Gallbladder removal - indications for the operation, preparation, diet and recovery

The full process of digestion in the gastrointestinal tract provides a gallbladder, accumulating bile in the required quantities. Excessive forms a stone, and it clogs the bile ducts. Appearance of symptoms of pancreatitis, cholecystitis can cause complications, require the implementation of cholecystectomy( the so-called removal of the gallbladder).Learn about the operation.

What is the removal of the gallbladder

Cholecystectomy is performed with cholecystitis( purulent), gallbladder tumors. It can occur in two types: through a peritoneal incision( laparotomy) or without incisions with laparoscopy( there will be only three holes in the wall of the abdomen).Laparoscopy is pleased with the benefits: it is much easier to transfer, the postoperative period is shorter, there are practically no cosmetic defects.

Indications for removal of

There are several indications of for the removal of the gallbladder:

permanent pain in the right upper quadrant, frequent infection of an organ that does not respond to conservative methods of treatment;

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organ pathology;
chronic cholecystitis;
permanent yellowness;
obstruction of the bile duct;
cholangitis( cause - conservative treatment does not help);
presence of chronic diseases in the liver;
secondary pancreatitis.

These symptoms refer to general indications for cholecystectomy. Each individual patient is individual, some cases require urgent surgical intervention, and some can wait a couple of days or weeks. To determine the degree of urgency and the patient's condition, doctors conduct a complete list of diagnostic studies.

Preparation of

Complete preparation for any kind of operation on the gallbladder includes:

ultrasound( US ) of the gallbladder and abdominal organs( liver, pancreas, intestines, etc.);
computed tomography - it helps to assess periapuzyrnye tissues, walls, contours of the bladder, the presence of nodes or adhesions;
fistulography;
MRI is a reliable research method that determines the stones, inflammation, narrowing of the scars, pathology of the ducts.

Laboratory methods of examining a patient make it possible to detect abnormalities. Assign the content of transaminases, bilirubin, alkaline phosphatase, thymol sample, the amount of bile, and others. Often requires a comprehensive examination of the heart and lungs. The operation is not performed if the patient suffers from acute cholecystitis, in the presence of acute inflammatory processes, acute pancreatitis.

Patient before complete removal should:

stop taking medications that dilute blood ( affect coagulation) to avoid severe bleeding during surgery;
the night before the operation on the recommendations of the doctor to stop eating;
in the morning to spend a cleansing enema or in the evening to drink laxatives;
before the operation take a shower with antibacterial agents.

Diet before operation

Before cutting the organ, 3-4 days before the scheduled operation, a diet is prescribed:

without products causing bloating( flatulence);
without too fried and spicy food;
recommends the use of sour-milk products, lean meat and fish;
completely exclude products that lead to fermentation - fruits, vegetables, beans, bread( especially rye).

Methods of removal

To remove the organ, a laparotomy or laparoscopy is performed. Laparotomy is the removal of the calculus through the incision of the organ walls. Conduct it from the xiphoid process along the midline of the abdomen to the navel. Another option for deleting is via mini-access. The incision is made at the location of the walls of the bile, the diameter is 3-5 cm. Laparotomy has such advantages:

a large incision allows the doctor to easily assess the condition of the organ, to probe it from all sides, the duration of the operation is 1-2 hours;
cut out faster than with laparoscopy, which is required in emergency situations;
during operation there is no high gas pressure.

Disadvantages of intervention:

tissues are severely injured, there will be a visible, coarse scar;
operation is performed by open , the organs are in contact with the medium, instrumentation, the operating field is more contaminated with microorganisms;
patient stay in hospital - at least two weeks;
severe pain after surgery.

Laparoscopy is an operation to remove a gallbladder, which is carried through small holes( 0.5-1.5 cm) on the abdominal wall. Such holes can be only two or four. A telescopic tube is introduced into one hole, called a laparoscope, which is attached to the camera, and the whole course of the operation is displayed on the monitor. The same method is easy to remove stones.

Advantages:

trauma is very small;
after 3 days the patient can already go home;
no pain, rapid recovery;
reviews - positive;
laparoscopic surgery does not leave large scars;The
monitor allows the surgeon to better see the operating field, increasing it up to 40 times.

Disadvantages:

surgeon movements are limited;
deforms wound depth;
difficult to determine the strength of the effect on the organ;
the surgeon gets used to the back( his arms) movement of the instrument;
increases intra-abdominal pressure.

How to remove

Remove the gallbladder of one of the patient's selected operations( the person chooses the method of removal) - laparoscopy or laparotomy. Before this, the person is introduced to the course of the operation, and its consequences, sign the consent of and begin preoperative preparation. If there is no emergency indications, then the patient begins preparation with a diet at home.

The hollow operation

The procedure for the abdominal operation is as follows:

The skin and the cellulose are dissected. After the cut, the wound is dried. On loans, blood clamps are placed.
Dissect aponeurosis( ligament).Bare the peritoneum, dilate the rectus abdominis muscles in the sides.
The abdominal wall is cut. Suction the blood, suck the liquid and dry it with swabs.
A revision of the abdominal organs is performed, the organ is cut out.
Install drains for exudate outflow.
Sew the anterior abdominal wall.

Laparoscopic cholecystectomy

If the spikes, inflammations, are found during the operation, they can begin a hollow operation. Laparoscopy of bile is performed under with general anesthesia , artificial respiration is applied:

A special needle is injected with the prepared substance into the abdominal cavity.
Next, the punctures are performed, in which the toolkit and the video camera are started.
During removal, the arteries and duct are cut off, sealed with metal clips, the pancreas is not affected.
The organ is taken out through the largest opening.
A thin drainage is laid, the wound is sewn, the hole is machined.

Treatment after removal of the gall bladder

After surgery, antibiotics are prescribed to prevent complications. They take their first three days while they are in the hospital. Then prescribe antispasmodics : Drotaverin, No-shpa, Buskopan. Next, drugs that contain ursodeoxycholic acid are used to reduce the risk of concrements. To avoid problems with digestion, the body is helped with drugs.

Drugs

Conservative treatment methods include the administration of broad-spectrum antibiotics such as:

Ceftriaxone;
Streptomycin;
Levomycetin.

Drugs that contain ursodeoxycholic acid - hepatoprotector and cholagogue;

Ursosan;
Ursofalk;
Urso;
Ursoliv;
Ursodex.

Prescribe analgesic medication for pain relief:

Spazmolgon;
No-shpu.

Ursosan is a drug that contains ursodeoxycholic acid. Reduces the synthesis of cholesterol in the liver, absorbs it in the intestines, dissolves cholesterol stones, reduces stagnation of bile and reduces the cholatecholesterol index. Ursosan is shown:

after the removal operation;
in the presence of stones with preserved bubble function;
may be an appointment for stomach disease;
for symptomatic therapy in primary biliary cirrhosis and other liver diseases.

The plus of the drug is its ability to replace toxic bile acids with nontoxic ursodeoxycholic acid, improves the secretory capacity of hepatocytes, stimulates immunoregulation. Disadvantages of the drug:

may be vomiting;
cause bouts of pain in the region of the liver;
cause a cough;
increase the activity of hepatic enzymes;
stones are often formed.

Ursodex is one of the types of hepatoprotectors. Well chasing bile, has immunomodulatory action and cholelitholytic. Normalizes membranes of hepatocytes and cholangiocytes. It is indicated for symptomatic therapy:

in primary biliary cirrhosis;
presence of stones or prevention of their formation;
with biliary reflux gastritis.

The great advantage of Ursodex is its ability to significantly reduce the size of stones. Of the minuses:

can cause acute inflammatory processes in the gallbladder or in the ducts;
clog bile ducts( including common ones);
not infrequently causes digestive disturbances;
skin itching;
vomiting as a side effect;
is able to increase the activity of normal hepatic transaminases.

Recommendations after removal of

To avoid postoperative complications, follow the rehab recommendations for 4-8 weeks( regularly):

Limit exercise and weight over 4 kilograms. This promotes frequent breathing and tension of the internal abdominal muscles.
Do not go anywhere from adhering to a strict diet: eat a fraction, but often, chicken broth, low-fat meat and fish, porridge, etc. are allowed.
It is necessary to drink 1.5 liters of clean water a day.

Life after removal of the gallbladder

Most people believe, with surgical intervention and when there is no gallbladder - normal life stops, and a person forever chained to tablets, a healthy lifestyle, only eats useful food. This is far from the case. A strict diet is observed only the first time , and a large number of drugs will gradually decrease to minimal maintenance therapy.

Complications of

The main and dangerous complication is bleeding. Can be internal and external. The internal one is more dangerous, when it appears, an emergency operation is performed. There may develop abscesses, inflammation of the pancreas, peritonitis. Late complications include the appearance of jaundice. Problems can also occur due to surgical errors during the operation.

Temperature

If there is a high temperature of 38 ° C or 39 ° C, which is combined with a headache, chills, muscle aches, you should immediately consult a doctor. These symptoms indicate the development of the inflammatory process. If you do not pay attention to this, more serious complications may develop, the body's condition will deteriorate, it will be difficult to restore all the processes back to normal.

Seizure after removal of

Postoperative seizure in patients may occur with lesions of extrahepatic tracts .Common causes:

Stones or cyst formation in ducts.
Diseases of the liver.
Bile stasis, which accumulates and when the capsule is enlarged, causes painful sensations.
The work of the digestive organs is disrupted due to a chaotic supply of bile to the intestine and duodenum, fat is poorly absorbed, the intestinal microflora is weakened.

Consequences of the

All the consequences are united by the term "postcholecystectomy syndrome".It includes:

Pathological changes, biliary colic after surgery.
Errors of the doctor and damage to the ducts, the remaining stones, not complete removal, pathological changes, the cystic duct remained very long, the granuloma of the foreign body.
Complaints bodies that did not disturb prior to surgery.

In women

According to statistics, surgical interventions are three times more common in women than in men. This is due to sudden hormonal irregularities, as well as with pregnancy. In most cases, attacks of pain and inflammatory processes were observed in women in an "interesting position".The consequences of removal of the gallbladder in women are the same as in men.

In men,

It is believed that men suffer from diseases of the bile ducts less often. This is far from the case, because they immediately fall on the operating table, not being treated before. All because they long suffer painful feelings, when it would be necessary to address to the doctor. After the operation, the body's recovery is faster than that of women, they begin to live a normal life if they follow a diet and exclude alcohol.

Intestinal problems

When the gallbladder is removed, the bile acid constantly gets into the intestinal mucosa, which leads to flatulence, diarrhea, which causes problems for patients in the postoperative period. Over time, the digestive processes of adapt to the absence of the organ and everything will return to normal. But there is an opposite problem - constipation. It occurs because of a slowed peristalsis of the intestine after the operation.

Allergy

If there is a history of allergic reactions, the operation should be performed after a test for antibodies to allergens( drugs).If this is not done, anesthesia can cause a serious allergic reaction in a person, which sometimes leads to lethal consequences. If you are aware of the presence of allergies, be sure to tell the doctors.

How many live after removal of the gallbladder

This operation is not problematic, the absence of gallstones does not affect the quality and life expectancy, disability is not assigned, it is possible to work. Adhering to simple changes in the diet and prescriptions of the attending physician, one can live to a very old age, even if the bladder was removed at a young age. This does not affect liver function.

The cost of

Prices for surgery vary from 38,500 r.up to 280047 rubles. The table shows clinics and the price for the operation, the region is Moscow( Internet resource).

Name of the clinic	Price, rubles
Miracle Doctor	38500
Best Clinic	50820
He clinic	65000
Clinical hospital	105000
European MC	280047