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Features of the operation to remove stones in the gallbladder
Features of the operation to remove stones in the gallbladder
Anonim

Gallstone disease (GSD) ranks third among the most common chronic diseases. There are many reasons provoking it, for example, heredity, taking hormonal drugs, obesity, etc.

Conservative treatment gives results only in the first stages of development, and surgical intervention is performed in the later stages.

What is gallstone surgery?

Today, several types of surgical intervention are used and the doctor selects the most suitable option:

  • Cholecystectomy. The gallbladder is removed;
  • Cholecystolithotomy. A minimally invasive method aimed at removing deposits, while the organ is preserved;
  • Lithotripsy. The procedure is aimed at crushing stones using ultrasound or laser, and then removing the fragments. It is prescribed for single small formations and in the absence of complications in the anamnesis;
  • Contact litholysis. Special acids are injected into the cavity of the gallbladder to dissolve the stones. Use this option as an alternative if other techniques are ineffective or impossible to perform.

Most often, doctors opt for the first option, that is, removal of the gallbladder, since while maintaining the organ, the risk of recurrence increases significantly. Removal is performed through an incision or using laparoscopy.

The second option is used because it has a number of advantages:

  • The risk of a postoperative hernia is significantly reduced, since the incision length is no more than 2 cm;
  • Given the minimal intervention, the recovery process does not take long;
  • After the surgery has been performed, pain and other discomfort is practically not bothering.

Indications for surgery

Complete removal of an organ occurs in several cases:

  • With choledocholithiasis, since with this form a lumen of the general flow is formed. In this case, inflammation may develop, blockage of the ducts and other complications may occur. During the operation, the ducts are necessarily sanitized;
  • In acute cholecystitis, if not treated, there is a high risk of death. If there is such a disease, the following exacerbations are possible: purulent inflammation, sepsis, necrosis and the formation of intra-abdominal abscesses;
  • With obstruction, when a blockage of the duct leading to the duodenum is diagnosed;
  • With calcification, when calcification of the walls of the organ occurs. If the patient is left untreated, there is a risk of developing a malignant tumor;
  • With polyps that have a vascular pedicle or a size greater than 1 cm, since in this case there is a risk of their degeneration into a tumor;
  • In an acute inflammatory process that develops in the gallbladder and touches nearby tissues;
  • With organ perforation and cholesterosis.

How is the operation for cholelithiasis carried out?

Before carrying out surgery, it is necessary to undergo an examination, which includes an analysis of urine, blood for ESR. Based on the information received, doctors take into account the risks of the disease and the procedure itself. No food is allowed six hours before the operation, and no drinking is allowed after midnight. In the morning, an enema is mandatory.

Laparoscopy for gallstone disease

The intervention is carried out under general anesthesia and lasts for 30-90 minutes. After anesthesia, the surgeon makes several punctures in the abdominal cavity and inserts trocars. The incisions are made in different sizes and the largest is for camera insertion and organ removal.

Laparoscopy is performed according to the following scheme:

  • Using a needle, the doctor injects carbon dioxide into the body cavity, which will create sufficient space for manipulation;
  • During manipulations, the doctor will tilt the table with the patient at least twice in order to move the organs to minimize their damage, and then to return them to their place;
  • Using a clamp, the bladder is fixed and a catheter is inserted into the duct, which will prevent its compression;
  • The sphincter is examined to make sure there are no stones;
  • An incision is made using microscissors. After that, the organ is removed from the bed, monitoring the existing damage;
  • Using an electrocautery (a tool with a heated loop), the incisions and vessels are sealed so that there is no bleeding;
  • At the next stage, aspiration is done, that is, aspiration of fluid from the cavity.

Cavity cholecystectomy of the gallbladder

This type of surgery is performed under general anesthesia.

The duration of the operation is 1-2 hours, and it takes place as follows:

  • To improve viewing, a contrast agent is injected into the duct. This will determine whether there are stones or not;
  • The surgeon makes an incision either under the ribs or along the midline in the navel;
  • Using metal clips or special threads, the doctor sutures up all the vessels and ducts associated with the problem organ;
  • The gallbladder is bluntly dissected to avoid cuts. All bandaged ducts and vessels are cut out and the organ is removed;
  • A drainage tube is then inserted into the wound to drain blood and other fluids from the body. This allows the doctor to monitor whether a purulent process is formed. If all is well, then the catheter is given after 24 hours;
  • At the next stage, the tissues are sutured and the patient is transferred to the intensive care unit. While the anesthesia departs, he is constantly monitored, monitoring the pulse and pressure.

Gallbladder lithotripsy

The operation is carried out externally using a special device that emits different types of waves. In soft tissues, ultrasound propagates quickly, without causing damage, and in the presence of stones, deformations occur. Lithotripsy is prescribed in 20% of cases. It cannot be performed if the patient is taking anticoagulants, which inhibit the formation of blood clots.

Anesthesia for lipotripsy is performed by injecting anesthetic into the spine or intravenously. Before the operation, the doctor, using ultrasound, selects the optimal position for the patient. Using the device-emitter, the doctor performs a procedure during which the patient can feel pain and slight tremors. A successful operation is considered if after it is carried out in the gallbladder there are no stones or their parts larger than 5 mm in size. This result is observed in 90-95% of cases.

Contraindications to gallbladder surgery

Despite the enormous benefits, such surgery can be harmful in some situations. First of all, this concerns the presence of previous operations in the abdominal cavity on the spleen, liver, as well as old injuries and wounds. The operation is considered risky if adhesions or internal organs adhered to the walls of the peritoneum are found, since they can be damaged.

For gallstones, surgery should not be performed for lung problems or respiratory failure. Contraindications include obesity of 2 and 3 degrees, peritonitis, heart disease and the last stages of pregnancy. Refusal to perform surgery is also due to other undesirable factors that can be detected during the study.

Recovery period after gallbladder surgery

Immediately after the stones and the gallstone itself have been removed, the patient is taken to the ward. When the anesthesia passes, the person may feel nausea, which Cerucal will help get rid of.

Other features of the postoperative period:

  • After a few hours, pains of varying intensity appear, for the relief of which painkillers and in some cases even narcotic analgesics are prescribed;
  • On the first day after the laparoscopy was performed, you should not eat anything. Begin feeding two days later;
  • If there is no discharge, the drain is removed;
  • After 2-3 days, the patient can walk. Diet food is used;
  • The duration of hospital stay is 1-7 days. It all depends on the condition, the presence of symptoms and on the test results;
  • A person returns to normal life after a few weeks.

We have presented to your attention information regarding the operation in case gallstones were found. Follow all the rules for a faster recovery.

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