Rehabilitation treatment after cholecystectomy. Laparoscopic gallbladder removal surgery: life after and rehabilitation

Traditional cholecystectomy (removal of the gallbladder) with an open access is a very traumatic intervention, after which treatment requires a significant amount of time. Fortunately, medicine does not stand still, and extensive traumatic operations have almost completely replaced minimally invasive laparoscopic interventions. The laparoscopic method allows you to recover much faster. However, the operation remains an operation, and recovery from laparoscopy takes some time.

The first day after surgery

The first 2 hours after laparoscopy of the gallbladder, the patient spends in the intensive care unit, where he is supervised by an anesthesiologist-resuscitator. If everything is in order and there are no concomitant diseases that can complicate the postoperative period, the patient is transferred to a regular ward.

First 4-6 hours you can't even drink. Then ordinary water without gas at room temperature is allowed, several sips at a time. In total, until the end of the day, you can drink no more than half a liter of water.

6 hours after operations can get up. For the first time, it is better to do this in the presence of staff (if you stand up sharply after a long lie, orthostatic collapse is possible - fainting due to the fact that the blood does not have time to redistribute). It is better to rise smoothly, and before getting up, you need to sit in bed.

Second day after surgery

The drainage is removed - a special tube that provided an outflow from the intervention area. In some cases, a drain tube is not inserted. This is a simple procedure that does not require any special pain relief. But in general, pain relievers may be needed in the first 2-3 days. Depending on the intensity of the pain syndrome, patients are prescribed paracetamol, dexalgin, ketans or other drugs.

You can start eating. In the postoperative period with gallstone disease, the following are allowed:

• fermented milk products (fat-free);
• porridge on the water;
• soups - recommended in vegetable broth;
• lean meat - boiled (beef, chicken, turkey - better lean, and in birds - breasts);
• mashed vegetables (boiled);
• bananas are allowed from fruits.

Drinking is allowed as usual. You can move freely around the department. "Walking" along the corridor is not only allowed, but also recommended: physical activity not only prevents thromboembolic complications, but also shortens the period of complete recovery.

The 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 is issued for the duration of the hospital stay plus three days - usually after the operation by the method of laparoscopy, this is enough. In the case when the patient's work is connected with physical activity, the sick leave must be extended at the clinic.

If there are concomitant diseases requiring medical supervision, or complications arise, it is necessary to prescribe after the removal of stones by laparoscopy later - in this case, the doctor determines the specific terms individually.

You can shower at home. The transparent stickers on the wounds do not need to be peeled off, they are waterproof, it is better to remove the white ones. In no case should the area of ​​postoperative wounds be treated with shower gels or rubbed with a washcloth. Gently blotting (without rubbing!) With a towel, they need to be lubricated with brilliant green or betadine solution, or 5% iodine solution (the main thing is not to get carried away: too abundant lubrication with alcohol solutions can cause burns).

Second week after surgery

On the 7-8th day after the operation, the stitches are removed. To minimize the consequences of the operation and avoid the formation of rough scars and keloids, you can start using silicone-based gels (Dermatiks, Kelo-Kot) or silicone occlusive dressings (Dermatiks, Mepiform). Funds based on silicone polymers are included in the standards for the treatment and prevention of hypertrophic scars. Also good (although expectedly less than that of silicone dressings) effectiveness was shown by preparations of a relatively inexpensive line of "Contraubeks". Any funds can be applied only to a clean and dry scar after suture removal and provided there is no pathological discharge from the postoperative wound.

Most patients can go to work around this time. For those whose working conditions imply physical activity, the sick leave can be extended up to 28 days - the surgeon of the polyclinic will give more precise recommendations.

5 days after removing the stitches, you can take a bath, swim in the pool, swim in open water.

First month after surgery

Rehabilitation after removal of the gallbladder by laparoscopy is almost complete. Must be strictly observed diet... It is optimal to follow a diet for life, turning it into a healthy diet. But, given the real state of affairs, it is recommended to withstand at least a month. After that, you can gradually add "non-dietary" foods to the diet, carefully listening to the body's reaction.

During the first month, physical activity is limited: you cannot lift more than 3-4 kg, any exercises on the abdominal press are strictly prohibited. Walking is allowed in calm pace swimming.

After a month, you can gradually return to physical activity, but strength exercises are prohibited for at least six months. Failure to comply with these conditions can provoke the development of a postoperative hernia. You can resume your intimate life at least 2 weeks after the intervention.

Complications after laparoscopy and their treatment

1. Bruises, or, in the language of medicine, subcutaneous hemorrhage. Special treatment is not required, but it can be lubricated with heparin ointment.

2. Wound infection. It manifests itself as redness, soreness, and sometimes suppuration. Requires antibiotic therapy, sometimes surgical debridement (opening) of wounds.

3. Residual choledocholithiasis. In about 0.5% of patients fails to identify stones in the bile ducts before and during surgery. After surgery, these stones can close the biliary tract, which is most often manifested by jaundice. In this case, if possible, an endoscopic (with the help of a gastroduodenoscope - a medical endoscope with illumination) intervention is performed: the ducts are sanitized from the place of their confluence into the duodenum. But sometimes you have to do a second laparoscopy.

4. Damage to the bile ducts. It happens about 1 time in a thousand and requires a second operation.

Some possible complications in the postoperative period require immediate treatment. You need to see a doctor immediately in the following cases: if the edges of the wound are swollen, reddened, hot to the touch, especially if pus is released from them. And also if the temperature rises (above 37.5 degrees), chills appear, headache, general malaise... Or if there is nausea, vomiting, or abdominal pain.

Frequently asked Questions

What are the consequences of gallbladder laparoscopy?

Cholecystectomy usually goes away without any consequences. Only 10-15% of patients develop a condition called postcholecystectomy syndrome. The pathology is manifested by pain in the right hypochondrium, nausea, bitter belching, heartburn, diarrhea. The problem can arise both in the early postoperative period and later. long time after laparoscopy. For the prevention of the disease, it is important not to delay the operation until complications of cholecystitis appear, and after the operation, follow the doctor's recommendations, especially regarding the diet.

What day can I get up after laparoscopy?

Getting up on your own is what you can do after surgery on the very first day. This approach is called "early mobilization" and is very important for preventing thromboembolic complications that are caused by prolonged immobility.

How long does it take to be discharged after the operation?

The day on which they are discharged after the intervention depends both on the policy of the clinic and on the patient's state of health. Some clinics consider a one-day hospital stay sufficient. Most often, the patient is discharged 3 days after surgery. But if he has chronic diseases that may worsen after the intervention and require medical supervision, or if complications develop, he will have to stay in the hospital for several days longer.

In this article, we will consider how rehabilitation proceeds after removal of the gallbladder.

The question that worries the patient is how to live on, what can and cannot be done during rehabilitation. For such patients, after surgery begins recovery period... The patient will be forced to adapt to atypical circumstances, and he will have to learn to live without this organ. The fragile digestive system after surgery is attacked by various bacteria that previously died on contact with bile.

Rehabilitation after removing the gallbladder is very important.

Postoperative period

Any invasive procedures are always a huge stress for the patient, so the rehabilitation period will not be very easy and simple. Recovery will be faster if the operation was performed sparingly, that is, through laparoscopy. This technique is less traumatic compared to and helps to avoid serious consequences.

First of all, the patient needs to take into account that after removal of the bile, the body will continue to function as before. The liver, as before, will secrete bile. It's just that now it will not accumulate in the bile until the onset of the active digestive phase, but will continuously drain along the bile duct to the area duodenum... It is in this regard that the patient will have to adhere to a special diet, which should help protect the digestive system from constant bile secretion.

How long does rehabilitation after removal of the gallbladder last, it is interesting to many. A special diet is prescribed only in the first thirty days. In the future, it can be gradually expanded and supplemented. After a few months, the patient will be able to eat almost everything. But still, do not get carried away with fatty and spicy dishes. And if possible, you need to completely exclude them from your diet.

Such a patient will need at least one year to learn how to do without this organ. During this period, its main function of storing bile will begin to be performed by the bile duct and channels inside the liver, thanks to which the need for a strict diet will completely disappear over time.

So, what is the rehabilitation after removal of the gallbladder?

Rules

The patient will need to comply certain rules rehabilitation:

• Compliance with a gentle diet and a strict diet. The patient will be assigned a table number 5 along with a fractional meal at least six times a day.
• Conducting moderate physical activity. Special exercises are recommended to strengthen the anterior abdominal wall. You can do this kind of gymnastics at home. For overweight patients, it is best to practice in groups under the strict supervision of an instructor.
• Medical treatment. Special therapy will help the patient to establish a gall-free life. But prescribe the required medications only a doctor has the right.

What is the rehabilitation period after removal of the gallbladder? Recovery doesn't take too long. At the same time, you do not need to radically change your lifestyle. You just need to strictly follow all doctor's prescriptions in order to minimize the risks of complications. In the process of long-term rehabilitation, the patient should undergo regular medical examinations. If necessary, the doctor will certainly prescribe additional therapy and give the correct recommendations for rehabilitation after removal of the gallbladder.

Initial rehabilitation

Immediately after the operation, the patient has questions about the recovery process. For example, such patients are interested in how long it will take to stay in the hospital, what they can eat when the doctor allows them to return to their usual life. The patient usually spends the first days in a hospital. It is in these conditions that the basic process of recovery is laid. The patient is informed about all the recommendations that are necessary for implementation during the rehabilitation period. Depending on the type of invasive intervention, the stationary therapeutic period can last from two to seven days.

Rehabilitation after removal of the gallbladder by laparoscopy takes less time. Elective surgery is performed using laparoscopy. Only in emergency situations, when the patient's life is in danger, is a median laparotomy used. Abdominal surgeries require patients to stay in the hospital for a longer period. It is thanks to laparoscopy, as a minimally invasive method, that the postoperative period is significantly reduced.

This intervention has an undeniable advantage over the abdominal method, namely:

Stationary events

Let's take a closer look at how rehabilitation proceeds after removal of the gallbladder by laparoscopy.

After minimally invasive laparoscopy, the patient is moved from the operating room to the intensive care unit. There he stays for a couple of hours after removing the bile to control the exit from anesthesia. In the event that unforeseen complications arise during this period, the duration of stay in the ward may be extended. Then the patient is sent to the general ward, in which he will stay until the moment of discharge.

For six hours after minimally invasive procedures, the patient will be prohibited from drinking and getting out of bed. Only the next day, you can drink plain water in small quantities. This will have to be done fractionally, two sips every half hour.

During the rehabilitation period after removal of the gallbladder by laparoscopy, it is necessary to get out of bed slowly, without sudden movement, doing this in the presence of a nurse. The next day, the patient is allowed to consume liquid food, and, in addition, to move freely around the hospital. In the first seven days, it is strictly forbidden to consume coffee along with tea, fizzy drinks, sweets, alcohol, fatty and fried foods. The following food options are allowed in the diet:

• Eating low-fat cottage cheese.
• Kefir along with unsweetened yogurt.
• Reception of oatmeal or buckwheat, boiled in water.
• Eating baked, non-acidic apples, bananas and boiled vegetables, steamed lean meats.

It is required to exclude from the diet foods that cause flatulence along with increased bile secretion, it comes about onions, garlic, peas, black bread and so on. Within ten days after the operation, the patient is not recommended to perform difficult physical work, lift weights. In addition, you will need to wear natural underwear that will not irritate a fresh wound.

How long rehabilitation lasts after removing the gallbladder, not everyone knows. usually lasts from seven to eleven days. And directly on the twelfth day, the sutures are removed to the patients (provided that there was a laparoscopy), then a sick leave with an extract from the card is issued. In addition, the surgeon provides recommendations for the further organization of life without gall.

Sick leave registration

A certificate of incapacity for work is given for the entire time a person is in the hospital and additionally for another twelve days of home rehabilitation. In the event that during this period the patient has complications, the sick leave is extended. The total period of the certificate of incapacity for work is determined for each patient on an individual basis.

How is rehabilitation after removal of the gallbladder by laparoscopy at home?

Home recovery

Each patient must understand that the recovery period will be easier if the diet is followed. After returning home, the patient must register for outpatient registration at the place of residence to the surgeon. It is this specialist who will monitor the health and condition of the patient, prescribing the required drug treatment.

The regularity of visiting a doctor is obligatory not only for those who need to close a sick leave. In the first days after laparoscopy, complications may occur. Their timely diagnosis and therapy will significantly speed up the healing process. The following directions and criteria for home recovery are highlighted:

The rehabilitation period after removing the gallbladder at home is often quick and easy. The patient recovers completely after 6 months.

For the best course of the recovery period, you must adhere to the following recommendations:

• You should not have sexual intercourse in the first month after the intervention.
• It is necessary to adhere to the prescribed diet to avoid constipation.
• Visits to sports clubs and fitness clubs should be postponed for at least a month.
• It is forbidden to lift weights for six months after the operation (more than five kilograms in weight).
• In the first thirty days, you can not work hard physically.

Otherwise, the rehabilitation period does not require compliance with any other conditions or rules. For quick wound healing, you need to attend a couple of physiotherapy sessions. It would be nice to start taking vitamins for immunity after the operation. The operation to remove the gallbladder hardly changes the usual life. Already twenty-one days after the laparoscopy, you can start working.

Diet

After six months of rehabilitation, the diet can be complete. A menu based on the principles of proper nutrition should remain with the patient for the rest of his life. Only in rare cases are some violations in the diet allowed, but in no case should this become the norm. The advice of specialists regarding the table after removal of the bile is based on the observance of the following nutritional principles:

In addition, it is required to observe a few more elementary rules: immediately after lunch, you cannot bend down and it is forbidden to lift weights, and you should also not sleep on your stomach or left side. It is advisable to reduce weight for obese people.

Taking medications

After surgery to remove the gallbladder, rehabilitation is not difficult. Patients often require minimal treatment. There is usually little pain during home recovery, but in rare situations, pain medications may be needed. In order to improve the chemical parameters, the doctor may prescribe the drug "Ursofalk". The use of any medication during home rehabilitation should be done solely as directed by the surgeon.

We suggest that you familiarize yourself with the article on the topic: "Rehabilitation after removal of the gallbladder by laparoscopy" on our website dedicated to the treatment of the liver.

Gallstone disease is one of the most common surgical pathologies. Because of this, the problem of treatment and rehabilitation of such patients does not lose its relevance. Despite the development of conservative methods (shock wave lithotripsy), surgical treatment remains the leading one. In this regard, rehabilitation after removal of the gallbladder includes several stages.

The classic method is to make a large incision in the abdominal wall, isolate and remove the gallbladder. Laparotomy is used when it is necessary to carry out an emergency intervention, the impossibility of performing a laparoscopic procedure. Like any other abdominal surgery, it is relatively difficult to tolerate. For this reason, a long recovery period is required.

Laparoscopic interventions are less traumatic for the patient.

Has a number of advantages over classical cholecystectomy. During laparoscopy, several small incisions of the abdominal wall are made, traumatization of organs and tissues is minimized. The patient's rehabilitation period is much shorter.

Stages of rehabilitation after cholecystectomy

• The early stationary stage (the first two days), when the changes caused by the operation and anesthesia are most manifested.
• Late stationary stage (3-6 days with laparoscopy and up to 14 days with laparotomy), when the functions of the respiratory system are restored, the gastrointestinal tract begins to adapt to work in the absence gallbladder, regeneration processes are activated in the intervention zone.
• Outpatient rehabilitation (1-3 months, depending on the type of operation), when the functions of the digestive and respiratory systems, the patient's physical activity are fully restored.
• Active spa treatment is carried out in 6-8 months.

Features of pathophysiological disorders in patients who underwent cholecystectomy

Effective rehabilitation of patients after cholecystectomy is impossible without knowledge of the features of the development of changes in the body during surgical treatment.

Violation of external respiration is associated with artificial ventilation of the lungs during surgery, sparing the anterior abdominal wall due to pain syndrome, decreased patient activity, and weakening of the body. This can lead to the development of postoperative complications, such as pneumonia. For prevention, breathing exercises, physiotherapy exercises are carried out.

Local changes in the organs of the digestive system are manifested by the development of edema and inflammation in the area of ​​intervention, a high risk of adhesion formation during classical surgery. With the laparoscopic method, the amount of damage is much lower, which means that it will take less time for full recovery. Disorders of the motor function of the gastrointestinal tract can persist for up to two weeks with laparotomy, and with a minimally invasive method, they practically do not appear.

Rehabilitation of patients in a hospital

While the patient is in the hospital, he should carry out the following rehabilitation measures:

• Breathing exercises for 3-5 minutes 5-8 times during the day. The patient makes 10-15 as deep breaths as possible through the nose, then sharp exhales through the mouth.
• Early activation of patients when it is allowed to get up a few hours after laparoscopic surgery.
• Diet therapy for the adaptation of the digestive system to new working conditions. The first day requires maximum sparing of the gastrointestinal tract.
• Physiotherapy exercises for quick recovery of physical activity.
• Drug treatment: enzymes, pain relievers, drugs to correct intestinal paresis.

Rehabilitation of patients in a polyclinic (outpatient stage)

Diet therapy is an important component of the rehabilitation of patients after cholecystectomy.

Dynamic observation:

• examination by a surgeon and a therapist on the 3rd day after discharge, then after 1 and 3 weeks;
• clinical and biochemical blood tests 2 weeks after discharge and 1 year later;
• Ultrasound is prescribed in the first month according to indications, after 1 year for all patients.

Medical and recreational activities:

• a gradual increase in the load on the abdominal press (exercises "scissors", "bicycle");
• an increase in the pace and duration of walking;
• breathing exercises.

Diet therapy:

• For the first 2 months, a moderate diet with a normal protein, carbohydrate and fat content is recommended.
• it is necessary to exclude dishes rich in spices, extractives, fatty, fried.
• products should be steamed, baked, boiled.
• you need to eat in small portions every 3 hours.
• after eating for 2 hours, do not work in an incline or lie down.
• the last meal should be at least an hour and a half before bedtime.

Drug treatment:

• with the development of duodeno-gastric reflux (throwing the contents of the duodenum into the stomach), antireflux drugs are prescribed (for example, Motilium 10 mg before meals three times a day).
• when erosions of the gastric mucosa appear, antisecretory drugs are prescribed (for example, Omeprazole 30 mg before meals twice a day).
• with pain syndrome, heartburn, antacids are recommended (Almagel, Maalox, Rennie).

Non-drug treatment:

• mineral water ½ glass up to 4 times a day;
• physiotherapy (ultrasound, magnetotherapy).

Spa treatment

Postponed cholecystectomy is a direct indication for spa treatment. The procedures listed below will help a person recover as soon as possible after surgery.

• Ingestion mineral waters in a degassed and heated form, ½ cup 4 times a day half an hour before meals.
• Balneotherapy. Radon, coniferous, mineral, carbon dioxide baths up to 12 minutes a day every other day. Up to 10 baths per course of treatment.
• Electrophoresis of succinic acid for the correction of adaptation processes.
• Medication to correct energy metabolism (Mildronate, Riboxin).
• Diet therapy and physiotherapy exercises.

Thus, cholecystectomy can be performed in two ways: laparotomy or laparoscopy. The duration of the recovery process depends on this. However, in any case, rehabilitation after removal of the gallbladder takes place in several stages.

Currently, laparoscopic operations are very widespread. Their share in the treatment of various surgical diseases, including stones in the gallbladder, takes from 50 to 90%, since

laparoscopy is a highly effective, and at the same time relatively safe and low-traumatic method of surgical interventions on the organs of the abdominal cavity and small pelvis. That is why, at present, laparoscopy of the gallbladder is performed quite often, becoming a routine operation recommended for

gallstone disease

As the most effective, safe, low-traumatic, fast and with minimal risk of complications. Let us consider what the concept of “gallbladder laparoscopy” includes, as well as what are the rules for the production of this surgical manipulation and the subsequent rehabilitation of a person.

Laparoscopy of the gallbladder - determination, general characteristics, types of operations

The term "gallbladder laparoscopy" in everyday speech usually means an operation to remove the gallbladder, performed using a laparoscopic approach. In more rare cases, under this term people can mean the removal of stones from the gallbladder using the laparoscopic technique of performing the operation.

That is, "laparoscopy of the gallbladder" is, first of all, a surgical operation, during which either the complete removal of the entire organ is performed, or the stones present in it are exfoliated. Distinctive feature an operation is the access by which it is performed. This access is carried out using a special apparatus - laparoscope, and therefore is called laparoscopic. Thus, gallbladder laparoscopy is a surgical operation performed using a laparoscope.

In order to clearly understand and understand the differences between conventional and laparoscopic surgery, it is necessary to outline the course and essence of both techniques in general terms.

So, the usual operation on the abdominal organs, including the gallbladder, is carried out using an incision in the anterior abdominal wall, through which the doctor sees the organs with his eye and can perform various manipulations on them with the instruments in his hands. That is, it is quite easy to imagine an ordinary operation to remove the gallbladder - the doctor cuts the abdomen, cuts out the bladder and sutures the wound. After such a conventional operation, a scar in the form of a scar, corresponding to the line of the incision made, always remains on the skin. This scar will never let its owner forget about the operation. Since the operation is performed using an incision in the tissues of the anterior abdominal wall, such access to the internal organs is traditionally called laparotomic.

The term "laparotomy" is formed from two words - this is "lapar", which translates as the abdomen, and "tomia", meaning to cut. That is, the general translation of the term "laparotomy" sounds like cutting the abdomen. Since, as a result of cutting the abdomen, the doctor is able to manipulate the gallbladder and other organs of the abdominal cavity, the very process of such cutting of the anterior abdominal wall is called laparotomy access. In this case, access is understood as a technique that allows a doctor to perform any actions on internal organs.

Laparoscopic surgery on the abdominal and pelvic organs, including the gallbladder, is performed using special instruments - a laparoscope and trocars-manipulators. A laparoscope is a video camera with a lighting device (flashlight), which is inserted into the abdominal cavity through a puncture on the anterior abdominal wall. Then the image from the video camera enters the screen, on which the doctor sees the internal organs. It is by focusing on this image that he will carry out the operation. That is, during laparoscopy, the doctor sees organs not through the abdominal incision, but through a video camera inserted into the abdominal cavity. The puncture through which the laparoscope is inserted has a length of 1.5 to 2 cm, so a small and almost invisible scar remains in its place.

In addition to the laparoscope, two special hollow tubes are inserted into the abdominal cavity, called trocars or manipulators, which are designed to control surgical instruments. Through the hollow holes inside the tubes, the instruments are delivered into the abdominal cavity to the organ to be operated on. After that, with the help of special devices on the trocars, they begin to move the instruments and perform the necessary actions, for example, to cut adhesions, apply clamps, cauterize blood vessels, etc. Controlling instruments using trocars can be roughly compared to driving a car, airplane, or other device.

Thus, a laparoscopic operation is the introduction of three tubes into the abdominal cavity through small punctures 1.5 - 2 cm long, one of which is designed to obtain an image, and the other two - for the production of the actual surgical manipulation.

The technique, course and essence of operations that are performed using laparoscopy and laparotomy are exactly the same. This means that the removal of the gallbladder will be performed according to the same rules and steps, both using laparoscopy and during laparotomy.

That is, in addition to the classic laparotomy approach, the laparoscopic approach can be used to perform the same operations. In this case, the operation is called laparoscopic, or simply laparoscopy. After the words “laparoscopy” and “laparoscopic”, the name of the operation performed, for example, removal, is usually added, after which the organ on which the intervention was performed is indicated. For example, the correct name for gallbladder removal during laparoscopy would be “laparoscopic gallbladder removal”. However, in practice, the name of the operation (removal of a part or the entire organ, exfoliation of stones, etc.) is skipped, as a result of which there remains only an indication of the laparoscopic access and the name of the organ on which the intervention was performed.

Laparoscopic access can be performed in two types of intervention on the gallbladder:

1. Removal of the gallbladder.

2. Removal of stones from the gallbladder.

Currently surgery to remove stones from the gallbladder is almost never performed for two main reasons. Firstly, if there are a lot of stones, then the entire organ should be removed, which is already too pathologically altered and therefore will never function normally. In this case, removing only stones and leaving the gallbladder is unjustified, since the organ will constantly become inflamed and provoke other diseases.

And if there are few stones, or they are small, then you can use other methods to remove them (for example, litholytic therapy with ursodeoxycholic acid drugs, such as Ursosan, Ursofalk, etc., or crushing stones with ultrasound, due to which they decrease in size and independently come out of the bladder into the intestine, from where they are removed from the body with a food lump and feces). In the case of small stones, litholytic therapy with medication or ultrasound is also effective and avoids surgery.

In other words, at present there is a situation that when a person needs an operation for gallstones, it is advisable to remove the entire organ completely, and not to exfoliate the stones. That is why surgeons most often resort to laparoscopic removal of the gallbladder, and not stones from it.

Benefits of laparoscopy over laparotomy

Laparoscopy has the following advantages over large cavity surgery:

• Small damage to the tissues of the anterior abdominal wall, since four punctures are used for the operation, and not an incision;
• Minor pain after surgery that subside within a day;
• A few hours after the end of the operation, the person can walk and perform simple actions;
• Short hospital stay (1 - 4 days);
• Fast rehabilitation and restoration of working capacity;
• Low risk of incisional hernia;
• Subtle or almost invisible scars.

Anesthesia for laparoscopy of the gallbladder

For laparoscopy, only the general endotracheal

with the obligatory connection of a ventilator

Endotracheal anesthesia is a gas and is formally a special tube through which a person will breathe using a ventilator. If endotracheal anesthesia is impossible, for example, in people suffering from bronchial

Intravenous anesthesia is used, which is also necessarily combined with artificial ventilation.

Laparoscopic removal of the gallbladder - the course of the operation

Laparoscopic surgery is performed under general anesthesia, as well as laparotomy, since only this method allows not only reliably relieving pain and tissue sensitivity, but also well to relax the abdominal muscles. With local anesthesia, it is impossible to provide reliable relief of pain and tissue sensitivity in combination with muscle relaxation.

After introducing a person into anesthesia, the anesthesiologist inserts a probe into the stomach to remove the fluids and gases present in it. This probe is necessary in order to exclude accidental vomiting and ingestion of stomach contents into the respiratory tract, followed by asphyxiation. The gastric tube remains in the esophagus until the end of the operation. After installing the probe, the mouth and nose are covered with a mask attached to a ventilator, with the help of which the person will breathe during the entire operation. Artificial ventilation of the lungs during laparoscopy is absolutely necessary, since the gas used during the operation and injected into the abdominal cavity presses on the diaphragm, which, in turn, strongly compresses the lungs, as a result of which they cannot breathe on their own.

Only after the introduction of a person into anesthesia, removal of gases and liquids from the stomach, as well as the successful attachment of a ventilator, the surgeon and his assistants begin to perform a laparoscopic operation to remove the gallbladder. To do this, a semicircular incision is made in the fold of the navel, through which a trocar with a camera and a flashlight is inserted. However, before the camera and flashlight are inserted, sterile gas, most often carbon dioxide, is pumped into the abdomen, which is necessary to expand the organs and increase the volume of the abdominal cavity. Thanks to the gas bubble, the doctor is able to freely operate with trocars in the abdominal cavity, minimally touching adjacent organs.

Then another 2 - 3 trocars are introduced along the line of the right hypochondrium, with which the surgeon will manipulate the instruments and remove the gallbladder. The puncture points on the abdominal skin through which trocars are inserted for laparoscopic gallbladder removal are shown in Figure 1.

Picture 1- The points where the puncture is made and trocars are inserted for laparoscopic removal of the gallbladder.

The surgeon then examines the location and appearance of the gallbladder first. If the bladder is closed with adhesions due to a chronic inflammatory process, then the doctor first dissects them, releasing the organ. Then the degree of its tension and fullness is determined. If the gallbladder is very tense, the doctor first cuts its wall and aspirates a small amount of fluid. Only after that a clamp is applied to the bladder, and the common bile duct, the bile duct, which connects it to the duodenum, is released from the tissues. The common bile duct is cut, after which the cystic artery is isolated from the tissues. Clamps are placed on the vessel, cut between them and carefully sutured the lumen of the artery.

Only after freeing the gallbladder from the artery and common bile duct, the doctor proceeds to release it from the hepatic bed. The bladder is separated slowly and gradually, cauterizing along the way electric shock all bleeding vessels. When the bladder is separated from the surrounding tissue, it is removed through a special small cosmetic puncture in the navel.

After that, the doctor, using a laparoscope, carefully examines the abdominal cavity for bleeding vessels, bile and other pathologically altered structures. The vessels are coagulated, and all altered tissues are removed, after which an antiseptic solution is injected into the abdominal cavity, which is used for washing, after which it is sucked off.

This completes the laparoscopic operation to remove the gallbladder, the doctor removes all trocars and sutures or simply glues the punctures on the skin. However, a drainage tube is sometimes inserted into one of the punctures, which is left for 1 to 2 days so that the remnants of the antiseptic rinsing fluid can freely drain from the abdominal cavity. But if during the operation, bile was practically not poured out, and the bladder was not very inflamed, then the drainage may not be left.

It should be remembered that a laparoscopic operation can be transferred to a laparotomy if the bladder is too strongly adhered to the surrounding tissues and cannot be removed using the available instruments. In principle, if any unresolved difficulties arise, the doctor removes the trocars and performs the usual extended laparotomy operation.

Laparoscopy of gallstones - the course of the operation

The rules for introducing anesthesia, installing a gastric tube, connecting a ventilator and inserting trocars to remove stones from the gallbladder are exactly the same as for cholecystectomy (removal of the gallbladder).

After the introduction of gas and trocars into the abdominal cavity, the doctor, if necessary, cuts off the adhesions between the gallbladder and the surrounding organs and tissues, if any. Then the wall of the gallbladder is cut, the tip of the suction is inserted into the cavity of the organ, with the help of which all the contents are removed. After that, the wall of the gallbladder is sutured, the abdominal cavity is washed with antiseptic solutions, trocars are removed and stitches are applied to punctures in the skin.

Laparoscopic removal of stones from the gallbladder can also be transferred to laparotomy at any time if the surgeon has any difficulties.

How long does a gallbladder laparoscopy take?

Depending on the experience of the surgeon and the complexity of the operation, gallbladder laparoscopy lasts from 40 minutes to 1.5 hours. On average, laparoscopic gallbladder removal takes about an hour.

Where to get the surgery?

You can do a laparoscopic operation to remove the gallbladder in the central district or city hospital in the general department

surgery or gastroenterology. In addition, this operation can be performed in research institutes dealing with diseases of the digestive system.

Laparoscopy of the gallbladder - contraindications and indications for surgery

Indication the following diseases are used to remove the gallbladder by the laparoscopic method:

• Chronic calculous and non-calculous cholecystitis;
• Polyps and cholesterosis of the gallbladder;
• Acute cholecystitis (in the first 2 - 3 days from the onset of the disease);
• Asymptomatic cholecystolithiasis (gallstones).

Laparoscopic gallbladder removal contraindicated in the following cases:

• An abscess in the gallbladder area;
• Severe diseases of the organs of the cardiovascular or respiratory system in the stage of decompensation;
• Third trimester of pregnancy (from week 27 to delivery);
• Unclear location of organs in the abdominal cavity;
• Operations on the abdominal organs, performed in the past by laparotomy access;
• Intrahepatic location of the gallbladder;
• Acute pancreatitis;
• Obstructive jaundice resulting from blockage of the biliary tract;
• Suspicion of a malignant tumor in the gallbladder;
• Severe cicatricial changes in the hepatic-intestinal ligament or the neck of the gallbladder;
• Blood clotting disorders;
• Fistulas between the biliary tract and the intestines;
• Acute gangrenous or perforated cholecystitis;
• "Porcelain" cholecystitis;
• The presence of a pacemaker.

A maximum of 2 weeks before the planned operation, the following tests should be passed:

• General analysis of blood and urine;
• Biochemical blood test with determination of the concentration of bilirubin, total protein, glucose, alkaline phosphatase;
• Coagulogram (APTT, PTI, INR, TV, fibrinogen);
• Blood group and Rh factor;
• Vaginal flora smear for women;
• Blood for HIV, syphilis, hepatitis B and C;
• Electrocardiogram.

A person is admitted to the operation only if the results of his analyzes are within the normal range. If there are deviations from the norm in the analyzes, then you will first have to undergo a course of the necessary treatment aimed at normalizing the condition.

In addition, in the process of preparing for laparoscopy of the gallbladder, one should take control of the course of existing chronic diseases of the respiratory, digestive and endocrine systems and take medications agreed with the surgeon who will operate.

On the day before the operation, you should finish eating at 18-00, and drinking - at 22-00. From ten o'clock in the evening on the eve of the operation, a person can neither eat nor drink until the beginning of the surgical intervention. To cleanse the intestines, a laxative and an enema should be taken on the day before the operation. An enema should also be given in the morning immediately before the operation. Laparoscopic gallbladder removal does not require any other preparation. However, if in any individual case the doctor considers it necessary to perform any additional preparatory manipulations, he will say this separately.

Laparoscopy of the gallbladder - postoperative period

After the operation is completed, the anesthesiologist “wakes up” the person by stopping the anesthetic gas mixture. On the day of surgery, bed rest should be observed for 4 - 6 hours. And after the data 4-6 hours after the operation, you can turn in bed, sit down, get up, walk and perform simple self-care actions. Also from the same moment it is allowed to drink non-carbonated

On the second day after the operation, you can start eating light, soft food, for example, weak broth, fruits, low-fat cottage cheese, yogurt, boiled lean crushed meat, etc. Food should be taken often (5 - 7 times a day), but in small portions. Drink plenty of fluids throughout the second day after surgery. On the third day after the operation, you can eat regular food, avoiding foods that cause strong gas formation (legumes, black bread, etc.) and bile secretion (garlic, onions, spicy, salty, spicy). In principle, from 3 to 4 days after the operation, you can eat according to diet No. 5, which will be described in detail in the corresponding section.

Within 1 - 2 days after the operation, a person may be disturbed by pain in the area of ​​punctures on the skin, in the right hypochondrium, as well as above the collarbone. These pains are caused by traumatic tissue damage and will completely disappear after 1 to 4 days. If the pain does not subside, but, on the contrary, intensifies, then you should immediately consult a doctor, as this may be a symptom of complications.

During the entire postoperative period, which lasts 7-10 days, one should not lift weights and perform any work related to physical activity. Also during this period, you need to wear soft underwear that will not irritate painful punctures on the skin. The postoperative period ends on the 7-10th day, when the stitches are removed from the punctures on the abdomen in a polyclinic.

Hospital for laparoscopy of the gallbladder

A sick leave is given to a person for the entire period of hospital stay, plus another 10 - 12 days. Since the discharge from the hospital is made 3 to 7 days after the operation, the total sick leave for laparoscopy of the gallbladder is 13 to 19 days.

With the development of any complications, the sick leave is extended, but in this case the terms of disability are determined individually.

After laparoscopy of the gallbladder (rehabilitation, recovery and lifestyle) Rehabilitation

after laparoscopy of the gallbladder usually proceeds rather quickly and without complications. Full rehabilitation, including both physical and mental aspects, occurs 5-6 months after the operation. However, this does not mean that for 5-6 months a person will feel bad and will not be able to live and work normally. Full rehabilitation does not only mean physical and mental recovery after the

and injuries, but also the accumulation of reserves, in the presence of which a person will be able to successfully withstand new trials and stressful situations without harm to himself and without the development of any diseases.

And the normal state of health and the ability to perform the usual work, if it is not associated with physical activity, appears within 10 - 15 days after the operation. Starting from this period, for the best rehabilitation, the following rules should be strictly adhered to:

• For one month or at least 2 weeks after the operation, you should observe sexual rest;
• Eat right, avoiding constipation;
• Any sports training should be started no earlier than a month after the operation, starting with a minimum load;
• Do not engage in heavy physical labor for a month after the operation;
• During the first 3 months after the operation, do not lift more than 3 kg, and from 3 to 6 months - more than 5 kg;
• For 3 - 4 months after the operation, follow the diet number 5.

Otherwise, rehabilitation after laparoscopy of the gallbladder does not require any special measures. To speed up wound healing and tissue repair, one month after the operation, it is recommended to undergo a course of physiotherapy, which is recommended by the doctor. Immediately after the operation, you can take vitamin preparations, such as Vitrum, Centrum, Supradin, Multi-Tabs, etc.
Pain after laparoscopy of the gallbladder

After laparoscopy, pain is usually moderate or mild, so they are well controlled by non-narcotic

analgesics

Such as

KetonalKetorolKetanov

Pain medications

are applied within 1 - 2 days after the operation, after which the need for their use, as a rule, disappears, since the pain syndrome decreases and disappears within a week. If the pain does not decrease every day after the operation, but increases, then you should consult a doctor, as this may indicate the development of complications.

After removing the stitches on the 7-10th day after the operation, the pain no longer bothers, but it can manifest itself with any active actions, or strong tension of the anterior abdominal wall (straining when trying to defecate, lifting weights, etc.). Such moments should be avoided. In the long-term period after the operation (after a month or more), there is no pain, and if any appear, then this indicates the development of some other disease.

Diet after laparoscopic gallbladder removal (food after laparoscopy of the gallbladder) Diet

Which should be followed after removal of the gallbladder, aimed at ensuring normal operation

Normally, the liver produces 600 - 800 ml of bile per day, which immediately enters the duodenum, and does not accumulate in the gallbladder, being released only as needed (after the food lump enters the duodenum). This ingestion of bile into the intestine, regardless of food intake, creates certain difficulties, therefore, it is necessary to follow a diet that minimizes the consequences of the absence of one of the important organs.

For 3-4 days after the operation, a person can eat mashed potatoes from vegetables, low-fat cottage cheese, as well as boiled meat and low-fat fish. This diet should be maintained for 3 - 4 days, after which you should switch to diet number 5.

So, diet number 5 involves frequent and fractional meals (small portions 5-6 times a day). All meals should be chopped and warm, not hot or cold, and food should be cooked by boiling, stewing, or baking. Frying is not allowed. The following dishes and products should be excluded from the diet:

• Fatty foods (fatty fish and meat, lard, dairy products with high fat content, etc.);
• Roast;
• Canned meat, fish, vegetables;
• Smoked products;
• Marinades and pickles;
• Hot spices (mustard, horseradish, chili ketchup, garlic, ginger, etc.);
• Any offal (liver, kidneys, brain, stomachs, etc.);
• Mushrooms in any form;
• Raw vegetables;
• Raw green peas;
• Rye bread;
• Fresh white bread;
• Soft pastries and pastries (pies, pancakes, cakes, pastries, etc.);
• Chocolate;
• Alcohol;
• Cocoa and black coffee.

The following foods and dishes should be included in the diet after laparoscopic gallbladder removal:

• Low-fat meats (turkey, rabbit, chicken, veal, etc.) and fish (pike perch, perch, pike, etc.) in boiled, steamed or baked form;
• Semi-liquid porridge from any cereals;
• Soups in water or weak broth, seasoned with vegetables, cereals or pasta;
• Steamed or steamed vegetables;
• Low-fat or low-fat dairy products (kefir, milk, yogurt, cheese, etc.);
• Non-acidic berries and fruits in fresh or in compotes, mousses and jellies;
• Yesterday's white bread;
• Jam or jam.

From these products, a diet is drawn up and various dishes are prepared, in which you can add 45 - 50 g of butter or 60 - 70 g of vegetable oil per day before meals. The total daily intake of bread is 200 g, and sugar is no more than 25 g. It is very useful to drink a glass of low-fat kefir before bedtime.

You can drink weak tea, non-acidic juices diluted with water in half, coffee with milk, compote, rosehip infusion. The drinking regimen (the amount of water consumed per day) can be different, it should be set individually, focusing on your own well-being. So, if bile is often secreted into the intestines, then you can reduce the amount of water you drink and vice versa.

After 3 - 4 months after strict adherence to diet No. 5, raw vegetables and not chopped meat and fish are included in the diet. In this form, the diet should be followed for about 2 years, after which you can eat everything in moderation.

Consequences of laparoscopy of the gallbladder

The main unpleasant and discomforting consequence of laparoscopic gallbladder removal is the periodic discharge of bile directly into the duodenum, which is called postcholecystectomy syndrome. The manifestation of this syndrome is the following symptoms:

• Stomach ache;
• Nausea;
• Vomit;
• Rumbling in the stomach;
• Flatulence;
• Diarrhea;
• Heartburn;
• Belching bitter;
• Jaundice and fever (rare).

Unfortunately, the manifestations of this syndrome can bother a person from time to time and it is impossible to get rid of them completely for life. When signs of postcholecystectomy syndrome appear, one should switch to strict adherence to diet No. 5, and stop severe pain by taking antispasmodics, for example, No-Shpy, Duspatalin, etc. Nausea and urge to vomit are well controlled with several sips of alkaline mineral water, for example, Borjomi.
Complications of gallbladder laparoscopy

Directly during the operation the following complications of gallbladder laparoscopy may develop:

• Damage to the blood vessels of the abdominal wall;
• Perforation (perforation) of the stomach, duodenum, colon, or gallbladder;
• Damage to surrounding organs;
• Bleeding from the cystic artery or from the liver bed.

These complications arise during the operation and require the transfer of laparoscopy to laparotomy, which is carried out by the surgeon.

Some time after laparoscopy The following complications may occur due to tissue damage and organ removal:

• Bile leakage into the abdominal cavity from a poorly sutured stump of the cystic duct, liver bed or common bile duct;
• Peritonitis;
• Inflammation of the tissues around the navel (omphalitis).

Hernia after laparoscopy of the gallbladder

A hernia after laparoscopy of the gallbladder is extremely rare - no more than in 5 - 7% of cases. Moreover, as a rule, a hernia is formed in obese people. Also, the risk of hernia formation is slightly higher in the field of laparoscopy of the gallbladder in those people who underwent surgery urgently, and not in a planned manner. In general, this complication is rare after laparoscopy.

More about hernias

Laparoscopy of the gallbladder - reviews Almost all reviews of laparoscopy of the gallbladder are positive, since people who have undergone this operation consider it rather quick, less traumatic and does not lead to the need for a long hospital stay. In the reviews, people note that the operation is not scary, it passes quickly and is discharged already on the 4th day.

Separately, it is worth pointing out which unpleasant moments people pay attention to: firstly, it is pain in the abdomen after the operation, and secondly, it is difficult to breathe due to the compression of the lungs by a gas bubble, which dissolves within 2-4 days, and finally thirdly, the need to fast for a total of 1.5 - 2 days. However, these unpleasant sensations go away rather quickly, and people believe that it is quite possible to endure them in order to benefit from the operation.

Cost of gallbladder laparoscopy (removal of the bladder or removal of stones)

Currently, the cost of laparoscopic removal of the gallbladder or stones from it ranges from 9,000 to 90,000 rubles, depending on the clinic and the region of Russia. The most expensive surgeries are performed in highly specialized medical institutions such as research institutes. However, doctors of city and regional hospitals often have not the worst experience in carrying out such operations, and their cost is significantly lower.

Gallbladder Laparoscopy - Instructional Video with In-depth Explanations

ATTENTION! The information posted on our site is reference or popular and is provided to a wide range of readers for discussion. Prescribing drugs should only be carried out by a qualified specialist, based on medical history and diagnostic results.

Can:		It is forbidden:
wheat and Rye bread(yesterday's);	bread and baked goods	butter dough;
any porridge, especially oatmeal and buckwheat; pasta, noodles;	cereals and pasta
lean meat (beef, chicken, turkey, rabbit) in boiled form, baked or steamed: meatballs, dumplings, steam cutlets;		fatty meats (pork, lamb) and poultry (goose, duck);
boiled low-fat fish;		fried fish;
cereal, fruit, dairy soups; weak broths (meat and fish); borscht, cabbage soup, vegetarian;		fish and mushroom broths;
cottage cheese, kefir, lactic acid products; mild cheese (including processed);	Milk products
limited amount of butter; vegetable oil(sunflower, corn, olive) - 20-30 g per day;		animal fats;
any vegetables in boiled, baked and raw form; fruits and berries (except sour ones), raw and boiled;	vegetables and fruits	spinach, onion, radish, radish, cranberry;
cracker;	confectionery	cakes, cream, ice cream; carbonated drinks; chocolate;
	Snacks, canned foods
vegetable and fruit juices; compotes, jelly, rosehip decoction		alcoholic drinks; strong tea; strong coffee
Essentuki No. 4, No. 17, Smirnovskaya, Slavyanovskaya, sulphate Narzan 100-200 ml warm (40-45 °) 3 times a day 30-60 minutes before meals	Mineral water

Postoperative period - hospital stay.

After the usual uncomplicated laparoscopic cholecystectomy, the patient from the operating room enters the intensive care unit, where he spends the next 2 hours of the postoperative period to monitor adequate recovery from the state of anesthesia. In the presence of concomitant pathology or features of the disease and surgery, the duration of stay in the intensive care unit may be increased. Then the patient is transferred to the ward, where he receives the prescribed postoperative treatment. During the first 4-6 hours after the operation, the patient should not drink or get out of bed. Until the morning of the next day after the operation, you can drink plain water without gas, in portions of 1-2 sips every 10-20 minutes with a total volume of up to 500 ml. The patient can get up 4-6 hours after the operation. You should get out of bed gradually, at first, sit for a while, and, in the absence of weakness and dizziness, you can get up and walk around the bed. It is recommended to get up for the first time in the presence of medical personnel (after a long stay in a horizontal position and after the action of medications, orthostatic collapse is possible - fainting).

The next day after the operation, the patient can freely move around the hospital, start taking liquid food: kefir, oatmeal, diet soup and go back to your regular fluid intake. In the first 7 days after surgery, it is strictly forbidden to consume any alcoholic beverages, coffee, strong tea, drinks with sugar, chocolate, sweets, fatty and fried foods. The patient's nutrition in the first days after laparoscopic cholecystectomy may include fermented milk products: low-fat cottage cheese, kefir, yogurt; porridge on the water (oatmeal, buckwheat); bananas, baked apples; mashed potatoes, vegetable soups; boiled meat: lean beef or chicken breast.

In the normal course of the postoperative period, the drainage from the abdominal cavity is removed the next day after the operation. Removal of the drainage is a painless procedure, it is carried out during the dressing and takes a few seconds.

Young patients after surgery for chronic calculous cholecystitis can be sent home the next day after surgery, the rest of the patients are usually in the hospital for 2 days. When you are discharged, you will be given a sick leave (if you need one) and an extract from the inpatient's card, which will outline your diagnosis and features of the operation, as well as recommendations on diet, physical activity and drug treatment. The sick leave is issued for the duration of the patient's stay in the hospital and for 3 days after discharge, after which it must be extended by the surgeon of the polyclinic.

The postoperative period is the first month after the operation.

In the first month after the operation, the functions and general condition of the body are restored. Careful adherence to medical recommendations is the key to a full recovery of health. The main areas of rehabilitation are compliance with the exercise regimen, diet, drug treatment, and wound care.

Compliance with the exercise regimen.

Any surgical intervention is accompanied by tissue injury, anesthesia, which requires the restoration of the body. The usual rehabilitation period after laparoscopic cholecystectomy is 7 to 28 days (depending on the nature of the patient's activity). Despite the fact that 2-3 days after the operation, the patient feels satisfactory and can walk freely, walk on the street, even drive a car, we recommend staying at home and not going to work for at least 7 days after the operation, which the body needs to recover. ... At this time, the patient may feel weakness, increased fatigue.

After surgery, it is recommended to limit physical activity for a period of 1 month (do not carry weights of more than 3-4 kilograms, exclude physical exercise, requiring tension of the abdominal muscles). This recommendation is due to the peculiarities of the formation of the process of the scar of the musculo-aponeurotic layer of the abdominal wall, which reaches a sufficient strength within 28 days from the moment of surgery. 1 month after the operation, there are no restrictions on physical activity.

Diet.

Dieting is required up to 1 month after laparoscopic cholecystectomy. It is recommended to exclude alcohol, easily digestible carbohydrates, fatty, spicy, fried, spicy foods, regular meals 4-6 times a day. New foods should be introduced into the diet gradually, 1 month after the operation, it is possible to remove dietary restrictions on the recommendation of a gastroenterologist.

Medical treatment.

After laparoscopic cholecystectomy, minimal medical treatment is usually required. Pain syndrome after surgery is usually mild, but some patients require the use of analgesics for 2-3 days. Usually these are ketans, paracetamol, etol-fort.

In some patients, it is possible to use antispasmodics (no-shpa or drotaverin, buscopan) for 7-10 days.

Taking ursodeoxycholic acid preparations (Ursofalk) improves the lithogenicity of bile and eliminates possible microcholelithiasis.

Reception medications should be performed strictly as directed by the attending physician in an individual dosage.

Postoperative wound care.

In the hospital, special stickers will be applied to the postoperative wounds located at the places where the instruments are inserted. It is possible to take a shower in Tegaderm stickers (they look like a transparent film), Medipor stickers (plaster white) must be removed before showering. The shower can be taken from 48 hours after surgery. Getting water on the seams is not contraindicated, but you should not wash the wounds with gels or soap and rub with a washcloth. After taking a shower, wounds should be lubricated with 5% iodine solution (either betadine solution, or brilliant green, or 70% ethyl alcohol). Wounds can be treated with an open method, without bandages. Bathing or swimming in pools and ponds is prohibited until the stitches are removed and for 5 days after the stitches are removed.

Sutures after laparoscopic cholecystectomy are removed 7-8 days after surgery. This is an outpatient procedure, the stitches are removed by a doctor or a dressing nurse, and the procedure is painless.

Possible complications of cholecystectomy.

Any operation can be accompanied by undesirable effects and complications. Complications are possible after any technology of cholecystectomy.

Complications from wounds.

It can be subcutaneous hemorrhages (bruises) that go away on their own within 7-10 days. No special treatment is required.

There may be reddening of the skin around the wound, the appearance of painful seals in the area of ​​\ u200b \ u200bwounds. This is most often associated with a wound infection. Despite the ongoing prevention of such complications, the frequency of wound infection is 1-2%. If these symptoms appear, you should consult a doctor as soon as possible. Late treatment can lead to suppuration of the wounds, which usually requires surgery under local anesthesia (debridement of the suppurating wound), followed by dressings and possible antibiotic therapy.

Despite the fact that our clinic uses modern high-quality and high-tech instruments and modern suture material, in which wounds are sutured with cosmetic sutures, however, hypertrophic or keloid scars may form in 5-7% of patients. This complication is associated with the individual characteristics of the patient's tissue reaction and, if the patient is dissatisfied with the cosmetic result, it may require special treatment.

In 0.1-0.3% of patients, hernias may develop in places of trocar wounds. This complication is most often associated with features connective tissue the patient and may require surgical correction in the long term.

Complications from the abdominal cavity.

Very rarely, complications from the abdominal cavity are possible, which may require repeated interventions: either minimally invasive punctures under the control of ultrasonography, or repeated laparoscopies or even laparotomies (open abdominal operations). The frequency of such complications does not exceed 1: 1000 operations. It can be intra-abdominal bleeding, hematomas, purulent complications in the abdominal cavity (subhepatic, subphrenic abscesses, liver abscesses, peritonitis).

Residual choledocholithiasis.

According to statistics, from 5 to 20% of patients with gallstone disease also have concomitant stones in the bile ducts (choledocholithiasis). The complex of examinations carried out in the preoperative period is aimed at identifying such a complication and applying adequate treatment methods (this can be retrograde papillosphincterotomy - endoscopic dissection of the mouth of the common bile duct before surgery, or intraoperative revision of the bile ducts with removal of calculi). Unfortunately, none of the preoperative diagnostic and intraoperative assessment methods are 100% effective in detecting stones. In 0.3-0.5% of patients, stones in the bile ducts may not be detected before and during surgery and cause complications in the postoperative period (the most common of which is obstructive jaundice). The occurrence of such a complication requires an endoscopic (with the help of a gastroduodenoscope inserted through the mouth into the stomach and duodenum) intervention - retrograde papilosphinctoromy and transpapillary sanitation of the bile ducts. In exceptional cases, repeated laparoscopic or open surgery is possible.

Bile leakage.

The outflow of bile through the drainage in the postoperative period occurs in 1: 200-1: 300 patients, most often it is a consequence of the release of bile from the bed of the gallbladder on the liver and stops on its own after 2-3 days. This complication may require a longer hospital stay. However, bile leakage along the drainage can also be a symptom of damage to the bile ducts.

Damage to the bile ducts.

Damage to the bile ducts is one of the most severe complications in all types of cholecystectomy, including laparoscopic. In traditional open surgery, the incidence of severe bile duct injuries was 1 in 1500 operations. In the first years of mastering laparoscopic technology, the incidence of this complication tripled - up to 1: 500 operations, however, with the growth of surgeons' experience and the development of technology, it stabilized at the level of 1 per 1000 operations. Eduard Izrailevich Halperin, a well-known Russian expert on this problem, wrote in 2004: "... Neither the duration of the disease, nor the nature of the operation (urgent or planned), nor the duct diameter, and even the surgeon's professional experience do not affect the possibility of damage to the ducts ...". The occurrence of such a complication may require repeated surgery and a long period of rehabilitation.

Allergic reactions to medications.

Trend modern world Allergization of the population is increasing, therefore, allergic reactions to medications (both relatively mild - urticaria, allergic dermatitis) and more severe (Quincke's edema, anaphylactic shock). Despite the fact that in our clinic, before prescribing medications, allergological tests are carried out, however, the occurrence of allergic reactions it is possible that additional drug treatment is required. Please, if you know about your personal intolerance to any medications, be sure to tell your doctor about it.

Thromboembolic complications.

Venous thrombosis and pulmonary embolism are life-threatening complications of any surgery. That is why much attention is paid to the prevention of these complications. Depending on the degree of risk determined by your attending physician, preventive measures will be prescribed: bandaging of the lower extremities, the introduction of low molecular weight heparins.

Exacerbation of gastric ulcer and duodenal ulcer.

Any, even minimally invasive, operation is stressful for the body, and can provoke an exacerbation of gastric ulcer and duodenal ulcer. Therefore, in patients at risk of such a complication, it is possible to carry out prophylaxis with antiulcer drugs in the postoperative period.

Despite the fact that any surgical intervention carries a certain risk of complications, however, refusal of the operation or delay in its implementation also carries the risk of developing serious illness or complications. Despite the fact that the doctors of the clinic pay great attention to the prevention of possible complications, the patient plays a significant role in this. Performing cholecystectomy in a planned manner, with non-started forms of the disease, carries a much lower risk of unwanted deviations from the normal course of the operation and the postoperative period. The responsibility of the patient for strict adherence to the regimen and recommendations of doctors is also of great importance.

Long-term rehabilitation after cholecystectomy.

Most patients after cholecystectomy completely recover from the symptoms that worried them and return to normal life 1-6 months after the operation. If the cholecystectomy is performed on time, before the onset of concomitant pathology from other organs of the digestive system, the patient can eat without restrictions (which does not negate the need for correct healthy eating), do not limit yourself in physical activity, do not take special drugs.

If the patient has already developed concomitant pathology from the digestive system (gastritis, chronic pancreatitis, dyskinesia), he should be under the supervision of a gastroenterologist in order to correct this pathology. A gastroenterologist will provide you with recommendations on lifestyle, diet, dietary habits and, if necessary, drug treatment.

Laparoscopy of the gallbladder- This is an endoscopic operation, which is performed through small incisions 1-1.5 cm long. Depending on the purpose, laparoscopy can be diagnostic (to examine the organ and identify pathology) or therapeutic (most often cholecystectomy is performed - removal of the gallbladder). Sometimes the operation is initially carried out for diagnosis, but during it the surgeon decides to remove the gallbladder, and diagnostic laparoscopy turns into therapeutic.

Some facts about laparoscopy of the gallbladder:

• cholecystectomy, - removal of the gallbladder, is one of the most common laparoscopic operations;
• for the first time removal of the gallbladder by the laparoscopic method was performed in 1987 in France by the surgeon Dubois (operation through an incision has existed for more than 100 years);
• with the advent of laparoscopy of the gallbladder, surgeons increasingly avoid open operations: in modern clinics, in 90% of cases, cholecystectomy is performed laparoscopically;
• but at first the method was perceived with skepticism by many doctors - only later was its effectiveness and safety proved.

Today laparoscopy of the gallbladder has become the "gold standard" in the treatment of gallstone disease. Open surgery was always difficult for patients, and complications often arose after them. But as long as the gallbladder remained in place, the disease was not cured - the stones formed again. Laparoscopy has helped solve this problem.
Features of the anatomy of the gallbladder

The gallbladder is a hollow organ that resembles a sac. It is under the liver.

Parts of the gallbladder:

• Bottom- a wide end that protrudes slightly from the lower edge of the liver.
• Body- the main part of the gallbladder.
• Neck- the narrow end of the organ, opposite to the bottom.
• Gallbladder duct- an extension of the neck, having a length of 3.5 cm.

Then the gallbladder duct is connected to the hepatic duct, and together they form a common bile duct - the common bile duct. It is 7 cm long and empties into the duodenum. At the confluence there is a muscle pulp, the sphincter, which regulates the flow of bile into the intestine.

The upper part of the gallbladder is adjacent to the liver, and its lower part is covered by the peritoneum, a thin film of connective tissue. The middle layer of the organ wall consists of muscles, thanks to which the gallbladder is able to contract and expel bile.

From the inside, the wall of the gallbladder is lined with a mucous membrane, which contains many glands that secrete mucus.

The bottom of the gallbladder is adjacent to the inside of the anterior abdominal wall.

The main function of the gallbladder is that it stores bile, which is formed in the liver, and then, as needed, secretes it into the duodenum. Usually, the emptying of the gallbladder occurs reflexively when food enters the stomach.

The gallbladder is not a vital organ. A person may well do without it. But the quality of life at the same time decreases, certain restrictions are imposed on the diet.

Bile ducts and pancreatic duct at different people can have different lengths, are connected to each other and flow into the duodenum in different ways. Sometimes, in addition to the main duct, additional ones depart from the body of the gallbladder. The doctor has to take these features into account during the laparoscopy.

Bile duct connection options.

The gallbladder is supplied with blood from the cystic artery, which branches out from the artery that feeds the liver.

What are the advantages of gallbladder laparoscopy over incision surgery?

Advantages	Laparoscopy of the gallbladder	Operation through the incision
Less invasiveness of intervention	4 punctures 1 cm each.	20 cm long incision.
Lower blood loss	During laparoscopy of the gallbladder, the patient loses an average of 30-40 ml of blood.	The blood loss is significantly greater.
Shorter rehabilitation periods	The patient is discharged from the hospital in 1-3 days.	The patient is discharged from the hospital after 1-2 weeks
Faster recovery of performance	Efficiency is fully restored in a week.	It takes 3-6 weeks to recover.
Less pain after surgery.	Usually, conventional pain relievers are sufficient to relieve pain.	Sometimes the pain is so severe that narcotic drugs have to be prescribed to the patient.
Lower incidence of postoperative complications.	Adhesions and hernias after laparoscopy are formed much less frequently.

What is a laparoscope? How is gallbladder laparoscopy performed? Endoscopic equipment used by the surgeon during laparoscopy of the gallbladder:

• Laparoscope... It is an optical tube in which a lens system, a miniature video camera and a light source are built. The laparoscope comes in a variety of lengths and thicknesses. The surgeon always begins the operation by making a hole in the anterior abdominal wall and inserting a laparoscope through it. The video camera is connected to a monitor on which the doctor can see the gallbladder and other internal organs.
  
• Insufflator... Designed to supply gas to the abdominal cavity. This is necessary in order to create free space inside, move the internal organs away from each other and improve visibility. Usually, carbon dioxide is used during gallbladder laparoscopy - it is safe.
  
• Trocar... Instrument for imposing holes on the abdominal wall. Consists of a hollow tube and a sharp stylet inserted into it. The surgeon pierces the abdominal wall with a trocar, then removes the stylet and leaves the tube.
• Irrigator / aspirator... Apparatus for washing the abdominal cavity and sucking out the contents.
• Endoscopic instruments... There are many varieties of them: various clamps, scissors, electric knives, staplers for applying metal staples, etc. The surgeon chooses the instruments that are needed in this case.

How is preparation for laparoscopy of the gallbladder carried out?

Studies that can be ordered by a doctor before laparoscopy :

• Complete blood count and general urine analysis - 7-10 days before surgery.
• Biochemical blood test - 7-10 days before surgery.
• Determination of blood group and Rh factor.
• Blood test for RW (for syphilis) - 3 months before surgery.
• Rapid blood test for hepatitis B, C.
• Blood test for HIV.

Also, before the operation, liver and gallbladder studies may be prescribed.:

• Ultrasonography... During it, you can determine the position, size, thickness of the walls of the gallbladder, the presence of stones in it, etc.
• Targeted biochemical blood test- determination of indicators characterizing liver function: ALT, AST, alkaline phosphatase.
• Retrograde cholangiopancreatography- X-ray of the gallbladder and biliary tract, which is performed after the introduction of a contrast agent through a probe.
• Other studies, which help to assess the state of the cardiovascular, respiratory system, kidneys.

Preparation for laparoscopy of the gallbladder

A surgeon and an anesthesiologist approach the patient before performing a surgical intervention in the hospital. They talk about the upcoming operation itself and about the anesthesia, provide information about the possible consequences and complications, and answer the patient's questions. At the end, they ask for written confirmation of consent for the operation and anesthesia.

It is advisable that the patient begins to prepare for the laparoscopy in advance, before being admitted to the hospital. The doctor gives advice on diet and exercise. This will make it easier to move the operation.

Chronic diseases need to be treated before laparoscopy.

Hospital preparation:

• On the eve of the operation, the patient is prescribed light food. The last reception takes place at 19.00 - after that you cannot eat.
• On the day of the operation, it is forbidden to eat or drink in the morning.
• A cleansing enema is done the night before and in the morning before laparoscopy. The day before the intervention, the doctor may prescribe a laxative.
• In the evening or in the morning, you need to take a shower, shave off the hair from the abdomen.
• If you are taking medications, you should ask your doctor if you can take them on the day of your laparoscopy.
• The night before and shortly before the operation, the patient is given special sedatives.
• Before going to the operating room, you need to take off your glasses, contact lenses, jewelry.

Anesthesia during laparoscopy of the gallbladder

During laparoscopy of the gallbladder, general endotracheal anesthesia is used. First, the anesthesiologist puts the patient to sleep with mask anesthesia or intravenous injection. When consciousness is turned off, the doctor inserts a special tube into the trachea and supplies gas for anesthesia through it - this way you can better control your breathing.

How is the operation performed?

The patient is placed on the operating table on his back. Possible positions:

Each doctor chooses the method that is more convenient from his point of view.

During laparoscopic operations on the gallbladder, 4 punctures are usually made on the abdomen in a strictly established sequence:

• First- just below the navel (sometimes a little higher). A laparoscope is introduced through it, the abdominal cavity is filled with carbon dioxide using an insufflator. All other punctures are made under the control of a video camera - this helps not to damage the internal organs.
• Second- in the middle just below the sternum.
• Third- 4-5 cm below the costal arch on the right on a vertical line mentally drawn through the middle of the clavicle.
• Fourth- at the level of the navel, on a vertical line mentally drawn through the front edge of the armpit.

Sometimes, if the liver is enlarged, a fifth hole has to be made. Today, cosmetic operations on the gallbladder have been developed, which are performed through three punctures.

First, the surgeon always examines the gallbladder and liver, determines the existing pathological changes. If a diagnostic laparoscopy was originally planned, then it may end there or, if necessary, go to a medical one.

If the operation fails laparoscopically, the surgeon makes an incision.

After laparoscopy of the gallbladder is completed, stitches are applied to the puncture sites (usually one suture for each puncture). In the future, weakly noticeable scars remain in these places.

Indications for diagnostic laparoscopy of the gallbladder

• Suspected malignant tumor of the liver or gallbladder when it cannot be detected using other diagnostic methods.
• Determination of the stage of a malignant tumor, its germination into neighboring organs.
• Liver disease that cannot be accurately diagnosed without laparoscopy.
• Accumulation of fluid in the abdomen, the reasons for which cannot be established.

Laparoscopic operations on the gallbladder Currently, the following types of surgical interventions are performed for diseases of the gallbladder:

• Laparoscopic cholecystectomy- removal of the gallbladder laparoscopically. It is one of the most common endoscopic surgery procedures.
• Choledochotomy- dissection of the common bile duct.
• Imposition of anastomoses- creation of messages between the bile ducts and other organs of the digestive system to improve the outflow of bile.

Indications for laparoscopic cholecystectomy

Indication	Description
Chronic calculous cholecystitis	The disease is characterized by inflammation in the wall of the gallbladder and the formation of stones in its lumen. In fact, this is one of the manifestations of gallstone disease. Chronic calculous cholecystitis develops as a result of metabolic disorders, the consumption of large amounts of fatty foods. Symptoms: soreness and a feeling of heaviness under the right rib; a feeling of bitterness in the mouth; nausea; periodic attacks of biliary colic - severe pain under the right rib, usually occurring after inaccuracies in the diet. To clarify the diagnosis, the doctor prescribes an ultrasound examination, radiography with contrast.
Gallbladder cholesterosis	A very rare disease in which fats accumulate in the wall of the gallbladder. Pathology often occurs in young people. The causes of gallbladder cholesterosis are not fully understood. The disease occurs against the background of metabolic disorders and is often combined with gallstone disease. Symptoms: paroxysmal pain under the right rib; indigestion. Since cholesterosis of the gallbladder is often combined with chronic calculous cholecystitis, it often manifests itself with similar symptoms. It is quite difficult to diagnose the disease. Most often, such patients are treated with a diagnosis of cholelithiasis. Cholesterosis of the gallbladder can be detected by ultrasound, contrast-enhanced radiography. Sometimes the diagnosis is made after surgery, when a fragment of the gallbladder is sent for biopsy.
Gallbladder polyposis	A polyp is a benign tumor of the gallbladder wall that protrudes above the surface of its mucous membrane. It can occur as a result of metabolic disorders, genetic predisposition, autoimmune reactions, the consumption of large amounts of fatty, fried, spicy foods. Gallbladder polyps occur in 3-4% of people. 80% of patients are women over the age of 35. Often, gallbladder polyps do not manifest themselves in any way. Dull pains under the right rib may bother you. Indications for cholecystectomy for gallbladder polyposis: a combination of polyps and gallstone disease; polyps measuring more than 1 cm; severe pain and other symptoms that greatly disturb a person, reduce his quality of life; identification of gallbladder polyps in a person suffering from familial intestinal polyposis - a hereditary disease; a rapid increase in polyp size - this increases the risk of its malignant degeneration.
Acute cholecystitis	The disease is characterized by acute inflammation in the wall of the gallbladder. Possible reasons: Cholelithiasis. In this case, acute calculous (stone) cholecystitis is diagnosed. Violation of blood circulation in the gallbladder in the elderly. Acute non-calculous (acalculous) cholecystitis is diagnosed. In severe cases, destruction of the gallbladder wall occurs. Inflammation can spread to adjacent organs, the abdominal cavity. There is a risk of developing peritonitis. In all cases with acute cholecystitis, removal of the gallbladder is indicated. This is most often done laparoscopically. Symptoms: severe pain under the right rib; nausea, vomiting; an increase in body temperature up to 38 ° C; after taking painkillers and antispasmodics, there is no improvement. Treatment: when the patient is admitted to the hospital, he is prescribed intravenous fluids through a dropper; if this does not help, then laparoscopic cholecystectomy is performed on an emergency basis; if, after intravenous infusions, the condition improves, then the patient begins to prepare for a planned operation.

Indications for choledochotomy:

Indications for the imposition of anastomoses:

• Cholelithiasis... After removing the gallbladder, the surgeon sutures the bile duct to the duodenum.
• Narrowing of the biliary tract.

Contraindications to laparoscopic interventions on the gallbladder

• Myocardial infarction in the acute period. The patient's heart may not withstand the stress during the operation.
• Stroke, acute cerebrovascular accident. A patient in this state should not be given general anesthesia.
• A blood clotting disorder that cannot be eliminated in any way.
• Peritonitis is an inflammation of the abdominal cavity that covers a large area.
• Obesity III and IV degrees. At the same time, laparoscopy of the gallbladder becomes difficult, complications occur more often.
• Late pregnancy.
• Gallbladder cancer. Diagnostic laparoscopy may be performed, but removal of the bladder is contraindicated.
• Lump in the neck of the gallbladder, which greatly complicates surgical procedures.

Relative contraindications(under certain circumstances, the doctor may still prescribe an operation):

• inflammation of the common bile duct;
• jaundice as a result of blocking the bile ducts with a stone or tumor and a violation of the outflow of bile;
• acute pancreatitis - inflammation of the pancreas;
• Mirizzi syndrome - inflammation and destruction of the walls of the gallbladder neck as a result of compression of its lumen with a stone, narrowing and fistula formation;
• hardening (sclerosis) and shrinkage (atrophy) of the gallbladder;
• cirrhosis of the liver;
• acute cholecystitis, if more than 3 days (72 hours) have passed since the onset of the first symptoms;
• operations in the upper abdomen, transferred less than 6 months ago;
• peptic ulcer of the stomach and duodenum.

When will the surgeon be forced to stop laparoscopy and switch to open surgery? Indications for performing an incision and performing an open operation:

• severe swelling of the gallbladder and surrounding tissues, which does not allow laparoscopic surgery to be performed safely;
• a large number of adhesions;
• suspicion of a malignant tumor of the gallbladder or bile ducts;
• fistula between the gallbladder and intestines;
• destruction of the gallbladder wall as a result of the inflammatory process, an abscess in the gallbladder region;
• vascular damage and bleeding;
• damage to the bile ducts;
• damage to internal organs.

How is the postoperative period?

• On the day of surgery, the patient is usually already allowed to get up, walk and eat liquid food.
• The next day, you can eat regular food.
• Approximately 90% of patients can be discharged within 24 hours after surgery.
• Working capacity is restored within a week.
• Small bandages or special stickers are applied to postoperative wounds. The stitches are removed on day 7.
• Pain may be troubling for some time after the operation. To remove them, use conventional pain relievers.

What complications are possible after laparoscopic gallbladder surgery? Complications are possible with any operation, and laparoscopy of the gallbladder is no exception. Compared to open surgery through an incision, interventions using endoscopy have a very low risk of complications - only 0.5%, that is, in 5 out of 1000 operated patients.

The main complications of gallbladder laparoscopy:

• Bleeding with damage to blood vessels... Bleeding at the insertion site of the trocar can most often be stopped with sutures. Bleeding from the liver can be stopped by electrocautery. If a large vessel is damaged, the surgeon is forced to make an incision and continue the operation in an open way.
• Damage to the bile ducts... This also often requires a transition to an open operation. If bile remains in the abdominal cavity, this will lead to the development of inflammation. At the same time, after laparotomy, the patient is worried about severe pain under the right rib, and the body temperature rises.
• Suppuration at the site of surgery... It rarely occurs. It is easy to deal with it due to the small size of the punctures. The doctor prescribes antibiotics. If an abscess forms under the skin, then it is opened.
• Internal organ damage... Most often, liver damage occurs during laparoscopy of the gallbladder. Slow bleeding occurs - it can be easily stopped with an electrocoagulator.
• Damage to the intestine during puncture of the abdominal wall with a trocar... In most cases, an incision is then made and the damaged intestine is sutured.
• Subcutaneous emphysema- gas accumulation under the skin. This happens if the trocar does not enter the abdominal cavity, but under the skin, and the doctor begins to supply air with an insufflator. Most often, this complication is observed in overweight people. A swelling forms at the puncture site. This is not dangerous - usually the gas will dissolve on its own. Sometimes it has to be removed with a needle.
• Spread of the tumor in the abdominal cavity... If the patient has a malignant tumor of the liver or gallbladder, then during laparoscopy, tumor cells may spread throughout the abdominal cavity. The patient develops symptoms that resemble inflammation. And only later, during the examination, metastases are detected.

Modern doctors are increasingly resorting to laparoscopic methods of surgery. Compared to standard abdominal surgery, laparoscopy is less traumatic, and the recovery period after it is shorter. According to medical statistics, most often in a year, the gallbladder is removed by the laparoscopic method.

The performed operation does not yet guarantee a complete recovery, therefore, treatment after removal of the gallbladder (GB) should be monitored by a doctor. To speed up the recovery of the body, the patient must follow a diet, take medications, perform therapeutic exercises, and improve the body.

Benefits and complications

During laparoscopy of the gallbladder, 4 punctures are made in the abdomen, into which surgical tubes (trocars) are inserted, the gallbladder is removed through the hole in the navel. A laparoscope (a video camera with a lighting device) allows you to monitor the progress of the operation.

The main indication for laparocopic cholecystectomy is gallstone disease (cholelithiasis). On the initial stage calculous cholecystitis (stones in the gallbladder), conservative methods are used: diet, drug treatment, destruction of stones by ultrasound. In the later stages, surgery is necessary.

Removal of the gallbladder is carried out in the following cases:

• Acute inflammation of the gallbladder, which is accompanied by a high temperature that does not subside for a long time.
• The presence of large stones in the biliary system.
• Signs of inflammation of the peritoneum.
• Fibrous or purulent exudate is present in the abdominal space.

Reference. The gallbladder is removed through an open incision or laparoscopic. The latter method is considered more modern and safer.

Benefits of Laparoscopic Cholecystectomy:

• After the operation, the patient regains activity faster. Already after 5-6 hours he was allowed to get out of bed under the supervision of the medical staff.
• The wounds are small and heal quickly.
• The patient needs intensive care for no more than 2 hours.
• After surgery, the patient does not have to stay in bed for a long time.
• Laparoscopy of the gallbladder is less likely to provoke complications than standard abdominal surgery.
• There are no large scars on the skin.
• The patient is discharged home earlier.

However, even laparoscopy can provoke complications:

• Injury to nearby organs and blood vessels.
• Puncture of the gastrointestinal tract, stomach, colon, duodenum, inflammation of the skin around the navel.
• There is a risk of umbilical hernia in overweight patients with congenital muscle abnormalities.

After laparoscopy, the risk of hernia formation is lower than after standard surgery, so the patient does not need to wear a bandage. However, for the first 6 months, he is forbidden to lift weights or strain the muscles of the anterior abdominal wall. The patient should go in for sports, but about a set of exercises, you need to consult a doctor.

Recovery stages

Rehabilitation after removal of the gallbladder involves the normalization of physical condition, change in attitudes, rules and values ​​of life. In addition, it is important to restore the patient's psychological state.

The recovery period after cholecystectomy is divided into several stages.

As you know, the gallbladder is an important organ that is involved in digestion. It is a reservoir for bile, which helps break down fats. Before the operation, the hepatic secretion had the concentration necessary for digestion. In the absence of gallbladder, bile accumulates in the bile ducts, and its concentration is low. Despite the fact that the ducts take over the function of the removed bladder, the functionality of the gastrointestinal tract is still impaired. This is due to the fact that the body needs time to get used to the new conditions of digestion. To avoid or reduce the severity of negative phenomena, the patient after the operation must adjust the diet.

During the rehabilitation period, you need to help your body to establish the work of the gastrointestinal tract. A postoperative diet can help meet this challenge. You also need to take medications and do simple exercise. The rehabilitation period is about 2 years.

Stages of the recovery period:

1. The first 2 days after laparoscopic cholecystectomy, the patient stays in stationary conditions. At this stage, negative effects are observed after anesthesia and surgery.
2. The late stage lasts from 1 to 2 weeks, the patient is in the hospital. The damaged tissues heal gradually, the functionality of the respiratory organs is normalized, and the gastrointestinal tract adapts.
3. The outpatient period lasts from 1 to 3 months. The patient regains health at home.
4. The patient is engaged in the improvement of the body in sanatoriums and dispensaries.

Reference. Due to strict dietary restrictions, the patient's mental state may deteriorate. Therefore, the doctor should tell you how the work of the digestive tract is changing and what needs to be done to avoid complications.

Features of the recovery period

In the absence of complications, the patient is discharged home in 1-2 days. However, this is not entirely correct, since doctors must monitor him, control his nutrition, physical activity, etc. This way his condition will normalize faster and he will be able to avoid complications.

Recovery after removal of the gallbladder lasts from 1 to 2 years. This period consists of different stages during which the functionality of the organism changes.

First of all, after laparoscopic cholecystectomy, you need to change your eating habits. The patient should eat fractionally (5-6 times a day) in small portions. This is important because the digestive organs cannot digest large amounts of food. If this rule is violated, the products will not be completely broken down, and the body will not be saturated with useful substances. As a result, the load on the gastrointestinal tract increases, there is a risk of re-formation of stones in the bile ducts.

Physical activity in the first 4 weeks after removal of the bile by the laparoscopic method should be abandoned. This is necessary, since the muscle tone has not yet returned to normal, therefore, the likelihood of internal hemorrhages and the formation of an umbilical hernia increases. In addition, there is pain in the puncture sites in the early stages.

Early period after laparoscopy

After laparoscopic cholecystectomy, the patient should be in bed. After 5-6 hours, he may try to roll over or sit down. If the patient feels normal, then under the supervision of a nurse, he can get out of bed. Fasting is recommended for 24 hours after surgery. The patient can afford a small amount of still water.

After the operation, the patient can get out of bed after 5-6 hours

Postoperative nutrition is strictly limited. On the second day, you can drink a little broth, eat cottage cheese or natural yogurt (low fat). The patient is assigned a table number 5, according to which it is necessary to take food often, but in small portions (200-300 g). Foods with a large amount of fats, coarse fibers or provoking excessive gas formation are contraindicated.

The postoperative period is overshadowed by minor pain or discomfort in the puncture area, sometimes there is a feeling of heaviness on the right under the ribs. The pain can spread to the lower back or collarbone. Painful sensations go away on their own after 2-4 days. Due to artificial ventilation of the lungs, the patient cannot take full breaths, as the abdominal wall hurts.

Reference. In the hospital, the patient is bandaged, his body temperature is monitored to prevent inflammation or other complications.

The patient is prescribed pain relievers (injections), antibacterial drugs, enzymes. In addition, he must undergo instrumental and laboratory research.

Vitamins can be taken immediately after laparoscopic cholecystectomy: Vitrum, Centrum, Supradin, Multi-Tabs, etc.

Prevention of pneumonia involves performing respiratory and therapeutic exercises. Exercises are performed 5 to 8 times a day for 3-5 minutes. The patient takes a deep breath through the nose 10 to 15 times, and then exhales sharply through the mouth.

Excessive physical activity is contraindicated. It is recommended to wear soft cotton underwear to avoid damaging the operating openings. Whether the patient needs to wear a bandage or not, the doctor makes a decision for each patient individually.

The time of discharge depends on the timing of the person's recovery. The patient goes home after the stitches are removed and if there are no complications.

Reference. The question of how long the sick leave is quite relevant. A document confirming temporary incapacity for work is issued for the entire period of hospital stay plus another 10-12 days. Since inpatient treatment lasts from 3 to 7 days, the approximate duration of a sick leave is from 13 to 19 days.

Many patients are interested in how many days sick leave is discharged in the presence of complications. The doctor determines the terms of incapacity for work for each individual.

Outpatient activities

After discharge, the patient must follow all the doctor's recommendations to speed up recovery. At the same time, his condition continues to be monitored.

After removing the gallbladder, you need to eat meals in a grated form.

To track the dynamics of the body's recovery, the following studies are carried out:

• 3 days after discharge, the patient is examined by a therapist or surgeon. The next visit to the doctor should be made after 1 week, and then after 3 weeks.
• A laboratory blood test is performed after 14 days, and then after 1 year.
• If necessary, after 4 weeks, an ultrasound of the abdominal organs is performed. After 1 year, ultrasound diagnostics is mandatory for everyone.

The postoperative period involves strict restrictions:

• Excessive physical activity is contraindicated for 7-10 days after leaving the clinic.
• Underwear should be soft and made from natural fabrics. It is forbidden to have sexual intercourse for 2-4 weeks.
• You can do simple physical exercises no earlier than after 1 month.
• During the first 12 weeks, the patient can lift weights no more than 3 kg, and from 3 to 6 months - about 5 kg.

To strengthen the abdominal muscles, you need to perform the exercise "bicycle", "scissors", while the load must be increased gradually. Outdoor hiking is recommended. Physical therapy will help speed up tissue healing. For rehabilitation to be successful, you need to perform breathing exercises.

Nutrition rules:

• It is necessary to exclude fried, fatty foods, spices from the diet.
• It is recommended to steam, boil or bake food.
• You need to eat food at intervals of 3 hours to normalize bile outflow.
• It is not recommended to bend over or lie down for 2 hours after the meal.
• The patient should drink no more than 1.5 liters of liquid per day.
• The last meal in the evening should be planned 3 hours before bedtime.

Before eating, it is recommended to grind the dish to a puree state. You need to expand the menu gradually. Fruits and vegetables are recommended to be stewed or baked before meals so that they are better absorbed and also retain useful substances.

In the 2nd month, the patient can eat finely chopped foods. The diet is allowed to replenish with fresh fruits and vegetables.

The wound needs to be cared for. You can take a shower only after a few days. The skin of the abdomen is washed without soap and other hygiene products; rubbing it with a washcloth is also prohibited.

Attention. Painful sensations may be present for about 8 weeks. If the pain becomes more pronounced, bloody marks appear, nausea, vomiting, fever occurs, then an urgent need to go to the doctor.

Digestion normalization

The postoperative period is often complicated by constipation. To avoid this, you need to replenish the diet with vegetables, observe moderate physical activity, eat kefir, natural yogurt, cottage cheese (with a low percentage of fat) every day. You can eliminate constipation medicines with a laxative effect that does not inhibit intestinal motility. Enemas do not need to be given often, as this threatens with stretching of the colon and dysbiosis.

Medicines are used to eliminate digestive disorders

For some time after laparoscopic cholecystectomy, the following symptoms may be present: burning behind the breastbone, belching, nausea, and a bitter taste in the mouth. If concomitant diseases are absent and the patient is on a diet, then these symptoms disappear on their own after a while.

Many patients are interested in the question of which pills to drink after removal of the gastrointestinal tract. Drug treatment is carried out only as directed by a doctor who decides on the choice of drugs.

With duodenogastric reflux (throwing the contents of the duodenum into the stomach), antireflux drugs are used, for example, Motilium. Treatment of heartburn, pain is carried out with the help of antacids: Rennie, Maalox, Almagel. For stomach ulcers, medications are used that suppress the secretion of bile (omeprazole).

If necessary, prescribe magnetotherapy, ultrasonic irradiation.

Sanatorium recovery

The following procedures are prescribed in the sanatorium:

• Patients drink medicinal warm mineral water without gas four times a day, 100 ml each.
• Hydrotherapy is prescribed with the addition of pine needles extract, radon, as well as mineral, carbonic water. The course consists of 10 procedures, 10-12 minutes each.
• To speed up the recovery of the body, electrophoresis with a solution of succinic acid (2.5%) is used.
• Physiotherapy exercises are carried out every day.
• The diet helps to relieve the digestive tract and normalize digestion.

In addition, drug treatment is carried out. The drugs normalize metabolic processes, restore the functioning of the digestive system.

Features of life after laparoscopic cholecystectomy

Patients undergoing laparoscopic gallbladder surgery are concerned about what their quality of life will be and how long they will live thereafter. If the surgical intervention took place without complications and on time, then there is no threat to life. In addition, if the patient follows the advice of the attending physician, then he has every chance to live to a ripe old age.

After surgery to remove the gallbladder, it is recommended to perform a therapeutic set of exercises

If the recovery period is easy, then the person can expand the menu as much as possible. However, fried, fatty foods, smoked meats and marinades should be excluded from the diet for the rest of your life. For the intestines to function normally, you need to give up foods that are difficult to digest. In addition, the temperature of the food must be monitored. The best option is warm food.

In the postoperative period, the patient must do exercises, because a passive lifestyle provokes various diseases. Due to the lack of movement, bile stagnation occurs, which can lead to repeated stone formation. It is recommended to regularly walk and swim.

Carefully. Physical activity should be increased gradually. Traumatic sports such as boxing, wrestling, weightlifting are contraindicated.

Approximately 12 months after the operation, the work of the hepatobiliary tract is normalized, the liver secretes the required amount of bile of normal consistency. The work of the digestive organs improves. Then the patient feels like a healthy person.

According to statistics, in 30–40% of patients, the postoperative period is complicated by postcholecystectomy syndrome (PCES). It is manifested by indigestion, pain, jaundice, itching. In the absence of proper therapy, the likelihood of dangerous complications increases. Treatment of PCES should be comprehensive. This is necessary to normalize the functionality of the biliary tract, liver, and pancreas.

Thus, rehabilitation after laparoscopic cholecystectomy is no less important than the operation itself. First of all, the patient must change his eating habits, engage in physiotherapy exercises, and take medications. In addition, after the operation, it is recommended to visit a sanatorium in order to speed up the recovery of the body and improve it. Only in this case will the patient return to a fulfilling life.

Many patients are concerned about how to live after removing the gallbladder. Will their lives be just as fulfilling, or are they doomed to be disabled? Is complete recovery possible after removal of the gallbladder? There are no extra organs in our body, but they are all conditionally subdivided into those without which further existence is simply impossible and into those in the absence of which the body can function

The process by which the gallbladder is removed is a forced procedure, it is a consequence of the formation of stones and a malfunction in the body, after which the gallbladder ceases to function normally. Stones that appear in the gallbladder begin to form due to chronic cholecystitis.

Diet after removal of the gallbladder will prevent postcholecystectomy syndrome.

Can:		It is forbidden:
wheat and rye bread (yesterday's);	bread and baked goods	butter dough;
any porridge, especially oatmeal and buckwheat; pasta, noodles;	cereals and pasta
lean meat (beef, chicken, turkey, rabbit) in boiled form, baked or steamed: meatballs, dumplings, steam cutlets;		fatty meats (pork, lamb) and poultry (goose, duck);
boiled low-fat fish;		fried fish;
cereal, fruit, dairy soups; weak broths (meat and fish); borscht, cabbage soup, vegetarian;		fish and mushroom broths;
cottage cheese, kefir, lactic acid products; mild cheese (including processed);	Milk products
limited amount of butter; vegetable oil (sunflower, corn, olive) - 20-30 g per day;		animal fats;
any vegetables in boiled, baked and raw form; fruits and berries (except sour ones), raw and boiled;	vegetables and fruits	spinach, onion, radish, radish, cranberry;
cracker;	confectionery	cakes, cream, ice cream; carbonated drinks; chocolate;
	Snacks, canned foods
vegetable and fruit juices; compotes, jelly, rosehip decoction		alcoholic drinks; strong tea; strong coffee
Essentuki No. 4, No. 17, Smirnovskaya, Slavyanovskaya, sulphate Narzan 100-200 ml warm (40-45 °) 3 times a day 30-60 minutes before meals	Mineral water

Postoperative period - hospital stay.

After the usual uncomplicated laparoscopic cholecystectomy, the patient from the operating room enters the intensive care unit, where he spends the next 2 hours of the postoperative period to monitor adequate recovery from the state of anesthesia. In the presence of concomitant pathology or features of the disease and surgery, the duration of stay in the intensive care unit may be increased. Then the patient is transferred to the ward, where he receives the prescribed postoperative treatment.

during the first 4-6 hours after the operation, the patient should not drink or get out of bed. Until the morning of the next day after the operation, you can drink plain water without gas, in portions of 1-2 sips every 10-20 minutes with a total volume of up to 500 ml. The patient can get up 4-6 hours after the operation. You should get out of bed gradually, at first, sit for a while, and, in the absence of weakness and dizziness, you can get up and walk around the bed. It is recommended to get up for the first time in the presence of medical personnel (after a long stay in a horizontal position and after the action of medications, orthostatic collapse is possible - fainting).

The next day after the operation, the patient can freely move around the hospital, start taking liquid food: kefir, oatmeal, diet soup and switch to the usual regimen of drinking. In the first 7 days after surgery, it is strictly forbidden to consume any alcoholic beverages, coffee, strong tea, drinks with sugar, chocolate, sweets, fatty and fried foods. The patient's nutrition in the first days after laparoscopic cholecystectomy may include fermented milk products: low-fat cottage cheese, kefir, yogurt; porridge on the water (oatmeal, buckwheat); bananas, baked apples; mashed potatoes, vegetable soups; boiled meat: lean beef or chicken breast.

In the normal course of the postoperative period, the drainage from the abdominal cavity is removed the next day after the operation. Removal of the drainage is a painless procedure, it is carried out during the dressing and takes a few seconds.

Young patients after surgery for chronic calculous cholecystitis can be sent home the next day after surgery, the rest of the patients are usually in the hospital for 2 days. When you are discharged, you will be given a sick leave (if you need one) and an extract from the inpatient's card, which will outline your diagnosis and features of the operation, as well as recommendations on diet, physical activity and drug treatment. The sick leave is issued for the duration of the patient's stay in the hospital and for 3 days after discharge, after which it must be extended by the surgeon of the polyclinic.

The postoperative period is the first month after the operation.

In the first month after the operation, the functions and general condition of the body are restored. Careful adherence to medical recommendations is the key to a full recovery of health. The main areas of rehabilitation are compliance with the exercise regimen, diet, drug treatment, and wound care.

Compliance with the exercise regimen.

Any surgical intervention is accompanied by tissue injury, anesthesia, which requires the restoration of the body. The usual rehabilitation period after laparoscopic cholecystectomy is 7 to 28 days (depending on the nature of the patient's activity). Despite the fact that 2-3 days after the operation, the patient feels satisfactory and can walk freely, walk on the street, even drive a car, we recommend staying at home and not going to work for at least 7 days after the operation, which the body needs to recover. ... At this time, the patient may feel weakness, increased fatigue.

After surgery, it is recommended to limit physical activity for a period of 1 month (do not carry weights of more than 3-4 kilograms, exclude physical exercises that require tension of the abdominal muscles). This recommendation is due to the peculiarities of the formation of the process of the scar of the musculo-aponeurotic layer of the abdominal wall, which reaches a sufficient strength within 28 days from the moment of surgery. 1 month after the operation, there are no restrictions on physical activity.

Diet.

Dieting is required up to 1 month after laparoscopic cholecystectomy. It is recommended to exclude alcohol, easily digestible carbohydrates, fatty, spicy, fried, spicy foods, regular meals 4-6 times a day. New foods should be introduced into the diet gradually, 1 month after the operation, it is possible to remove dietary restrictions on the recommendation of a gastroenterologist.

Medical treatment.

After laparoscopic cholecystectomy, minimal medical treatment is usually required. Pain syndrome after surgery is usually mild, but some patients require the use of analgesics for 2-3 days. Usually these are ketans, paracetamol, etol-fort.

In some patients, it is possible to use antispasmodics (no-shpa or drotaverin, buscopan) for 7-10 days.

Taking ursodeoxycholic acid preparations (Ursofalk) improves the lithogenicity of bile and eliminates possible microcholelithiasis.

Taking medications should be performed strictly as directed by the attending physician in an individual dosage.

Postoperative wound care.

In the hospital, special stickers will be applied to the postoperative wounds located at the places where the instruments are inserted. It is possible to take a shower in Tegaderm stickers (they look like a transparent film); Medipor stickers (white plaster) must be removed before taking a shower. The shower can be taken from 48 hours after surgery. Getting water on the seams is not contraindicated, but you should not wash the wounds with gels or soap and rub with a washcloth. After taking a shower, wounds should be lubricated with 5% iodine solution (either betadine solution, or brilliant green, or 70% ethyl alcohol). Wounds can be treated with an open method, without bandages. Bathing or swimming in pools and ponds is prohibited until the stitches are removed and for 5 days after the stitches are removed.

Sutures after laparoscopic cholecystectomy are removed 7-8 days after surgery. This is an outpatient procedure, the stitches are removed by a doctor or a dressing nurse, and the procedure is painless.

Possible complications of cholecystectomy.

Any operation can be accompanied by undesirable effects and complications. Complications are possible after any technology of cholecystectomy.

Complications from wounds.

It can be subcutaneous hemorrhages (bruises) that go away on their own within 7-10 days. No special treatment is required.

There may be reddening of the skin around the wound, the appearance of painful seals in the area of ​​\ u200b \ u200bwounds. This is most often associated with a wound infection. Despite the ongoing prevention of such complications, the frequency of wound infection is 1-2%. If these symptoms appear, you should consult a doctor as soon as possible. Late treatment can lead to suppuration of the wounds, which usually requires surgery under local anesthesia (debridement of the suppurating wound), followed by dressings and possible antibiotic therapy.

Despite the fact that our clinic uses modern high-quality and high-tech instruments and modern suture material, in which wounds are sutured with cosmetic sutures, however, hypertrophic or keloid scars may form in 5-7% of patients. This complication is associated with the individual characteristics of the patient's tissue reaction and, if the patient is dissatisfied with the cosmetic result, it may require special treatment.

In 0.1-0.3% of patients, hernias may develop in places of trocar wounds. This complication is most often associated with the peculiarities of the patient's connective tissue and may require surgical correction in the long term.

Complications from the abdominal cavity.

Very rarely, complications from the abdominal cavity are possible, which may require repeated interventions: either minimally invasive punctures under the control of ultrasonography, or repeated laparoscopies or even laparotomies (open abdominal operations). The frequency of such complications does not exceed 1: 1000 operations. It can be intra-abdominal bleeding, hematomas, purulent complications in the abdominal cavity (subhepatic, subphrenic abscesses, liver abscesses, peritonitis).

Residual choledocholithiasis.

According to statistics, from 5 to 20% of patients with gallstone disease also have concomitant stones in the bile ducts (choledocholithiasis). The complex of examinations carried out in the preoperative period is aimed at identifying such a complication and applying adequate treatment methods (this can be retrograde papillosphincterotomy - endoscopic dissection of the mouth of the common bile duct before surgery, or intraoperative revision of the bile ducts with removal of calculi). Unfortunately, none of the preoperative diagnostic and intraoperative assessment methods are 100% effective in detecting stones. In 0.3-0.5% of patients, stones in the bile ducts may not be detected before and during surgery and cause complications in the postoperative period (the most common of which is obstructive jaundice). The occurrence of such a complication requires an endoscopic (with the help of a gastroduodenoscope inserted through the mouth into the stomach and duodenum) intervention - retrograde papilosphinctoromy and transpapillary sanitation of the bile ducts. In exceptional cases, repeated laparoscopic or open surgery is possible.

Bile leakage.

The outflow of bile through the drainage in the postoperative period occurs in 1: 200-1: 300 patients, most often it is a consequence of the release of bile from the bed of the gallbladder on the liver and stops on its own after 2-3 days. This complication may require a longer hospital stay. However, bile leakage along the drainage can also be a symptom of damage to the bile ducts.

Damage to the bile ducts.

Damage to the bile ducts is one of the most severe complications in all types of cholecystectomy, including laparoscopic. In traditional open surgery, the incidence of severe bile duct injuries was 1 in 1500 operations. In the first years of mastering laparoscopic technology, the incidence of this complication tripled - up to 1: 500 operations, however, with the growth of surgeons' experience and the development of technology, it stabilized at the level of 1 per 1000 operations. Eduard Izrailevich Halperin, a well-known Russian expert on this problem, wrote in 2004: "... Neither the duration of the disease, nor the nature of the operation (urgent or planned), nor the duct diameter, and even the surgeon's professional experience do not affect the possibility of damage to the ducts ...". The occurrence of such a complication may require repeated surgery and a long period of rehabilitation.

Allergic reactions to medications.

The trend of the modern world is an increasing increase in the population's allergization, therefore, allergic reactions to medications (both relatively mild - urticaria, allergic dermatitis) and more severe (Quincke's edema, anaphylactic shock). Despite the fact that allergological tests are carried out in our clinic before prescribing medications, the occurrence of allergic reactions is possible, and additional medication is required. Please, if you know about your personal intolerance to any medications, be sure to tell your doctor about it.

Thromboembolic complications.

Venous thrombosis and pulmonary embolism are life-threatening complications of any surgery. That is why much attention is paid to the prevention of these complications. Depending on the degree of risk determined by your attending physician, preventive measures will be prescribed: bandaging of the lower extremities, the introduction of low molecular weight heparins.

Exacerbation of gastric ulcer and duodenal ulcer.

Any, even minimally invasive, operation is stressful for the body, and can provoke an exacerbation of gastric ulcer and duodenal ulcer. Therefore, in patients at risk of such a complication, it is possible to carry out prophylaxis with antiulcer drugs in the postoperative period.

Despite the fact that any surgical intervention carries a certain risk of complications, however, refusal of the operation or delay in its implementation also carries the risk of developing serious illness or complications. Despite the fact that the doctors of the clinic pay great attention to the prevention of possible complications, the patient plays a significant role in this. Performing cholecystectomy in a planned manner, with non-started forms of the disease, carries a much lower risk of unwanted deviations from the normal course of the operation and the postoperative period. The responsibility of the patient for strict adherence to the regimen and recommendations of doctors is also of great importance.

Long-term rehabilitation after cholecystectomy.

Most patients after cholecystectomy completely recover from the symptoms that worried them and return to normal life 1-6 months after the operation. If the cholecystectomy is performed on time, before the onset of concomitant pathology from other organs of the digestive system, the patient can eat without restrictions (which does not negate the need for a proper healthy diet), do not limit oneself in physical activity, and do not take special medications.

If the patient has already developed concomitant pathology from the digestive system (gastritis, chronic pancreatitis, dyskinesia), he should be under the supervision of a gastroenterologist in order to correct this pathology. A gastroenterologist will provide you with recommendations on lifestyle, diet, dietary habits and, if necessary, drug treatment.

krasgmu.net

Removal of the gallbladder is a very serious operation, which is associated with the loss of an organ. Naturally, there are no extra organs in the human body, but we are so arranged that we are able to adapt to everything. True, this requires time and our help to the body, that is, compliance with certain rules and diet.

The main function of the gallbladder is the accumulation and concentration of bile, which a person needs to digest food. During the meal, the bladder contracts and the concentrated bile is released into the duodenal lumen. This ensures the initial stage of digestion until the liver warms up and starts working at full capacity. After removal of the gallbladder, bile begins to be secreted into the intestine constantly, and at the beginning of the digestive process it is not enough. What are the rehabilitation measures and recovery after removal of the gallbladder?

In order for the restoration of the body after removal of the gallbladder to be easy and painless for the patient, you need to follow some rules.

It is necessary to eat strictly according to the clock in order to develop a conditioned digestive reflex. If it is not possible to eat at the same time, for example, you are late at work, then at least have a snack. The newly formed reflex must be reinforced. As in Pavlov's dogs: "the light came on - the gastric juice dripped", so in humans: it's time for lunch - the liver has already begun to work actively.

You can't eat quickly, in a hurry. Eat slowly, getting pleasure and pleasure from the process. Eating food slowly allows our digestive organs time and opportunity for them to start working at full capacity. It is very useful to drink a glass of liquid 10-15 minutes before meals: juice, water, jelly, green tea... This little exercise will help the digestive organs warm up before eating.

The diet and diet must be followed for at least six months after the operation, this is how much time the body needs to rebuild and get used to functioning normally without the gallbladder.

During recovery from removal of the gallbladder, Diet 5 or a hepatic diet that is known to any physician is recommended. Its principles are as follows:

- avoid fatty foods, giving preference to products with a minimum fat content (milk 1-1.5%, cottage cheese 7%, sour cream 10%, and so on);

- give up lard, pork, fatty lamb, duck and goose meat;

- it is better to replace animal fats with vegetable fats, since they do not contain cholesterol;

- eat more fish, fish fat contains a large amount of omega 3 fatty acids, which are very beneficial for the gastrointestinal tract and the whole body;

- exclude fried and smoked dishes from the diet;

- Eat boiled dishes, baked in their own juice or steamed;

- it is forbidden to eat mayonnaise, mustard, horseradish, fresh onions and garlic;

- Long-term storage products containing preservatives, thickeners, stabilizers, dyes are harmful to the gastrointestinal tract.

Drinking after removing the gallbladder during the recovery of the body should be taken at least 2.5-3 liters per day, including juices, soups, juicy fruits, compotes, jelly. However, if the patient has renal or heart failure, severe hypertension, then the volume of daily fluid intake should be reduced to 0.7-1 liters. From drinks, you can use tea, low-fat milk, juices, some mineral waters as prescribed by a doctor, but coffee, cocoa and alcoholic beverages should be categorically discarded.

Choleretic drugs after removal of the gallbladder, it is advisable to use from the pantry of mother nature. Freshly squeezed beet juice changes the composition of bile very well after the operation. Initially, it can be diluted in half with water to give the body a habit.

The following decoction has a very strong choleretic effect. Mix in equal frequent chopped corn silk and tansy. Take a tablespoon of the mixture and pour it with one glass of boiling water, boil in a water bath for 15 minutes. You need to take the broth 15 minutes before each meal, 2 tablespoons, within a week.

Tea from immortelle, yarrow and rhubarb is no less good for stimulating the separation of bile. Mix the chopped 5 parts of yarrow herb, 3 parts of immortelle flowers and 2 parts of rhubarb roots. Pour 1 tablespoon of the mixture with a glass of boiling water and insist in a closed glass or enamel container for 40 minutes and drink half a glass warm two hours after eating.

It is very useful to periodically use blind probing or typage to cleanse the liver. To do this, in the morning, on an empty stomach, drink a glass of warm (slightly above room temperature) mineral water Essentuki 17 without gas. Due to the large amount of salts, this water stimulates bile secretion. Next, a warm heating pad is taken and placed on the liver area. The patient lies on his right side and lies for 30-40 minutes. After the procedure, you need to get up, have breakfast and continue your life in a normal rhythm. This is the so-called mild liver cleansing. More severe cleaning is carried out only after consulting a doctor.

One and a half to two months after the operation to remove the gallbladder, the patient should start daily walks. Walking in the fresh air, in addition to muscular load, will prevent bile stagnation, and will also help to improve the oxygen saturation of the tissues of the whole body.

Morning exercises, Pilates exercises, yoga are also recommended. Exercises should not be difficult, exercises in which the abdominal muscles are intensely contracted are excluded. The complex of restorative gymnastics can be carried out in rehabilitation centers. In any case, within 9-12 months after the surgery, any heavy physical activity associated with the tension of the abdominal muscles is prohibited, as this can lead to the formation of a postoperative hernia.

Tags: restoration, removal, gall, bladder, bile, diet, liver

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Types of cholecystectomy

Laparotomic cholecystectomy

The classic method is to make a large incision in the abdominal wall, isolate and remove the gallbladder. Laparotomy is used when it is necessary to carry out an emergency intervention, the impossibility of performing a laparoscopic procedure. Like any other abdominal surgery, it is relatively difficult to tolerate. For this reason, a long recovery period is required.

Laparoscopic cholecystectomy

Laparoscopic interventions are less traumatic for the patient.

Has a number of advantages over classical cholecystectomy. During laparoscopy, several small incisions of the abdominal wall are made, traumatization of organs and tissues is minimized. The patient's rehabilitation period is much shorter.

Stages of rehabilitation after cholecystectomy

• The early stationary stage (the first two days), when the changes caused by the operation and anesthesia are most manifested.
• Late stationary stage (3-6 days with laparoscopy and up to 14 days with laparotomy), when the functions of the respiratory system are restored, the gastrointestinal tract begins to adapt to work in the absence of the gallbladder, and regeneration processes in the intervention zone are activated.
• Outpatient rehabilitation (1-3 months, depending on the type of operation), when the functions of the digestive and respiratory systems, the patient's physical activity are fully restored.
• Active spa treatment is carried out in 6-8 months.

Features of pathophysiological disorders in patients who underwent cholecystectomy

Effective rehabilitation of patients after cholecystectomy is impossible without knowledge of the features of the development of changes in the body during surgical treatment.

Violation of external respiration is associated with artificial ventilation of the lungs during surgery, sparing the anterior abdominal wall due to pain syndrome, decreased patient activity, and weakening of the body. This can lead to the development of postoperative complications, such as pneumonia. For prevention, breathing exercises, physiotherapy exercises are carried out.

Local changes in the organs of the digestive system are manifested by the development of edema and inflammation in the area of ​​intervention, a high risk of adhesion formation during classical surgery. With the laparoscopic method, the amount of damage is much lower, which means that it will take less time for full recovery. Disorders of the motor function of the gastrointestinal tract can persist for up to two weeks with laparotomy, and with a minimally invasive method, they practically do not appear.

Rehabilitation of patients in a hospital

While the patient is in the hospital, he should carry out the following rehabilitation measures:

• Breathing exercises for 3-5 minutes 5-8 times during the day. The patient makes 10-15 as deep breaths as possible through the nose, then sharp exhales through the mouth.
• Early activation of patients when it is allowed to get up a few hours after laparoscopic surgery.
• Diet therapy for the adaptation of the digestive system to new working conditions. The first day requires maximum sparing of the gastrointestinal tract.
• Physiotherapy exercises for quick recovery of physical activity.
• Drug treatment: enzymes, pain relievers, drugs to correct intestinal paresis.

Rehabilitation of patients in a polyclinic (outpatient stage)

Diet therapy is an important component of the rehabilitation of patients after cholecystectomy.

Dynamic observation:

• examination by a surgeon and a therapist on the 3rd day after discharge, then after 1 and 3 weeks;
• clinical and biochemical blood tests 2 weeks after discharge and 1 year later;
• Ultrasound is prescribed in the first month according to indications, after 1 year for all patients.

Medical and recreational activities:

• a gradual increase in the load on the abdominal press (exercises "scissors", "bicycle");
• an increase in the pace and duration of walking;
• breathing exercises.

Diet therapy:

• For the first 2 months, a moderate diet with a normal protein, carbohydrate and fat content is recommended.
• it is necessary to exclude dishes rich in spices, extractives, fatty, fried.
• products should be steamed, baked, boiled.
• you need to eat in small portions every 3 hours.
• after eating for 2 hours, do not work in an incline or lie down.
• the last meal should be at least an hour and a half before bedtime.

Drug treatment:

Non-drug treatment:

• mineral water ½ glass up to 4 times a day;
• physiotherapy (ultrasound, magnetotherapy).

Spa treatment

Postponed cholecystectomy is a direct indication for spa treatment. The procedures listed below will help a person recover as soon as possible after surgery.

• Ingestion of degassed and heated mineral waters, ½ glass 4 times a day, half an hour before meals.
• Balneotherapy. Radon, coniferous, mineral, carbon dioxide baths up to 12 minutes a day every other day. Up to 10 baths per course of treatment.
• Electrophoresis of succinic acid for the correction of adaptation processes.
• Medication to correct energy metabolism (Mildronate, Riboxin).
• Diet therapy and physiotherapy exercises.

Thus, cholecystectomy can be performed in two ways: laparotomy or laparoscopy. The duration of the recovery process depends on this. However, in any case, rehabilitation after removal of the gallbladder takes place in several stages.

physiatrics.ru

The basics of recovery after cholecystectomy

Rehabilitation of patients after removal of the gallbladder does not require numerous therapeutic measures. Its basis is scrupulous adherence to the doctor's recommendations. Full recovery provides a set of measures, including:

• medical procedures;
• operating moments and dosing of loads;
• correction of eating habits.
• The process of rehabilitation itself is primary, post-hospital and remote.

Early recovery

Primary rehabilitation after organ removal takes place in a hospital. Here its foundations are laid, the patient is informed about the measures that must be taken after the operation.

Depending on the type of operation and the dynamics of recovery, the hospital period lasts from 2 to 7 days.

The operation of removing the bladder is carried out using the traditional and laparoscopic method. For planned surgery, the second is preferred. Abdominal surgery is performed in emergency, life-threatening complicated cases, or if previously undetected complications are revealed during laparoscopy.

The postoperative period after removal of the gallbladder with a less invasive method of laparoscopy demonstrates the advantages of this type of intervention:

• intensive care takes a minimum of time (up to 2 hours);
• a small surface of wounds heals well;
• long bed rest is not required after organ removal;
• a small percentage of complications from the digestive tract;
• the stationary recovery period is significantly reduced;
• the patient's return to an active life occurs quickly enough.

Inpatient activities

Inpatient observation includes 3 phases: intensive care, general regimen, discharge for outpatient treatment.

Intensive therapy

Immediately after the operation to remove the bladder, the patient is monitored until complete recovery from anesthesia, on average, 2 hours. At the same time, the final stage of antibiotic therapy (administration of antibiotics) is carried out, examination of wound surfaces or applied dressings to identify excessive discharge. If the temperature and seams are normal, the patient is adequate, can talk about his health and describe the sensations, which means that the intensive period is over, the patient is transferred to the general regime.

General mode

The main goal of recovery after removal of the gallbladder in the hospital is as soon as possible and complete inclusion of the operated biliary tract in the work of the digestive system. This prevents the formation of adhesions in the abdominal cavity and within the ducts. To achieve this goal, filling of the stomach empty before surgery and physical activity are required. Therefore, with an uncomplicated postoperative period, bed rest is canceled after a few hours.

On the first day after the operation to remove the gallbladder, it is recommended to drink water in small portions. This not only "turns on" the digestion, but also promotes the elimination of anesthetic drugs from the body, ensures the beginning of recovery. On the second day, fractional food is added in liquid form.

On the same day, a drainage tube is removed that removes fluid from the abdominal cavity. by this time the drainage problem has usually been resolved.

It is recommended to get out of bed by the end of the first day. For the first time, the patient gets up under the supervision of health workers, because jerky movements can lead to fainting. Without side effects the patient moves further independently.

Sutures are examined and processed daily during recovery in the hospital.

Checkout

The condition after uncomplicated removal does not require constant medical supervision, therefore, with normal recovery rates, the patient is transferred to outpatient monitoring. He receives a sick leave (if required), an extract with data on the size of the intervention (for the local surgeon) and written recommendations for recovery.

Outpatient period

After discharge, you must register with the surgeon at the place of residence. It is he who oversees the rehabilitation process, removes postoperative stitches, adjusts medical prescriptions. This period can last from 2 weeks to 1 month.

Important! Visits to the doctor are mandatory not only for those who need to close the sick leave: at this postoperative moment, small complications that are significant for later life are very likely. Their timely identification and prevention of consequences can only be done by a specialist.

Lifestyle changes

The most important thing in rehabilitation after organ removal is the correct actions of the patient. No doctor guarantees a favorable outcome if the patient does not fulfill all the requirements of this recovery period.

Diet and catering

The production of bile by the liver is restored in the hospital. But since the situation when an excessive portion of it is not excreted, but stagnates in the ducts, is extremely undesirable, it is required to provide it with unhindered movement. This is achieved:

• meals - each serving stimulates the movement of bile from the liver to the intestines;
• physical activity - the necessary peristalsis of the ducts and intestines is provided;
• elimination of spasms and expansion of the lumen of the biliary tract - this is facilitated antispasmodic drugs prescribed by a doctor;
• elimination of mechanical obstacles - you cannot sit for a long time, especially after eating, wear tight clothes in the waist and abdomen area.

Power features

Proper nutrition is one of the key aspects of rehabilitation after cholecystectomy surgery. The quality, quantity of bile, its inclusion in the general metabolism directly depends on the regularity of the intake and the composition of food.

Meal mode

The basic rule of nutrition after removal of the gallbladder is fragmentation and regularity. The daily volume of products is divided into 5 - 6 doses. You need to eat every 3 - 3, 5 hours. This may require changing the daily routine and making adjustments to the organization of work.

Important! It is required to reduce the size of the usual portions: if you maintain the volumes of one-time food intake as with three to four meals a day, then weight gain is almost inevitable.

Quality food composition

• do not include fried and smoked foods in the diet;
• limit the intake of animal fats, sweets, pastries, spicy and salty foods;
• prefer natural products to canned ones;
• exclude alcohol, strong tea and coffee;
• do not reheat food, but cook immediately before use.

Special conditions

Immediately after discharge, during the first month, the food is mashed. Expand the diet gradually, no more than 1 product for each meal (to identify the causes of complications, if any). Vegetables and fruits are heat treated - stewed or baked.

From the second month to six months of recovery after the operation, they gradually switch to chopped food, over time the size of the pieces increases. Vegetables and fruits are taken fresh.

From the second half of the year of rehabilitation, the composition of the products becomes complete.

Important! The principles of healthy eating during this period are followed in most cases - exceptions, although possible with good health, should not become the norm.

Possible Digestive Problems

In the first days and weeks after the operation, there are troubles with bowel movements. Most often, convalescents are concerned about constipation. The situation, which is quite explainable from the point of view of physiology, does not add optimism. Recommended:

• increase the amount of vegetables in the diet;
• regularly consume fresh dairy products;
• dose physical activity - its excessive increase or decrease can cause constipation;
• on the recommendation of a doctor, take a laxative that does not reduce motility in the future;
• do not abuse enemas - in addition to overstretching of the large intestine, this can cause depletion of microflora, which is already unstable in the first stages of rehabilitation.