The gall bladder is one of the main elements of the digestive and excretory systems. He is responsible for the accumulation, storage and secretion of bile, which the body needs to digest food. Dysfunction of the gallbladder leads to the development of many diseases. Drug treatment and diet in most cases contribute to the solution of this problem. But with pathologies, the patient’s condition can be relieved in only one way – cholecystectomy.
What is cholecystectomy?
In medicine, the term involves surgical intervention to excise the gallbladder. Literally translated from Latin means “removal of the bladder with bile.” For the first time such an operation was performed by a German surgeon in 1882. Then, many patients suffered from cholelithiasis. Since that moment, much has changed – now such a procedure is considered no more difficult than removing the appendix. After the operation, the patient returns to his previous lifestyle, subject to certain rules.
The principles of biliary tract surgery, identified in the distant XIX century, are relevant to this day. These include:
- Gallbladder removal is required. If this is not done, the stones may form again, then the procedure will have to be repeated.
- During the operation, it is necessary to examine the bile ducts for the presence of stones in them.
- The fewer attacks of cholecystitis before the intervention of surgeons, the more likely to return to normal life sooner.
- The art of the surgeon plays an important role in the results of the intervention.
Doctors do not immediately proceed to radical measures to remove the gallbladder. First, medication, a diet are prescribed, some turn to traditional medicine. If all these procedures have not brought the desired effect, it is better to resort to the help of surgeons. Timely and high-quality operation will relieve painful attacks, help restore the previous level of quality of life.
When the gall bladder is removed
The presence of bile inflammation, large stones, is the main indication for organ removal. The stones can be different – from sand to the formation of the size of a chicken egg. At the same time, operations to remove the gallbladder are divided into planned, urgent and emergency. Scheduled are most preferred. Relative indicators for surgical intervention are the following diseases:
- chronic calculous cholecystitis;
- asymptomatic cholelithiasis.
There is a group of indicators for which gallbladder removal is necessary. Absolute indications include:
- biliary colic – pain due to a violation of the outflow of bile, often occurs during pregnancy;
- malignant tumors;
- biliary obstruction – inflammation of the bladder due to infection;
- polyposis – the growth of the epithelial layer of the bladder mucosa over 10 mm;
- pancreatitis is a blockage of the duct connecting the duodenum to the pancreas.
Types of Surgery
The operation of cholecystectomy of the gallbladder can be carried out by four methods: cavity laparotomy, laparoscopy, mini-laparotomy, transluminal surgery. Which type to choose, the surgeon decides, based on the following indications:
- the nature of the disease;
- patient status;
- the presence of complications from the gallbladder and other body systems.
Laparotomy is a traditional type of gallbladder removal. Its main advantages include full access and an overview of the organ to be removed. Such an intervention is indicated in the presence of peritonitis or a large lesion of the biliary tract. The disadvantages are postoperative complications, a large incision, a long rehabilitation of the patient.
Endoscopic cholecystectomy or laparoscopy is by far the most common minimally invasive type of surgery. The advantages of the method are:
- low rates of trauma, blood loss and the risk of bacterial infection;
- short stay in the hospital – 2-3 days;
- quick recovery;
- minimal effect of anesthesia;
- small postoperative scars.
This method has its drawbacks. They are as follows:
- Increased pressure in the venous system from the gas introduced into the abdominal cavity. It can cause complications with breathing problems and impaired cardiovascular activity.
- Limited visibility of the removed organ.
- Unjustified risk in the absence of pathologies or the presence of contraindications.
In modern medicine, the transluminal surgery to remove the gallbladder is already used. With this method, natural human openings are used – the oral cavity, the vagina. Another popular way is cosmetic laparotomy. It involves the removal of an organ through the umbilical opening using microscopic incisions. After such an operation, inconspicuous seams remain.
In the case of a scheduled operation, you need to know some features. Preparation for cholecystectomy begins at home. The doctor prescribes a special diet, laxatives for 3-4 days. It is necessary to stop taking drugs that affect blood coagulation. Also applies to nutritional supplements, vitamins. The patient should think about a list of personal items that will be needed in the hospital.
To determine the patient’s condition and approve the operation methodology, preliminary diagnostic tests are carried out. After hospitalization, the doctor may prescribe:
- Ultrasound of the abdominal cavity and gall bladder.
- Computed tomography for accurate examination of the removed organ.
- MRI for a complete study of pathologies.
- Laboratory tests – blood and urine tests to establish quantitative indicators of the state of the gallbladder.
- Comprehensive examination of the cardiopulmonary system.
Immediately before the operation itself, certain rules must be observed. These include:
- one day before the procedure, it is allowed to eat light, lean dishes;
- ingestion of food, fluid 8 hours before the removal of the bladder is strictly prohibited;
- a cleansing enema is needed at night and in the morning on the day of surgery;
- before the procedure, it is advisable to take a shower using antibacterial detergents.
Diet before surgery
Before surgery, the patient needs to reduce the load on the liver and digestive system. Therefore, 14 days before the operation, it is recommended to follow some nutritional rules. Food should be taken 5-6 times a day in fractional portions. Alcohol, coffee are completely excluded. Fried, fatty, salty, spicy dishes are prohibited.
Allowed herbal foods – liquid cereals, vegetable broths, herbal tea. Restrictions are tightened 3 days before the removal of the bubble. Prohibited foods that promote increased gas formation in the intestine:
- black bread;
- carbonated drinks;
- high fiber foods;
- dairy products.
How to remove the gallbladder
Gallbladder removal operations are performed only by qualified specialists. After all, the outcome of the procedure largely depends on the knowledge and skills of the surgeon. Deciding on a method for removing a bag of bile lies almost entirely with the doctor. If possible, the patient’s desire is also taken into account. In this case, the psychological attitude of the patient is very important.
The operation using the classical technique is performed under general anesthesia. Using local anesthesia is dangerous. At the beginning of the procedure, the surgeon makes an incision on the abdomen 20-30 cm in the midline from the navel to the sternum or under the costal arch on the right. Extensive access to the removed organ. Then it is separated from the adipose tissue, bandaged with surgical thread. At the same time, the cystic arteries, bile ducts, and blood vessels are clamped with special clips.
Next, the bubble is excised. A study of the nearby area for the presence of stones. A drainage tube is inserted into the common bile duct to drain the fluid, the sacrum to avoid possible inflammation. Using a laser, hepatic bleeding stops. With the help of suture material, the surgical wound closes. The whole procedure takes an average of 1-2 hours.
With laparoscopy, endotracheal (general) anesthesia is used. The patient is intubated with the lungs – connected to an artificial ventilation apparatus. This need is due to the fact that with general anesthesia, all organs, including the diaphragm, relax. As the main tool, trocars are used – thin devices that push apart tissues. First, the surgeon makes 4 punctures in the abdominal wall with trocars – 2 by 5 cm, 2 by 10 cm. An endoscope is inserted into one of the holes – a miniature video camera.
Next, the abdominal cavity is filled with gas – carbon dioxide. This action expands the visibility for the surgeon. In the remaining punctures, manipulators are introduced, which are used to clip the arteries and blood vessels of the bladder. Then the diseased organ is cut off, and drainage is installed. The surgeon necessarily does cholangiography – checks the bile duct for any abnormalities. After that, the tools are removed, large punctures must be sutured, small ones are sealed with a plaster. The wound is treated with antiseptics.
Complications of cholecystectomy
After surgery, there is a risk of complications. According to statistics, they occur in 10% of postoperative patients. This is due to many factors – the qualification of the surgeon, the presence of concomitant diseases, the age of the patient, the individual characteristics of the body. Complications are divided into types:
A possible consequence after an open operation is the formation of an adhesive process. This often occurs with cholangitis, acute cholecystitis. The main complications include:
- outflow of bile;
- infection of the postoperative suture;
- swelling of the wound;
- vascular thrombosis;
- allergic reactions;
- internal and secondary bleeding;
- exacerbation of pancreatitis;