What does laparoscopic surgery mean? Laparoscopy of the gallbladder (removal of stones or the entire organ by laparoscopic surgery) - advantages, indications and contraindications, preparation and course of the operation, recovery and diet

The date: 29.06.2020

In modern medicine, surgeries are increasingly performed in gentle ways. One of them is laparoscopy. This is a low-traumatic procedure that is widely used in the treatment and diagnosis of various diseases of the abdominal cavity, as well as in gynecology, urology and traumatology. The risk of complications after it is minimized, and the patient can return to normal life in a short time.

Laparoscopy: what is the operation and why is it needed

Unlike the classical operation, medical manipulations are carried out not through an incision, but through small punctures. Thanks to this, a person does not have ugly scars on the skin, and healing is easier and without complications. This method is used not only for surgery on internal organs, but also for diagnostic purposes.

It is especially advisable to conduct laparoscopy for various neoplasms. Indeed, in one procedure, the doctor can not only examine the tumor, but also take the biomaterial for analysis, and, if necessary, remove it.

Indications:

infertility, the cause of which has not been identified in other studies;
benign and malignant neoplasms;
congenital pathologies of the development of internal organs;
diseases of the female reproductive system - polycystic ovaries, adhesions in the fallopian tubes, endometriosis, cysts, polyps, fibroids and others;
ectopic pregnancy;
chronic inflammation in the pelvic organs;
internal bleeding;
peritonitis;
intestinal obstruction;
accumulation of fluid in the abdominal cavity;
traumatic injury to internal organs.

The laparoscopic method is used in almost all areas of medicine. With its help, tissues are taken for histological examination, a detailed study of the state of the digestive tract, genitourinary and reproductive systems is carried out. It is also successfully used to treat diseases of the liver and biliary tract.

Laparoscopy is also used in emergency situations. In this case, there is no time to conduct a full detailed study to find out the cause of the serious condition of a person. The use of laparoscopic equipment allows you to quickly find the source of bleeding, eliminate it, and also remove damaged tissues or organs. In this case, large incisions are not required, which means that blood loss can be avoided.

Contraindications to surgery

But despite the low trauma, the laparoscopic method has a number of relative (temporary) and absolute contraindications.

Absolute contraindications:

Severe pathologies of the cardiovascular and respiratory systems.
Poor blood clotting, which cannot be corrected.
Multiple operating or traumatic scars in the puncture area.
Coma.
Irreducible hernia of the abdominal wall and diaphragm.

In an emergency, if there is a risk of death, then the choice is made in favor of the operation. There is only one absolute general contraindication - agony (near-death state).

If planned laparoscopy is planned, then the reason for its transfer is ARVI, poor test results, hypertensive crisis. After recovery, it is necessary to wait a month for the body to recover before setting the date for the operation.

Doctors also refer to relative contraindications:

Elderly age.
1st and 3rd trimester of pregnancy.
Peritonitis.
Obesity stage 3-4.

Important! Only a doctor can decide whether it is advisable to carry out routine therapeutic or diagnostic laparoscopy.

How to properly prepare for the procedure

Before laparoscopy, as before any other surgical intervention, you need to undergo a full examination and pass a number of tests. This is necessary to exclude possible complications, as well as to identify contraindications.

Common to all are:

detailed blood test;
tests for HIV, syphilis and hepatitis;
laboratory examination of urine, feces;
fluorography.

In gynecology, an additional smear is taken from the vagina, colposcopy and intravaginal ultrasound are performed. If an abdominal operation is scheduled, an ultrasound examination is recommended. In the presence of chronic diseases, consultation and conclusion of a specialized doctor is required.

There is also a preliminary conversation with the anesthesiologist. The doctor chooses the optimal type of anesthesia, and also finds out if the patient is allergic to drugs. If any inflammation is detected during the preparation period, drug therapy is carried out.

Before the operation, the patient must sign a written consent agreement for laparoscopy. The doctor must explain in detail to the patient the essence and purpose of the procedure.

With strong excitement, sedatives are allowed. Patients who have a tendency to vascular diseases are shown the use of special anti-varicose stockings or elastic bandage during surgery.

7 days before the date of the laparoscopy, all gas-forming products should be excluded from the diet. This is carbonated water, legumes, cabbage, milk, all cereals except rice. From fruits, apples, grapes and pears are banned.

If the patient, for health reasons, needs to take any medications constantly, then the surgeon should be informed about this. A hygienic shower is recommended on the day of the procedure. All jewelry and contact lenses must be removed.

Operation

When prescribing a planned laparoscopy in gynecology, the woman's menstrual cycle must be taken into account. If there is no need for urgency, then surgery is scheduled for a "dry" period. The result of diagnostics in gynecology, as well as the effectiveness of treatment, directly depends on the phase of the cycle.

It is forbidden to drink or eat immediately before the procedure. The procedure is usually done in the morning. Its duration depends on the purpose. Diagnostics and taking of biomaterial takes no more than 30 minutes, and medical manipulations can last 1-2 hours.

The essence of laparoscopic surgery

The number of punctures depends on the location of the operation. Usually, 3 or 4 small holes are made up to 1.5 cm in size. In most cases, general anesthesia or drug sleep is used.

A puncture is made with a special device (trocar), and the necessary instruments are inserted through it into the operating area. The main instrument is a laparoscope, it is a hollow tube with a microscopic camera with which doctors control their manipulations. Information from the camera is displayed on the monitor in the operating room. An optical cable is also used, which is equipped with a light installation.

So that the tissues adjacent to the intervention zone do not interfere with the operation, they are lifted by injecting a gas mixture into the cavity. This creates a space for medical manipulation. This is followed by a thorough visual inspection. If necessary, a part of the pathological tissue is taken for laboratory research.

After the end of the surgical work, the instruments are removed. Cosmetic sutures are applied to the punctures. After the operation, a person is in the hospital for 2 to 7 days. It depends on the volume of the intervention. After 7-10 days, the stitches are removed. If self-absorbable sutures have been applied, then they do not require removal. Scars lighten over time and become outwardly almost invisible.

Rehabilitation period

Wound healing after laparoscopic surgery is much faster than after classical surgery. The main care is treatment with an antiseptic solution. If the doctor's recommendations are followed, there are practically no complications. In the early days, pain is possible, but they go away on their own. Sometimes it is required to wear a postoperative bandage. After a week, you can already return to the usual rhythm of life.

The only limitation is refusal from heavy physical activity for 1-2 months. It depends on the individual characteristics of the organism.

Advantages and disadvantages of the laparoscopic method

The indisputable advantages of this method of carrying out the operation include:

subtle postoperative scars;
complications in the postoperative period are practically excluded;
quick recovery - after a week you can lead a normal lifestyle;
minimal blood loss due to small punctures;
simultaneous diagnosis and treatment.

A great advantage is the ability to remove the affected organ or formation, if found. Even if the procedure was carried out only for diagnostic purposes.

The disadvantages are:

distorted perception of the depth of the manipulations being carried out;
limited space, during which it is not always possible to perform the required amount of work;
sharp tools that only need to be worked by looking at the screen. This requires experience and specialized training.
the absence of tactile sensations does not allow to correctly calculate the force that is applied to the organ.

In modern surgery, equipment is used that greatly reduces the difficulties of the surgeon's work in the process of laparoscopic intervention.

Possible complications

Considering that during the operation by the laparoscopic method, surgeons do not penetrate the abdominal cavity with their hands, the risk of infection is minimized. It is also impossible to leave a napkin or any instrument in the cavity. In rare cases, complications may occur:

The occurrence of subcutaneous emphysema due to the introduction of carbon dioxide into the peritoneum.
Traumatic damage to blood vessels or organs with instruments.
Electrodes can cause electric burns, which surgeons may not notice.
Hypothermia when using dry cold gas.

The number of complications during laparoscopy is much less than after abdominal surgery. They can be avoided if the operation is performed by an experienced specialist. The cost of laparoscopy depends on many factors (anesthesia, materials, medications, etc.).

Laparoscopy is a low-traumatic method of diagnostics and surgery.

Laparoscopy is performed by penetrating the abdominal cavity to the pelvic organs with the help of several punctures, and then manipulating instruments are inserted through them.

The manipulators are equipped with micro-instruments, illumination and micro-cameras, which allow performing operations with visual control without making large incisions, which reduces the risk of postoperative complications, minimizes surgical tissue trauma and shortens the rehabilitation period.

When conducting laparoscopy, so that the abdominal wall does not interfere with the examination and operations, it is raised by forcing air into the abdominal cavity - a pneumoperitoneum is applied (the abdomen is inflated).

The operation is accompanied by incisions and painful irritations, therefore, it is performed under anesthesia.

Indications

Laparoscopy is widely used in gynecology:

with infertility of an unknown cause, which was not identified with a detailed non-invasive study.
with the ineffectiveness of hormone therapy for infertility,
during operations on the ovaries (sclerocystosis, ovarian cysts, ovarian tumors),
if you suspect endometriosis, adhesive disease,
with chronic pelvic pain,
with endometriosis of the uterine appendages, ovaries, pelvic cavity,
with myomatous lesions of the uterus,
with ligation of the fallopian tubes, with an ectopic pregnancy, rupture of the tube,
with torsion of the ovary, cysts, ovarian apoplexy, internal bleeding,
when examining the small pelvis.

Contraindications to laparoscopy

Laparoscopy in gynecology is absolutely contraindicated

with severe cardiovascular and pulmonary diseases,
in a state of shock, in a coma,
with severe depletion of the body,
in case of violations in the coagulation system.

Also, operation by laparoscopy is contraindicated for hernias of the white line of the abdomen and the anterior abdominal wall, for hernias of the diaphragm.

Routine laparoscopy is contraindicated in ARVI, you must wait at least a month from the moment of illness. Also, operation is prohibited in case of pronounced changes in blood and urine tests, with bronchial asthma, with hypertension with high blood pressure.

Training

Laparoscopy operations can be planned and emergency.

In emergency operations, preparation can be minimal when it comes to saving the patient's life.

For planned operations, a complete examination is required with the delivery of all tests:

blood (general, biochemistry according to indications, for hepatitis, syphilis and HIV, for coagulation),
blood for glucose.

A study of the blood group and the Rh factor is mandatory.

Before the operation, a gynecological smear, ECG and fluorography, ultrasound of gynecological organs are required, and if there are chronic diseases, a therapist's conclusion about the safety of anesthesia.

Before the operation, the surgeon explains the essence of the procedure and the scope of the intervention, and the anesthesiologist examines and identifies the presence of allergies and contraindications to anesthesia.

If necessary, medication and psychoprophylactic preparation for the operation is prescribed.

In the absence of contraindications to the operation and anesthesia, the woman signs a written consent for the operation separately for this type of anesthesia.

Operation

Planned operations are usually prescribed in the morning, and before that a light diet is prescribed a few days before, and in the evening before the operation, an enema is cleansed.

Prohibit eating, and after 22.00 and water, and in the morning repeat the enema. It is forbidden to eat and drink before the operation.

If there is a danger of thrombosis before the operation, elastic bandaging of the legs or wearing anti-varicose compression stockings is indicated.

The essence of laparoscopic surgery

Depending on the volume of the operation and its location, three or four punctures are used.

One of the trocars (a device for puncturing the abdominal cavity and conducting instrumentation) is inserted under the navel, the other two on the sides of the abdominal cavity. At the end of one trocar there is a camera for visual inspection, at the other there is a light set, a gas blower and instruments.

Carbon dioxide or nitrous oxide is injected into the abdominal cavity, determined with the volume and technique of the operation, the abdominal cavity is revised (its thorough examination) and the manipulations are started.

On average, laparoscopic operations last from 15-30 minutes to several hours, depending on the volume. Anesthesia can be inhaled and intravenous.

At the end of the operation, a revision is performed again, the blood or fluid accumulated during the operation is removed. Thoroughly check the vascular clearing (if there is no bleeding). Eliminate gas and get tools out. Sutures are applied to the trocar insertion sites on the skin and subcutaneous tissue, and cosmetic sutures are applied to the skin.

After laparoscopy

The patient regains consciousness while still on the operating table, doctors check her condition and reflexes, and is transferred to the postoperative room on a gurney.

With laparoscopy, early getting out of bed and taking food and water are shown, they lift a woman to the toilet and to activate blood circulation after a few hours.

The discharge is carried out two to five days after the operation, depending on the volume of the intervention. Suture care is carried out every day with antiseptics.

Complications

The complication rate in laparoscopy is low, much lower than in operations with large incisions.

When a trocar is inserted, there can be injuries to internal organs, damage to blood vessels with bleeding, and when gas is injected, there can be subcutaneous emphysema.

Also, complications include internal bleeding with insufficient clearing or cauterization of blood vessels in the area of the operating area. All these complications are prevented by strict adherence to the technique and careful revision of the abdominal organs during the operation.

in comparison with abdominal and highly traumatic operations in gynecology, laparoscopy has a number of undoubted advantages, especially at a young age: there are practically no scars from the operation,
less risk of postoperative complications and adhesions,
the rehabilitation period is significantly reduced.

Thanks

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

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 abdominal and pelvic organs. That is why nowadays 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 - definition, general characteristics, types of operations

The term "laparoscopy of the gallbladder" 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. A distinctive feature of the operation is the access through 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 have a general understanding of the course and essence of both techniques.

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 a conventional 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 is always left on the skin, corresponding to the line of the incision made. 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 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. Control of instruments using trocars can be roughly compared to driving a car, an airplane, or any 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 intended 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 classical laparotomy approach, the laparoscopic one 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 part or the entire organ, exfoliation of stones, etc.) is skipped, as a result of which only an indication of the laparoscopic access and the name of the organ on which the intervention was performed remains.

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 much pathologically changed 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 excrete 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 24 hours;
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 general endotracheal anesthesia is used 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 asthma, 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 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. For 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- 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 is released from the tissues - the bile duct connecting it to the duodenum. The choledoch is cut, after which the cystic artery is isolated from the tissues. Clamps are placed on the vessel, cut between them and the artery lumen is carefully sutured.

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, while cauterizing all the bleeding vessels with an electric current. 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 to rinse, 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 flow out of 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 gallbladder stones - 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 the production of 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 to remove the gallbladder by the laparoscopic method are the following diseases:

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:

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.

Preparation for laparoscopy of the gallbladder

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);
Vaginal flora smear for women;
Blood for HIV, syphilis, hepatitis B and C;

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 water.

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 frequently (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 the conditions of the 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 hospital is discharged from the hospital 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 fairly 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 means not only physical and mental recovery after stress and trauma, 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 Ketonal, Ketorol, Ketanov, etc. Anesthetic drugs are used within 1 - 2 days after surgery, 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 is no longer bothering, 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, it indicates the development of some other disease.

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

The diet that should be followed after removal of the gallbladder is aimed at ensuring the normal functioning of the liver. 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). Such 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 to 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 unacceptable. 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.);
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, fresh or in compotes, mousses and jellies;
Yesterday's white bread;

The level of development of modern medicine allows some surgical operations to be performed without large incisions. Laparoscopy is one such method that allows you to examine and operate on internal organs. The procedure is widely used in gynecology, both in our country and abroad.

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What is the essence of the method

Laparoscopic intervention - popular method of diagnosis and treatment many diseases and processes affecting the genitourinary sphere.

This is a low-traumatic operation, which is performed through a small incision in the anterior abdominal wall using high-precision instruments and a special video camera.

The advantage of this procedure is that after it complications rarely occur recovery is quick, and within a few days the patient can live an active and fulfilling life.

You should not be afraid of the procedure: the doctor informs in advance about all important aspects:

what tests need to be done before laparoscopy;
what manipulations are carried out during the procedure;
how long will it take to recover;
what regimen to follow and what you can eat after laparoscopy.

Feature of diagnostic laparoscopy

Diagnostic laparoscopy is different from the usual purpose of holding. In the first case, it means first examination and identification of pathology, and then its elimination, in the second case, the operation is performed immediately.

Within the framework of one procedure, the doctor can both find the cause of the ailment and eliminate it, but this is not always the case. Example: During diagnostic laparoscopy, a cyst may be detected. To remove it, you need a separate operation.

The diagnostic procedure is highly accurate, as powerful equipment is used that can multiply the area under study. An examination is made not only of the abdominal cavity, but also of the surrounding space.

Medical examination

Laparoscopy is required in cases where:

the patient complains of pain in the pelvic region or in the abdomen;
neoplasms of unknown origin appeared;
the cause of the obstruction of the fallopian tubes is unknown;
you need to determine the causes of infertility;
it is necessary to check whether the fallopian tubes are passable along their entire length.

To clarify the diagnosis do laparoscopy in the following situations:

the woman has (or is regularly) pains in the abdomen, while there is a suspicion that they are caused by internal bleeding, appendicitis, adhesions or;
upon examination, the doctor or the patient herself discovered a tumor;
fluid is present in the abdominal cavity;
another study showed pathological changes in the outer tissues of the liver;
for whatever reason, the fallopian tubes must be artificially made impassable.

Other situations are possible when laparoscopy in gynecology provides accurate information about the state of the organ.

Important! When an internal organ is examined, the doctor has the opportunity to take a tissue sample to conduct a more thorough analysis after the procedure.

Features of preparation

The specialist tells the patient in advance what laparoscopy is, why it is needed in a particular case, and how long it will take.

The patient is also notified in advance of possible complications after the procedure or during it.

Preparation for laparoscopy differs depending on whether or not emergency or planned intervention.

If an emergency surgery is to be done, the blood pressure is measured, the blood is checked for clotting, and the group is determined (in case a transfusion is needed). Before the scheduled procedure, blood and urine tests, cardiogram and fluorography are done.

Preparation of the patient for laparoscopy begins after the test results are ready. During the day, you need to reduce the amount of food and liquid consumed. The last meal should be no later than 17 hours. In the evening and in the morning, an enema is done, the remaining preparatory manipulations are also carried out in the morning, before the operation. On the day of the laparoscopy do not eat or drink!

Laparoscopy

Laparoscopy in gynecology in almost all cases is done under general anesthesia. Exceptions are diagnostic procedures or short-term interventions. They can be carried out with anesthesia to a limited part of the body. In such cases, regional anesthesia or spinal epidural anesthesia is practiced.

Important! General anesthesia is not used during the procedure if the woman cannot tolerate a particular drug.

When choosing an anesthetic and calculating its amount, the anesthesiologist takes into account the patient's gender, weight, height, age and existing chronic diseases.

First, anesthesia is administered, then the woman is connected to an artificial respiration apparatus and a catheter is inserted. When the anesthetic works, three small holes (incisions) are made in the peritoneum or other area.

How the incisions are made depends on the type of operation. For example, to remove a cyst, an incision is made in the lower part of the anterior abdominal wall.

The hole for the video camera is larger than the others, usually under or above the navel. A camera and instruments are passed through the incisions into the cavity. A special gas is pumped into one of the holes so that the tools can be moved. After completing these actions, an image appears on the monitor. Focusing on it, the surgeon performs manipulations in the body cavity.

The duration of the operation depends from the nature of the pathologists, usually diagnostic laparoscopy lasts from 15 minutes to 1 hour. When the procedure is over, remove the instruments and the chamber, pump out the gas. Two holes are sutured, and in the third, a drainage tube is installed to remove the contents of wounds, abscesses, as well as postoperative residues in the form of bloody particles from the peritoneum. In this case, it is imperative to install drainage, because it prevents peritonitis.

Since the procedure takes place under general anesthesia, pain is not felt, but it is may occur later when the anesthetic wears off.

Postoperative period

Recovery after laparoscopy in most patients proceeds quickly and without complications. Already in the first few hours, starting from the time when the anesthesia ceases to work, you can turn in bed, sit down and go to bed on your own.

After 5-7 hours, if the patient feels well, she can begin to walk.

In the first 5-6 hours, painful sensations persist in the lower back and abdomen, but you should not be afraid of this. If the pain is mild, you can do without analgesics, otherwise it is recommended to take a pill.

On the day of laparoscopy and the next day, some patients have a fever - usually it does not exceed 37.5 degrees. Discharge in the form of ichor and transparent mucus from the genital tract is possible. They usually stop after 1 or 2 weeks, but if this does not happen, you need to see a doctor.

How to eat after the procedure

A special diet after the procedure is recommended due to the weakening of the intestines. On the first day, he is not able to fully perform his functions. In addition, nausea and vomiting sometimes occur. The reason is that the body has not yet fully recovered from anesthesia, and the intestines and other organs have been irritated by laparoscopic instruments and gas.

You can drink after the procedure no earlier than 2 hours later. For 1 time allowed drink 2-3 sips plain or mineral water, strictly without gas! The next portion can be drunk in an hour, and so on.

The rate of consumed water is increased gradually, bringing it to the usual volume in the evening. If the next day there is no bloating and nausea, you can start eating light food, but only on the condition that active intestinal motility is present. Water is allowed to drink without restrictions.

If the nausea and vomiting persist, the patient is left in the hospital and measures are taken to keep the intestines working. Treatment includes stimulation, a fasting diet and the introduction of electrolytes through a dropper.

Consequences and complications

The negative consequences of laparoscopy are rare and mainly arise due to the individual characteristics of the organism.

Possible consequences

Most dangerous phenomena:

pneumothorax;
subcutaneous emphysema with mixing or compression of the mediastinal organs;
perforation of the wall or damage to the outer lining of the intestine;
gas embolism (the result of the ingress of carbon dioxide into the vessel);
massive bleeding resulting from trauma to a vein, artery, or large vessel.

Long-term complications after laparoscopy - adhesions, which, depending on the location, can lead to infertility, dysfunction of the gastrointestinal tract. Adhesions are formed both against the background of the existing pathology and as a result of the inept actions of the surgeon, but more often they are due to the characteristics of the organism.

It is extremely rare, but it also happens that during the procedure a small vessel is damaged or the liver capsule ruptures, and this remains unnoticed. In the postoperative period, slow bleeding develops. In such a situation, repeated surgical intervention is required.

Non-dangerous consequences- a small amount of gas or hematoma in the places where the instruments were inserted. Such formations dissolve on their own.

Care of seams

Sutures after laparoscopy are lubricated with antibacterial drugs daily, and, if necessary, several times a day. The doctor tells you in detail how to do this. First, an alcohol solution is used, and then brilliant green or, if there is a burning sensation, a hypertonic solution.

For processing you need to use gauze swab, but by no means cotton wool, as its particles can catch on the seam and provoke inflammation. If the wound is not sealed, it will heal faster, but in this case the risk of injury increases, so the final decision remains with the doctor. The stitches are removed through 7 days after the procedure, and when using self-absorbable threads, this is not necessary.

Different types of laparoscopic procedures have their own characteristics. The main stages of laparoscopy:

the operation is performed under general anesthesia. Before laparoscopy, the patient will be consulted by an anesthesiologist to make sure there are no allergies or contraindications to anesthesia;
in the abdominal wall, the doctor makes 3-4 small incisions (from 5 to 10 mm);
the abdominal cavity is filled with carbon dioxide. This increases the field of view, makes manipulations accurate and safe;
a laparoscope is inserted through the incisions, and, if necessary, to perform medical manipulation, special instruments;
the surgeon visually controls the operating field and all his actions on the monitor screen, increasing their accuracy and efficiency.

How long does the operation take

The duration of a laparoscopic operation or study is from 1.5 to 2.5 hours, depending on the volume and type of intervention.

Laparoscopy in gynecology and abdominal surgery at the Clinical Hospital on Yauza

We perform a wide range of laparoscopic examinations and operations. Let's name the main ones:

laparoscopic bowel resection;
laparoscopic removal of the ovarian cyst;

Laparoscopic appendectomy

Appendectomy is one of the most common operations in surgical practice to remove an inflamed appendix. Indications for laparoscopic appendectomy are:

detection of appendicitis during diagnostic laparoscopy;
acute appendicitis;
the presence of diabetes mellitus in patients with appendicitis (this reduces the risk of postoperative infectious complications);
significant obesity (laparoscopic access provides minimal tissue trauma).

Laparoscopic cholecystectomy

This is the most effective way to remove the gallbladder in case of gallbladder diseases. The main indications for surgery are as follows:

gallstone disease and its complications (acute blockage of the bile duct, etc.)
polyps in the gallbladder
an incapable gallbladder to receive or excrete bile.

Laparoscopic hernioplasty

Laparoscopic hernioplasty - laparoscopic removal of an inguinal hernia. Our specialists carry out the removal of all types of abdominal hernias - inguinal, femoral, umbilical - regardless of their origin. We use modern intraoperative tracking systems, mesh alloprostheses that strengthen the abdominal wall and prevent hernia recurrence.

Laparoscopic bowel surgery

We carry out laparoscopic removal of intestinal tumors, resection of individual sections of the intestine for ulcerative colitis, Crohn's disease.

Gynecological laparoscopic operations

Among the indications for diagnostic or therapeutic laparoscopy in gynecology are the following:

endometriosis;
uterine fibroids;
ovarian cysts and tumors;
emergency gynecological pathology;
tubal and ovarian infertility;
suspicion of an ectopic pregnancy;
preparation for IVF;
prolapse (prolapse) of the walls of the vagina, uterus.

After laparoscopy

After surgical laparoscopy, the patient is usually in the hospital for 1 to 2-3 days, depending on the type and complexity of the intervention. Full recovery takes from 10 days to 2-3 weeks. Exercise should be limited for 2 weeks. After laparoscopic manipulations, no significant scars remain on the skin: the incisions through which the access was carried out heal in a few days.

Contraindications to laparoscopy

Among the contraindications for laparoscopy are the following:

decompensated hypertension accompanied by hypertensive crises;
decreased blood clotting, hemophilia.
decompensated respiratory failure;
significant bloating
ventral hernia with a tendency to infringement;
abscesses of the abdominal cavity;
the presence of a large number of fistulas, scars of the anterior abdominal wall.

If you are wondering where to do a laparoscopic operation in Moscow, contact the Clinical Hospital on the Yauza. Our specialists will carry out a thorough diagnosis and, if necessary, perform a surgical intervention.

Our specialists:

Advantages of laparoscopy at the Clinical Hospital on Yauza

Doctors. Experienced highly qualified surgeons with extensive experience in diagnostic and therapeutic laparoscopy.
Modern equipment. The Yauza Clinical Hospital is equipped with equipment from the world's leading manufacturers - Karl Storz, Covidien, Erbe, etc.
Safety. Minimal risks of bleeding and complications.
Innovative operating room design. Infection-resistant seamless monolithic blocks, 5 levels of sterility, thanks to a sophisticated ventilation system.
Low invasiveness. Lack of significant postoperative scars and pain.
Fast recovery. The time spent in the hospital is no more than a day The recovery time is 2 times shorter compared to abdominal operations.
Only positive feedback from patients about laparoscopy. Patients who underwent laparoscopy in our hospital are satisfied with the result.
Good cosmetic result. After the laparoscopy procedure, no scars remain on the skin.

Cost of services

The price of laparoscopy in the Clinical Hospital on Yauza depends on the type and volume of the upcoming operation and is determined by the doctor after examining the patient and the necessary diagnostics.

Service prices You can look at or check by phone indicated on the site.