparoscopy of the gallbladder:
- On the abdominal wall, the doctor can damage blood vessels;
- The stomach, gallbladder and other nearby internal organs may be punctured or damaged by the laparoscope;
- Bleeding may begin from the liver bed or gallbladder artery.
Complications of a more complex nature are eliminated with another operation - laparotomy.
Due to the removal of the organ and nearby tissues, the patient may also experience some complications.
- If, after removing the gallbladder, its stump was poorly sutured, bile could enter the abdominal cavity;
- Peritonitis;
- The tissue around the navel could become inflamed.
In very extreme cases, 5-7% of patients may experience a hernia after laparoscopy. Most often this happens in people with large body weight. Or this complication occurs in those patients who underwent emergency surgery and were not planned in advance.
Diet
The patient’s nutrition is one of the main factors that allows not only to alleviate the patient’s condition and shorten the rehabilitation period, but also to help the body adapt to new living conditions. Since, despite the absence of a gallbladder, the liver continues to produce bile, which begins to flow haphazardly into the duodenum, it is necessary to adhere to some dietary restrictions aimed at reducing the intensity of bile production and optimizing the digestive process.
In the postoperative period, the diet should consist of semi-liquid pureed food that does not contain fats, spices and coarse fiber, for example, low-fat fermented milk products (cottage cheese, kefir, yogurt), boiled pureed meat, pureed boiled vegetables (potatoes, carrots). You should not eat marinades, smoked meats and legumes (peas, beans), regardless of the cooking method.
In addition to the question of what you can eat, how often should you eat is of great importance? Increasing the frequency of meals will normalize the digestive process and adapt it to new conditions. Thus, eating small portions of food 5–7 times will avoid the liver’s response to the appearance of a large food bolus in the stomach, and bile production will remain within normal limits. From the 3rd–4th postoperative day, you can switch to a normal diet, adhering to the diet and frequency of meals provided in dietary table No. 5.
Advantages and disadvantages
Let's consider what advantages the laparoscopic method of gallbladder removal has.
- Laparoscopy is a closed technique, and thanks to this, the interaction of internal organs and tissues is completely eliminated during the operation. There is also no risk of contracting infections.
- This operation requires small incisions to be made. This in turn reduces the traumatic process of the operation.
- After laparoscopy, no scars are formed, so the abdomen will not be cosmetically damaged.
- Short postoperative period, no more than 3 days.
- Those who cannot miss work can start it in a week.
With all its advantages, such surgical intervention also has a number of disadvantages. Let's get to know them.
- If the patient has chronic diseases of the cardiovascular or respiratory system, then laparoscopy is not indicated for him. Because carbon dioxide is injected into the abdominal cavity during surgery, there is a risk of compression of the lungs or heart. This can lead to increased pressure in the venous system, and there may be complications in the functioning of the heart. Or there will be strong pressure on the diaphragm, making breathing difficult.
- Diagnostic manipulations and possibilities during the operation are somewhat limited.
- Laparoscopy cannot be performed if the patient’s situation is too advanced. In these cases, unexpected pathologies may occur in the gallbladder, and additional surgical adjustments will be required.
If at least one of these points is present, a traditional laparotomy is performed.
Reviews
Anastasia: It’s a shame that we don’t perform surgeries to preserve the gallbladder. I have gallstones, but I don’t want to remove them, because I’ve heard a lot at work about the digestive problems that will arise after removing them. Six months ago I had an attack, they said I had to operate, as there would be a repeat attack and then no one would do laparoscopy at all - only open surgery. Now I don’t know what to do...
Mikhail: To avoid digestive disorders, you need to follow a diet. Removing the gallstone is a lifelong limitation. And don’t think that it was deleted and everything went away. After removal everything is just beginning.
Evgeniy: They do operations with preservation, but very reluctantly. If there is no inflammation yet, then they suggest crushing it with ultrasound or dissolving it with medications. I went through this myself. As a result, the stones were crushed using ultrasound and then removed laparoscopically from the gallbladder. But they said that they will form again. A year has passed since the operation and I still feel fine.
Maxim: My father had laparoscopic gall removal about 3 years ago. The recovery is really fast, as he was up and walking on the same day. I can’t say that he follows any kind of diet, but I haven’t heard any complaints from him about digestion. Maybe each organism is individual. Many people complain that after surgery they run to the toilet “like ducks.”
List of permitted and prohibited products
| You can eat | It is forbidden to eat |
| You can include lean meat in your diet, such as veal, chicken, as well as turkey and rabbit meat. | Exclude meat and dairy products with high fat content. |
| Sea fish or river predators, such as hake, pollock, perch or pike. | Fried foods should not be consumed. |
| Porridge is cooked from cereals until semi-liquid. | Smoked products are prohibited. Any offal. |
| Boil low-fat infusions and make soups from them; you can also add vegetables, pasta or cereals. | Spicy dishes, pickles and marinades. |
| Vegetables can either be stewed, boiled, or steamed. | Rye bread or fresh baked goods, any baked goods. |
| It is allowed to eat white bread, but yesterday's bread, not fresh. | Black coffee, chocolate, cocoa. |
| Boil compotes, prepare jelly only from non-acidic varieties of fruits or berries. | Alcohol. |
| Honey. | Mushrooms in any form are not recommended. |
| Low calorie dairy products. | Raw vegetables. |
Allowed products are subjected to heat treatment - boiled, steamed or baked in the oven.
Does the patient feel anything during laparoscopy?
The patient is transported to the operating room on a gurney.
Laparoscopic cholecystectomy is performed under general anesthesia. The last sensation is a slight pain from the injection when anesthesia is administered. It is better to voice all wishes to the medical staff before the injection. A patient wakes up in the intensive care unit. To monitor the patient's condition, the following are connected to him:
- tonometer - change in blood pressure;
- electrocardiograph - cardiac rhythm;
- hematology analyzer - analysis of blood characteristics;
- catheter - monitoring the amount and composition of urine.
A nasogastric tube was also installed to prevent vomit from entering the respiratory system if the patient vomits. The administration of medications is carried out through a dropper.
The patient sleeps almost all the time in the intensive care unit - the effects of anesthesia, nervous tension and physical fatigue are felt, as after any operation.
