The operation to remove gallstones. Preparing for the planned operation

Gallstone disease has become today one of the most common phenomena among pathologies of the abdominal cavity, and an operation to remove gallstones is one of the methods of cardinal solution of the problem.

Gallstone disease - what is it?

This disease associated with the formation of bile ducts and gall bladder stones (concrements). It develops for the following reasons:

• Congestion or change in the composition of bile;
• Inflammatory processes;
• Violation of biliary excretion (dyskinesia).

By composition, there are three types of stones. Most often (in 80-90% of cases) there are cholesterol stones. Their formation is facilitated by excessive cholesterol content in the bile. In this case, crystals are formed due to the precipitation of excess cholesterol into the precipitate. If the motility of the gallbladder is broken, then these formations are not discharged into the intestinal space, but remain inside it and begin to increase.

Pigmentary stones are formed because of the increased disintegration of blood cells - red blood cells. Most often it can be observed with hemolytic anemia. There are also mixed educations. They are a combination of both forms. They include cholesterol, bilirubin and calcium.

Is operation necessary?

Everyone diagnosed with gallstones is sooner or later confronted with the question of whether surgical intervention is necessary or conservative enough. It is worth mentioning that stones alone are not the basis for removing the gallbladder. If they do not show themselves and do not affect the normal work of other organs, then surgery can not be thought about. However, if there were pains in the gallbladder, a general condition, jaundice, then it is urgent to consult a surgeon. It is he who, after carrying out the survey, will decide whether surgical intervention is necessary, and which. But it must be taken into account that cholecystitis of the gallbladder implies the already begun inflammatory process. If you overly postpone the decision, the chances of completely recovering from the operation after surgery are dramatically reduced. Even if a single attack was observed, stones in the gallbladder should be removed.

Indication for surgical intervention

When addressing the need for surgical intervention, specialists usually take into account the following factors:

• The presence of stones (concrements) of various sizes, occupying more than a third of the volume of the gallbladder;
• If the disease occurs with frequent attacks of pain in the gallbladder (biliary colic), the operation is performed regardless of the magnitude of the stones;
• If the stones are located both in the gall bladder and in the ducts;
• With a decrease in the ability of the gallbladder to contract or its complete disconnection;
• With the development of biliary pancreatitis;
• When the integrity of the walls of the gallbladder;
• With blockage of the common hepatic duct.

There are international recommendations for determining the need for surgical intervention in cholelithiasis. Summing up the points that are assigned to different diagnostic indicators, the doctor determines whether the operation is required, as well as the relative and absolute indications to it.

Types of operations

As a rule, the process of formation of gallstones is not a fast one. Of course, if you are not lucky, and the ambulance brought you to a surgical hospital with a sharp attack, which was diagnosed as cholecystitis of the gallbladder, then you have a small choice. But in most cases, people who know about their problem, discuss with the doctor in advance all the details, determine the date of planned surgery.

In modern medicine, there are two methods for performing gallbladder removal (cholecystectomy):

• Open cholecystectomy - a traditional method that involves opening the abdominal cavity;
• Laparoscopic cholecystectomy is a more modern technique, which today is given preference.

Open cholecystectomy

This operation to remove stones in the gallbladder is a classic of surgical intervention. Through a wide incision along the midline of the abdomen, the abdominal cavity is examined, the gallbladder removed and, if necessary, drained (installing tubes to ensure the outflow of exudate and other biological fluids).

Despite the emergence of more modern and high-tech methods, open cholecystectomy continues to be relevant. This can be explained by the fact that some clinics do not have the necessary equipment or specialists to perform laparoscopic operations. In addition, for them, there are certain contraindications.

Laparoscopy of the gallbladder

This is another type of surgery for cholelithiasis. To date, this method is becoming more common because of its effectiveness, low-trauma, shortening of the recovery period. The operation is performed using a laparoscope - a special device that allows access to the damaged organ with the help of several punctures of the abdominal wall, through which manipulators are introduced and, in fact, a laparoscope. This method allows not only to remove the gallbladder without leaving postoperative scars, but in some cases, and remove only the stones, leaving the organ in place. Such a method is used not only for the treatment of cholelithiasis, but also for the removal of appendicitis, the treatment of inguinal hernias, certain gynecological diseases, and diagnostic operations. Despite the obvious advantages of laparoscopic holicystectomy, this method has its contraindications. These include:

• An abscess located in the operation area;
• The last three months of pregnancy;
• Severe cardiopulmonary pathology.

In addition, it should be borne in mind that when performing a laparoscopic operation, in the event of the slightest difficulties in its course, surgeons pass to open cholecystectomy. Thus, approximately 5% of laparoscopic operations end.

Preparing for an operation

Like any surgical intervention, an operation to remove gallstones requires some preparation. In addition to the standard examination, which includes the delivery of tests (general blood analysis and urine analysis, blood biochemistry, coagulogram - blood coagulation test, liver tests), it is necessary to make ultrasound of the abdominal cavity, ECG, chest X-ray, according to FGS and colonoscopy, and To receive the conclusion of the therapist. In addition, the preparation for the planned operation includes the abolition of drugs that affect blood coagulability. These include various anticoagulants, vitamin E, non-steroidal anti-inflammatory drugs. A few days before the operation, a diet with cholelithiasis requires special attention. The menu should not contain heavy meals, and from midnight on, when the operation is performed, you should generally exclude food and drink. On the eve of an operation day, cleansing enemas or special preparations are taken in the morning and evening to clean the intestines . In the morning take a shower with antibacterial soap.

Postoperative period

Today it is difficult to surprise someone with cholecystectomy. This operation to remove stones in the gallbladder has long been put on the "flow", and is done approximately as often as appendectomy. The patient is allowed to turn in bed four hours after the operation, during which he can not drink and make sudden movements. Then you can start drinking small amounts of water without gas (1-2 sips, but not more than 500 ml). Six hours after laparoscopic surgery, the patient can get up. It is better to do this if one of the medical personnel or relatives is nearby, because after a long time the body was in a horizontal position and in a state of anesthesia, dizziness and fainting may arise when trying to get up. Already on the next day after the operation the patient can freely move around the hospital.

After a surgical intervention, a diet with cholelithiasis is of great importance. The menu the next day can include liquid food - oatmeal on the water, diet soups, dairy products. In the future, the diet can include boiled beef, chicken breast, baked apples or bananas. It must be remembered that in the first week after the operation, alcohol, strong tea or coffee, sugar, fried and fatty foods are prohibited.

Litholithic therapy

If surgical intervention is not possible due to severe somatic diseases or bleeding disorders, or if the patient refuses to perform the operation, litholytic therapy is performed. This method, which uses drugs containing bile acids, designed to dissolve the resulting stones. Starting it, you need to take into account that the duration of treatment can be from one to two years, and even if you can completely dissolve gallstones completely, this does not guarantee that they will not appear again. In addition, various complications of cholelithiasis can occur during treatment, including those that require surgical intervention.

Criteria for litholytic therapy

Another limitation of litholytic therapy is certain requirements for the criteria of the disease:

1. Stones in the gallbladder should be cholesteric, dimensions not exceeding 20 mm.
2. Functions of the gallbladder are preserved, and the stones do not occupy more than half of its volume.
3. The bladder and common bile duct should maintain their patency.
4. Since the formation of stones, more than two years have not passed.
5. In the anamnesis there should be uncomplicated course of the disease - moderate pains, rare attacks of hepatic colic.

Treatment is carried out under the supervision of ultrasound once in 3-6 months. If after half a year there is no improvement, then it is recognized as ineffective, and again raises the question of surgical intervention. If litholitic therapy was successful, ultrasound is done at least once every three months in order to detect newly formed gallstones in time.