Removal of the gallbladder (cholecystectomy )
Gastroenterology / / May 11, 2016
Removal of the gallbladder (cholecystectomy) video
Normal anatomy of the gallbladder
The gallbladder - a hollow organ located in the abdomen, on the right, under the liver.Its volume of about 50-70 ml, and is shaped like a pear.Its main purpose - the accumulation and concentration of bile, which is synthesized by the liver cells and the subsequent release of its 12-duodenum, periodically, mostly due to food intake.Bile aids in the digestion and absorption of fat-soluble vitamin absorption, cholesterol, amino acids and calcium salts, and also involved in activation of the bile wall digestion in the gut and enhances the secretion of intestinal motor activity.
When the gallbladder is removed?Indications for cholecystectomy
Cholecystectomy is performed to treat gallbladder disease, mainly due to the formation of gallstones in the gallbladder (cholelithiasis).Stones can be hard and small as pebbles inside the gallbladder.Stones can be as a grain of sand or as large as a golf ball.
Common indications for cholecystectomy is:
- Hindering the normal flow of bile, leading to severe abdominal pain (biliary colic)
- Infection or inflammation of the gallbladder (cholecystitis)
- Obstruction of bile ducts, leading to the duodenum (biliary obstruction)
- Blockage of the duct leading from the pancreas into the duodenum (pancreatitis)
Just to indications for cholecystectomy include exacerbation of chronic cholecystitis, calculous cholecystitis, acute cholecystitis, is not amenable to conservative therapy, cholesterosis.
How to prepare for cholecystectomy, surgery to remove the gallbladder?
- To prepare for a cholecystectomy, your surgeon may ask you to take a laxative 3-4 days before surgery to clear the bowel.
- Do not eat the night before surgery.Do not eat or drink for at least four hours before the operation, but you can drink a sip of water with medications.
- It is necessary to stop taking certain medications and supplements that affect blood clotting, because they may increase the risk of bleeding.In any case, tell your doctor about all medications and supplements you are taking.
- Hygienic procedures before surgery, for example, a shower with antibacterial soap.
- Plan in advance plan your stay in the hospital.Most patients are able to go home the same day after cholecystectomy, but there can be complications that require one or more nights in the hospital.If the surgeon has to make a long incision in the abdomen to remove the gallbladder, you may have to stay in the hospital longer.You can not always know in advance what procedure will be used.Plan ahead in case you have to stay in hospital, what personal items you may need, such as a toothbrush, comfortable clothing, and books and magazines to pass the time.
Most surgeries for gallbladder removal today is performed using laparoscopic surgical techniques, in which thin surgical instruments - trocars are introduced into the abdomen through a small incision.The operation is performed under anesthesia, so that the patient is asleep and does not feel any pains.
During a laparoscopic cholecystectomy, the surgeon makes a small incision in the four abdominal cavity, two of which have a length of 5 millimeters, and the other two have a length of 10 millimeters.A tube with a tiny camera is inserted into the abdomen through one of the incisions.During the introduction of trocars do not cut the fabric, and only widen.The patient is under general anesthesia, the abdomen is inflated with carbon dioxide.The rest of the instruments are inserted through 2 more cut.Then, when the gallbladder is found, it is removed.
Next cholangiography carried out, a special x-ray to check for abnormalities bile duct.If your doctor feels that there are other problems in the bile ducts, they can be eliminated.Thereafter, the incision is closed.Laparoscopic cholecystectomy takes one or two hours.
However, laparoscopic cholecystectomy is not suitable for everyone.In some cases it is necessary to make a large incision, for example due to scar tissue from previous surgery or complications, or very large stones.In this case, it conducts an open cholecystectomy.
traditional (open) cholecystectomy
If the gallbladder is extremely inflamed, infected, or has large stones, used another surgical approach, called open cholecystectomy.
During open cholecystectomy surgeon makes a 15-inch incision in the abdomen just below the rib cage and the ribs on the right side.Muscles and tissue are retracted to facilitate access to the liver and gallbladder.Then shift the liver to the gallbladder is open.The vessels of the cystic duct and artery and from the gallbladder are cut, and the gallbladder is removed.The common bile duct, which removes bile from the liver to the small intestine, and checked for the presence of stones.Small drainage tube may be left for several days to drain the fluid when it is an inflammation or infection in the peritoneal cavity.Then the incision was sutured.
open cholecystectomy takes one or two hours.
recovery after removal of the gallbladder (cholecystectomy)
After surgery, you will be sent to the intensive care unit for recovery from anesthesia.When the action ends with anesthesia, you will be taken to your room.Further reduction varies depending on your procedure:
after laparoscopic cholecystectomy patients often go home the same day after the operation, although sometimes requires one night of hospital stay.After discharge, you can return to a normal diet and activities almost immediately.
After open surgery, you can expect that you will go home as soon as you are able to eat and drink without pain and able to walk unaided.It usually takes two to three days to a week.The ability to return to a normal diet comes after 1 week and return to normal activities after 4 - 6 weeks.
Perhaps you will experience some of these symptoms during recovery:
- Abdominal pain.You may feel pain in one or both arms for several days after surgery.This occurs because the gas after abdominal surgery.Your doctor will prescribe pain medicines to use at home.If you are taking pain pills 3 or 4 times a day, try to take them at the same time each day for 3 - 4 days.Try to get up and walk, if you have some pain in my stomach.This can relieve your pain.
- Pain in the section between 1 and 2 weeks.This pain should decrease each day.Click on the area of the incision when you cough or sneeze to ease discomfort and protect your seam rupture.
- Sore throat from the breathing tube.Sucking on ice chips or gargling may have a calming effect.
- Nausea and vomiting.Your doctor may prescribe medicines, if necessary.
- Loose stools after eating.It may last from 4 to 8 weeks.
- Bruising and bruising around the wound.They will pass on their own.
- Redness of the skin around the wound.This is normal.
- A small amount of watery or dark bloody fluid from the incision.It is normal in a few days after surgery.The surgeon may leave 1 or 2 drainage tubes in the stomach, one will help drain any fluid or blood that remains in the stomach.The second tube is drained bile during recovery.This tube will be removed by your surgeon after 2 - 4 weeks.Before removing it, will be a special X-ray called cholangiography.You will receive instructions on how to care for these tubes before discharge home.
activities after the removal of the gallbladder (cholecystectomy)
You must be able to carry out most of your regular activities in a period of 4 to 8 weeks.Prior to this:
- Do not lift anything heavier than a 4.5 - 7 kg, while the doctor will not let you.
- Avoid strenuous activity.This includes heavy exercising, weightlifting and other activities that make you breathe hard or strain.
- regularly make short walks.
wound care after surgery
Change the dressing over your operating wound once a day, or earlier if it becomes dirty.Your doctor will tell you when you will not need to use bandages.Keep the wound clean by washing it with a mild soap and water.You can also take a shower, after removing the bandage if your incisions are closed stitches, staples or special glue.
If the seams are closed by means of strips for the edges of the seamless information of a skin wound or skin emplastic seam erased Strip, cover the incision with plastic wrap before showering for the first week.Do not try to wash off the strip, let them fall off by themselves.
Do not take a bath or swim in the pool or pond, visit bath or sauna to the specific instructions of your doctor.
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diet after gallbladder removal (cholecystectomy)
you can return to the usual diet almost immediately, but it is usually recommended to limit consumption of fatty or spicy foods, eat frequent small meals.
If you have hard stools:
- Try to walk more and be more active, but do not overdo it.
-Try to reduce the dosage of pain medication, some of which can cause constipation.
- You can use a laxative.But do not take any laxatives without consulting your doctor.
- Ask your doctor about high-fiber foods.
forecast after gallbladder removal (cholecystectomy)
Cholecystectomy can alleviate pain and discomfort from gallstones.Conservative treatments such as dietary changes, as a rule, can not stop the formation of gallstones, and symptoms may recur.Cholecystectomy is the only way to prevent the formation of gallstones.
Some people experience mild diarrhea after cholecystectomy, although it usually goes away with time.Most people do not experience problems with digestion after cholecystectomy, because the gall bladder is not necessary for healthy digestion.
Complications and Risks of cholecystectomy
cholecystectomy carries a small risk of complications.The risk of complications depends on your general health status and the reasons for cholecystectomy.This can be:
- bile leak during
operation - Bleeding
-Tromboz vessels in operation
- Problems with the heart
-Travmy nearby organs, such as the bile ducts, liver and small intestine
Call your doctor or nurse if:
- Do you have a fever, and the temperature is above 38 ° C.
- The wound is bleeding, red or warm to the touch.
- The edges of the surgical wound edges are thick, yellow, green or milky discharge from the drainage.
- Do you have pain that can not be removed painkillers.
- It's hard to breathe.
- Do you have a cough that does not go.
- You can not drink or eat.
- Your skin or the white of the eye yellowing.
- your bowel movements gray clay-colored.