Laparoscopic operations during the oncology of the liver. Laparoscopy abdominal cavity

Conduct a visual examination of the internal organs and obtain accurate survey results using diagnostic laparoscopy. This is a minimally invasive surgical operation, often used in gynecology, when ultrasound and other research methods cannot give a complete picture for diagnosis.

What is the purpose of diagnostic laparoscopy

To date, this method is widely used in the sphere of gynecology and allows you to diagnose almost any disease. Laparoscopy also helps differentiate surgical and gynecological pathologies. The procedure allows you to obtain a much more accurate review of the organs compared to the usual cut of the abdominal wall due to a multiple increase in the image and the possibility of aiming to see the body of interest in the smallest details.

The reviews are subject to all the floors of the abdominal cavity and the retroperitoneal space. Therapeutic and diagnostic laparoscopy can also be carried out, during which the necessary manipulations simultaneously occurs.

Indications for diagnostic laparoscopy

The diagnosis of laparoscopic method can be carried out in some cases:

• In gynecological disorders, such as adnexitis, an ooforite.
• To identify the causes of infertility, with suspicion of the obstruction of the uterine pipes.
• Acute diseases organs with uncertain symptoms.
• For acute pancreatitis To determine the state of the pancreas and peritoneum.
• After spontaneous gnage management.
• For the differential diagnosis during jaundice, to track the outflow of the bile, the appearance of obturation.
• If there are neoplasms in the zone of small pelvis - the ovarian cysts, tumors.
• After the injuries of the abdomen organs, especially if there is no patient without consciousness and explicit symptoms.
• In the case of the wounds obtained, to determine the hemorrhages, inflammation.
• With postoperative peritonitis.
• If there is an ascite formed by an obscure reason.
• For the diagnosis of abdominal tumors.

Contraindications

Indications may be relative and absolute. The first often depend on the qualifications of the surgeon, the possibilities of the equipment, the state of the patient, diseases. That is, after eliminating the causes of restrictions, the operation can be carried out.

Relative contraindications include:

• Allergy.
• Peritonitis.
• Postoperative spikes.
• Pregnancy from four months.
• The estimated presence of tumors of appendages.
• The period after passing acute colds and infectious diseases.

Absolute contraindications:

• The state of hemorrhagic shock.
• Serious pathology of the cardiovascular system.
• Renal and liver failure.
• Not corrected coagulopathy.
• Malignant ovarian tumor, RMT (there is laparoscopic monitoring during radiation and chemotherapy).

Preparation for diagnostic laparoscopy

The preparatory stage includes a preliminary examination, as with any operational intervention. This is a collection of anamnesis, conducting research of blood, urine, taking smears, holding ECUC and ultrasound. The patient before the operation must be mainly observed a liquid diet, do not take food that causes excessive gas formation. The reception of special medicines may be needed depending on the nature of the disease, the presence of related pathologies. When preparing it is very important to comply with all prescriptions of the doctor so that the operation takes place as easily and gave accurate results.

How diagnostic laparoscopy

The procedure is carried out in several stages:

1. The introduction of anesthesia is a common or local, it is determined individually.
2. Purpose gas into the abdominal cavity using a special tool and a small hand (usually in the navel area). The gas is completely safe and serves to raise the abdominal wall, providing a volume for a good review.
3. Introduction of the tool and cameras through two other miniature holes.
4. After all necessary manipulations, the instrument and gas are removed, the seams and dressings are superimposed.
5. Most often, the patient can go home every day after the operation.

Results of diagnostic laparoscopy

In the course of the study, the doctor carefully passes all the necessary sites, paying attention to the presence of visible pathologies, adhesions, inflammatory processes, formations, cysts. The diagnostic seen in the diagnostic process is fixed, after which the patient is issued a conclusion.

Diagnosis of laparoscopy in gynecology

The approach is effective for most gynecological diseases. The main indications, emergency and planned, include:

• Ectopic pregnancy, twisting, cyst break.
• Apoplex ovarian.
• Endometriosis, ovarian tumors.
• Pain in the lower belly of unclear origin.
• Pathology of the development of genital organs.

Laparoscopic diagnosis for infertility

This method makes it possible to make a diagnosis when infertility, indicate the exact cause of violations. Among violations leading to infertility and diagnosed by laparoscopy:

• Inflammatory processes in the zone of small pelvis.
• Endometriosis, Mioma.
• Ovarian cysts, polycystic and sclerokystosis.
• Spikes, obstruction of uterine pipes.

During the study, dissection can be made and other actions.

Where to make diagnostic laparoscopy in Moscow

And to carry out laparoscopy in order to form a diagnosis or treatment, you can in the modern clinic of the Central Bank of the Russian Academy of Sciences. Equipped with the latest equipment, qualified doctors will study competently. Sign up for reception using the form feedback or another in a convenient way, ask questions about price, Rules for the preparation and conduct of the procedure.

Laparoscopy liver (peritoneoscopy) is a valuable and relatively new method in the diagnosis of diseases of the liver and biliary tract.

Modern laparoscopy is often not limited to the inspection of the abdominal organs. It is also necessary sight, color photography, and sometimes cholecystocholangiography.

Laparoscopy liver is performed using a special tool laparoscope. The main parts of it are a sleeve with a trocar, lighting tube, optical diagnostic and optical operating tubes and a flexible tool for biopsy. Optical tubes allow observation at an angle of 130 °.

Technique laparoscopy liver

Laparoscopy technique is easy. After the imposition of the pneumoperitoneum (most often in the abdominal cavity, fitted room air is introduced into the abdominal cavity, you can also use oxygen, carbon dioxide or nitrogen, or in their combination), an endoscope is introduced into the abdominal cavity. For the introduction of the tool, the point is selected on abdominal wall, poor vessels (3-4 cm below navel but midline or 3-4 cm left and up from the navel). At the place of administration of the endoscope make infiltrative anesthesia 0.25% novocaine solution. In the presence of hepatomegaly or tumor in the abdominal cavity, other points are usually chosen, so as not to injure the palpable in the abdominal cavity.

Indications

Laparoscopy should be applied according to strict indications: to establish the nature of the disease, for example, in determining the nature of the jaundice, when the needle biopsy is combined with hazards, especially when (caroli). Kalk recommends a diagnostic laparoscopy with all progressive jaundice, lasting than 4 weeks (in the first 2 weeks of the appearance of the liver and gallbladder, cannot be distinguished mechanical jaundice from liver cell).

Another main indication to the laparoscopy of the liver are the ascites of unclear origin, in which they are generally somewhat resorted to the puncture of the abdominal cavity, the variety of which is essentially laparoscopy. Endoscopic study often discovers not intended cirrhosis of the liver, and cancer on the background of cirrhosis, tuberculous peritonitis.

Hepatamegali of unclear origin is also an indication for laparoscopy. This group includes mainly tumor and cystic liver damage, as well as other rare diseases. Close to this group are cases of so-called unidentified tumors in the field of right hypochondrium, when laparoscopy decides whether palpable tumors with liver and bile paths are connected.

Laparoscopic examination can give valuable results and in suspected or pericholecystitis, especially in cases where the clinical picture is erased.

With the damage to the biliary tract with jaundice, laparoscopy is especially necessary when symptomatics is unclear, oral or intravenous cholecystography does not give sufficient information to establish a diagnosis and at the same time there are no urgent indications for surgical intervention. In these cases, with laparoscopy from the gallbladder, bile sucks, then introduced contrast substance And radiograms (laparoscopic cholecistangiography) are made. The puncture of the gallbladder is carried out under the control of vision or through the edge of the liver, or directly through the bottom and body of the bubble. Laparoscopic cholangiography is a complex study and admissible only under the condition if the patient in the case of complications (bile peritonitis) is provided with urgent surgical care.

Contraindications

A few contraindications to liver laparoscopy can be divided into common and local. The general includes cardiovascular and respiratory failure and hemorrhagic diathesis, to local - acute inflammation Abdominal organs and peritoneum, as well as a diaphragmal.

In an endoscopic study, it is usually possible to see the upper surface of the liver (almost 2/3 of it, ranging from the front edge to the diaphragm dome), and pathological conditionsaccompanied by a seal of hepatic tissue, you can see the lower surface of the liver. During the inspection, the size of the liver, its color, surface nature, condition of the edge and consistency is determined. In the position of the patient on the back or on the left side, the gall bubble is inspecting, and on the right side - the spleen. Usually it is good to explore the bottom of the gallbladder and a significant part of the body. The neck of the gallbladder and extrahepatic bile ducts are not visible normal. It is visible only if it is enhanced. During the inspection, attention also draws attention to the state of the veins of the stomach, the gland, the diaphragms, ligaments. With portal hypertension, they are usually expanded.

Laparoscopy capabilities are limited by the following difficulties:

• difficulty in conducting a thorough examination of the abdominal cavity (insufficient pneumoperitoneum, the emphysema of the gland after the imposition of pneumoperitoneum, massive tumor education);
• difficulties in conducting differential diagnosis of diseases from one laparoscopic examination.

The latter circumstance makes it combine the endoscopic examination of the liver with other research methods.

Laparoscopic removal of liver cysts is organ-bearing surgical intervention used to treat single and multiple benign extensive formations in the liver. For the operation, access is carried out through small punctures in the anterior abdominal wall.

The first group is developing either as a result of imbinal development disorders, or due to damage leading to a local violation of the outflow of bile from rally. There are more often in women.

Samoa frequent causeleading to the emergence of a second type of cyst, is echinococcus. Such formations require a special approach, because the fluid contains the form of this helmint.

The only method of eliminating cysts while preserving the liver itself is its resection. Sparing accessby laparoscopy It becomes a gold standard for a resection of a cyst and is widely used in the Bilyak clinic, Uzhgorod in Transcarpathia.

Indications for the operation

If a person has formedcyst liver, operation prescribed when the diameter of the formation exceeds 7-10 cm. Small cysts usually do not have any manifestations. Large (and they are and up to 20 cm in diameter) can be manifest with liver symptoms:

• severity in the right hypochondrium;
• muscle pain in the right side;
• mechanical jaundice;
• general signs inflammatory disease With the suppuration of the cyst.

The removal is also subject to cysts of any size, localized in the gate of the liver and giving pronounced clinical picture. The operation is still prescribed if alternative treatment has been ineffective, or the complications of cysts developed.

Against the background of the lack of manifestations, the neoplasms are often detected when an abdominal cavity organs are ultrasound according to any third-party occasion. Due to the risk of complications (suppuration, breaking, hemorrhage into the wall, transmission of common bile duct), recommended for removal.

Today, about 90% of hepatic cyst is cleaned with laparoscopy. In this case, excision is carried out within healthy tissues, avoiding excessive resection of the sections of the organ. This allows you to fully preserve its functionality.

Preparation for the operation

Only the surgical removal of the liver cyst ensures a positive result. Methods - Three:

1. Cleaning the cysts with its capsule (used if the echinococcal liver cyst has been removed).
2. Resection of a liver parenchyma site with a pile.
3. Exhaust walls of the cyst itself.

The best result shows the laparoscopic resection of the affected area of \u200b\u200bthe liver. The key to success is a thorough examination of the patient before the operation. List of research includes:

• clinical and biochemical blood tests;
• clinical analysis of urine;
• Ultrasound liver;
• x-ray study, cT scan;
• blood test for the presence of echinococcal antigen.

For processing the data obtained, our clinic specialists are just one day. According to the results of the analysis of the information received, it is plannedmaloveraumatic Recuracy of liver cysts.

Anesthesia is general, therefore attention is paid to the patient's nutrition. 2-3 days before the intervention, rich in fiber and capable of causing reinforced gas formation products are excluded. On the eve of the operation - strict fasting from the evening.

Course of operation

Most often, pathology is localized in the left lobe of the liver. Polls for trocars with a minimally invasive resection of the cyst of the left lobe of the liver are arranged as follows.

During the operation, it is necessary to disseid the liver parenchyma, so hemostasis is paid special attention to the hemostasis. For this, the blood vessels that bring the blood flow, with the help of a stapler, brackets are superimposed. This allows the surgeons of the Bilyak clinic to carry out laparoscopic resection of liver cysts without blood loss.

A special ultrasonic scalpel with a hepatic resection nozzle instantly stops capillary bleeding from dissected fabric. It can be avoided characteristic of an excess coagulation of the edges of the cutting of the excess coagulation. So the healing passes at times faster.

When localizing cysts in right share, Her disposalaccording to the method of laparoscopy takes more time and requires a little different location of punctures. More attention is paid to vascular formations of the gate of the liver. But the principle of the operation is observed in general, the removal of the liver cyst is made by the bunch.

The resected preparation is placed in an endoscopic container, extracted from the abdominal cavity through the widest puncture.

Upon completion of the main process, a permanent hemostasis is superimposed on the edges of the levetered liver. Next, temporary ligatures are removed, after which the operating field is re-examined. Making advantage of the absence of blood leaks, trocars are extracted from the abdominal cavity, the punctures are closed or invented.

In general, the course of the operation largely depends on the location and size of education. For instance,removal of cyst liver 3 degrees It is more difficult than excision of the formations of the initial stages.

Benefits of the technique

In modern surgery,removal of liver cyst laparoscopic method It is even more common than a classic extension operation. This is explained by the fact that laparoscopy gives many benefits:

• no risk of error due to careful video surveillance using a special camera;
• the ability to preserve healthy body fabrics;
• minimal tissue injuries due to the abandonment of the traditional cut;
• the elimination of the possibility of infection, since the contact of the organs with gloves, dressing material and air is eliminated;
• minimizing pain syndrome after surgery;
• low probability of recurrences and complications;
• short period of rehabilitation;
• aesthetics due to the absence of gross scars.

During the operation, the body fabric is not damaged, thanks to the use of modern miniature instruments. With their help, surgeons are removed only by the cyst, so after intervention, the liver fully retains its functionality.

Recovery after surgery

Patient who didremoval of the cyst of the liver , on the same day it can get up, and the next one is to eat. Usually it is written out after 2-3 days of stay in the hospital. The recovery period lasts a month during which a person is recommended to avoid active exercise, especially related to lifting weights.

Also at the time of rehabilitation it is very important to revise the diet. Food should be light and diet, so you need to exclude fat and fried foods, sharp dishes, marinades, smoked, spices.

Features of treatment in the clinic

Laparoscopy of the cyst of the liver is an operation that requires non-lawyage training of a surgeon and a serious technical equipment. Not every healing institution can help in this case. But all this can be found in the Uzhgorod Bilyak clinic in Transcarpathia. Internships in leading clinics in Europe and the USA, their own outstanding experience of doctors, make it possible to get medical care In Ukraine, with compliance with world standards.

Each patient is allocated a separate chamber, an individual nursing post is provided. A qualified doctor follows the recovery process.

Food is organized with the observance of the individual characteristics of the body of each patient. In the menu - only environmentally friendly products.

Physiotherapy methods are not disregarded. One of the most progressive - ozone therapy.

The use of activated oxygen by proven schemes has a noticeable effect and significantly reduces the recovery period, which is reduced to three to four days.

Operation to remove the cyst of the liver cost: 19 800 UAH.The price includes the full support of the patient. Throughout the standard stay in the clinic, namely:

• drug and surgical support;
• round-the-clock observation of the doctor;
• individual nurse post;
• dressing and all nursing manipulations;
• stay in the clinic;
• food.

Note! In other clinics, the above is not included in the price of the operation, but is charged additionally, and therefore the cost of operational intervention increases significantly. In the surcharge, even dressings, injections, enema, etc. And in the clinic of the Bilyak, the price for the removal of the liver cyst does not change.

Honored Doctor of Ukraine, Candidate of Medical Sciences, doctor of the highest category.
Specialization: Surgery, Urology, Gynecology.
Archpriest UEs, prior of the temples of St. Archdaikon Stephen and Rev. Againappish Pechersk.

Laparoscopy liver today is used quite wide. It is used both when examining the internal state of the organ and treatment. Sometimes this surgical method It becomes decisive when setting an accurate diagnosis to the patient.

Laparoscopy liver is a complex endoscopic intervention, during which the doctor carries out the necessary medical manipulations on the patient's organs. The operation is carried out through a small incision in the abdominal cavity under general anesthesia.

Laparoscopy of the liver

As a diagnostic method while suspected malignant tumorSuch type surgical intervention It often becomes a decisive factor when choosing further patient treatment tactics.

The operation is often used to obtain biopsy materials and during certain medical actions. It is carried out by using multifunction endoscopic equipment.

When appointing laparoscopy of the liver, the doctor gets the opportunity to estimate:

The use of the method allows to identify very many diseases of the liver and biliary ducts, as well as assess the structure of neighboring organs and the abdominal cavity as a whole.

Essence and types of procedure

Typically, the operation is carried out in cases where other research methods left too much unresolved medical issues. Then it becomes a way to choose when assessing the patient's condition. In such a case, surgery provides a specialist exhaustive information.

In general, its main types are allocated:

• diagnostic;
• medical laparoscopy of the liver.

In the first case, it is used to establish the most accurate cause and degree of neglection of the disease. Very often this operation is carried out at differential diagnosis ectopic pregnancy, unclearly manifest abdominal injuries, suspicion of cancer or the development of severe liver failure. In such a situation, the surgeon has the possibility of a thorough inspection of the body, obtaining the necessary images, as well as the study of the state of hard-to-reach surfaces.

Very often at the same time, it applies such a research method as a laparoscopic liver biopsy for histological or cytological analysis.

Therapeutic version of the technique is carried out to restore the functionality of the organ, resection of its part, removing the oncological focus, eliminating the formation of scar tissue or adhesions, etc.

In some cases, both types of laparoscopy are used in parallel.

This surgical intervention is carried out in emergency or in planned mode.

Indications and contraindications

Most often liver laparoscopy is prescribed due to:

Contraindications for the implementation of the procedure most often become pronounced vascular lack of liver or neglected oncological process.

With a significant thrombocytopenia, it is also not conducted.

It should not be appointed due to excessive patient obesity, intestinal obstruction, suspected peritonitis, serious cardiopathology, etc.

Preparation for Laparoscopy Liver

According to the reviews of numerous patients who passed this operation, it is required to prepare most carefully.

In order for a specialist to be able to fully and efficiently carry out the laparoscopy of the liver, it is necessary to go through a number of major preliminary procedures.

To them, as a rule, belong:

• biochemical study of plasma;
• clinical study blood;
• general urine analysis;
• VSK and DC;
• vasserman reaction;
• exception of HIV and hepatitis;
• definition of the rhesus factor;
• fluorography;
• Ultrasound abdominal cavity;

Before carrying out laparoscopy of the liver must pass at least eight hours of full starvation.

It is necessary to free the intestine with the help of a cleansing enema, as well as accept Fortrans.. To suppress increased gas formation, it is recommended for several days to use Activated carbon.

If a patient has too strong nervous tension, the doctor discharges him sedatives and sleeping pills.

In general, it should be noted that the reception of most drugs should be temporarily suspended, except for those pharmacological agents that are categorically not subject to cancellation or fully approved by the attending specialist.

The reception to the surgeon is required to come, pre-released from any jewelry, dental or auditory prostheses and contact lenses.

Methodology

An hour before the operation, the patient is necessary to completely empty the bladder.

Laparoscopy liver is carried out under conditions of sterile operating room.

Rehabilitation period

Recovery after the laparoscopic operation passes quite easily and quickly. Negative consequences are observed very rarely and, as a rule, are connected with violation of the rules of restoration measures after surgery.

Three days after laparoscopy need to be fully held in the hospital under constant control medical personnel. The place of operation is disinfected and is sometimes strengthened by a bandage.

The use of the principles of therapeutic nutrition is also required. Fried dishes, fat, smoked meals fall under the ban. It is worth a preference to easily digestible products excluding increased gas formationwhich includes fermented milk products, low-fat fish, boiled lean meat, weak broths.

After a period of ten or fourteen days, it is allowed to remove the suture material. For several months it is necessary to apply a gentle mode that limits the increased physical exertion.

Useful video

What are the advantages of laparoscopic operations, a specialist voiced in this video.

The consequences of laparoscopy

As already mentioned, complications after this type of surgical intervention occur quite rarely.

Usually during the first day after it is observed:

Similar sensations do not need special treatment And when applying correctional therapy pass quite quickly.

In case of non-compliance with the rules of recovery after the operation, its severe consequences are infection, violation of the integrity of vessels or injury of internal organs.

The cost of diagnostic laparoscopy is near the mark in twelve thousand rubles. The level of payment of therapeutic depends on the activities carried out and the volume of executed medical services. For example, cholecystectomy will cost a patient about sixty-five thousand rubles, and the price of repeated reconstructive operations on the biliary ways can reach a hundred and fifty thousand.

It is necessary to conclude that the laparoscopy of the liver is an effective surgical intervention in difficulties with diagnosis or during the need for operational treatment organ It is performed by experienced doctors, does not cause a patient with severe influences and is not risking the development of complications.

Covarity malignant neoplasms It is that in the difficulties of the diagnosis of the primary focus of the tumor, it is possible to skip its ability to spread in the body - metastasis. Therefore, you need to know the symptoms of MTS liver damage.
Do not confuse primary liver cancer and metastase in it.

Metastases are cancer cells that through biological environment of the body (blood, lymph) fall into various organs and systems, forming a secondary focus of the development of the tumor.

What causes a metastatic lesion of the organ

The high probability of the development of metastatic liver damage is associated with its physiological and topographical features:

• intensive blood supply (admission to the liver of large blood volumes for cleaning);
• proximity to the abdominal bodies, when this organ becomes the first "target" on the path of distribution of metastases: high probability of the development of MTS process in the liver during primary stomach cancer, pancreas, esophagus.

The alertness should also cause skin neoplasms - Melanoma often gives metastases to the liver. And if you consider that the diagnosis of melanoma is made in many cases after removing the pigment spot, such precious time can be lost. Sometimes the complaints from the liver are the first stage in the search for the focus of metastasis.

What signs of MTS defeat

Symptoms of metastatic liver damage at the initial stages are similar to complaints with other, neonqualistic diseases:

• reducing body weight against the absence of appetite;
• total fatigue with constant weakness;
• dyspeptic phenomena: nausea with vomiting, meteorism, stool violation;
• subfebrile temperature, increased sweating, tachycardia;
• the change skin Pokrov: The skin acquires the earthly yellow color, itching the skin;
• the symptoms of ascites are noted, during palpation, the liver comes out from under the edge of the rebel arc, pain and feeling of "cutting" appear in the epigastrium and hypochondrium, especially characteristic of the breath, pronounced vascular pattern.

It is worth noting that the symptoms of metastases in the liver and the development of primary cancer are similar.

What if such complaints appeared

When there is a primary malignant focus, oncologists are mandatory performed a special examination for metastases. However, not always metastases in the time interval appear after diagnosing the tumor. Often, the primary tumor can be asymptomatic if there are metastatic lesions of other organs or systems.
If symptoms of liver damage appeared, it is necessary to identify the reason for complaints and complete the full diagnosis.

What methods of diagnostics will be applied in suspected malignant process

Laboratory research. Due to the compensatory liver mechanisms, such research is low-informative. If there are deviations from the norm in biochemical analyzes blood, they can be characteristic of many diseases of this organ. The exception is the analysis of oncomarcresses (alpha-fetoprotein), which allows you to judge the presence of an oncological process.
Radiological, radioisotope studies. Laparoscopy. The main method is a computed tomography. With CT, you can estimate the size of the liver, the structure of the parenchyma, the presence or absence of nodes that can be metastases. Also applies radionuclide scanning, RDP radoscopy. Good diagnostic results give laparoscopy with which, in addition to visualization, it is possible to obtain a puncture biopsy.

How to treat

Metastases in the liver are poorly treatable. The main method of treatment is surgical. Resection or organ, or its segment, where metastasis is located. In special cases, liver transplantation is shown.
Chemotherapy for metastases in the liver is used as a method that gives temporary results, facilitating the general condition.
Radiation therapy with similar metastases is practically not used.

Gallbladder Removal: Laparoscopy Operations

According to statistics, in our country, about 15% of the population suffers from a tyranny disease in our country and over time, there is only a tendency towards increasing the incidence. Most effective method The treatment of the gallbladder disease is a surgical operation, namely laparoscopic cholecystectomy, which, with the development of complications, is vital.

• Causes for laparoscopy
• Testimony
• Gallbladder Removal Operation: Quick description
• First time after cholecystectomy
• Nutrition Patient first week after surgery
• • Damage or injury in the field of general gallway
  • Injured large vessels
  • Wound infection
  • Violation of the internal organs
• Life after surgery
  • Diet
  • Sport classes
• Further control by the doctor after removing the gallbladder

Causes for laparoscopy

Causes of stones:

Testimony

Align the absolute and relative diagnosis of the operation to remove the gallbladder:

Absolute diagnosis:

• gangrene gallbladder;
• stones in the area of \u200b\u200bthe gallway (general);
• intestinal obstruction;
• non-working gallbladder in history (based on cholecistography and data ultrasound) and recurrent colic in the gallbladder area;
• diagnosis "Chronic cholecystitis".

Relative diagnosis:

• chronic calculous cholecystitis, when the disease is manifested by the presence in the bustling bubble at least several stones.

Gallbladder Removal Operation: Quick description

Most often laparoscopy occurs in hospitals - hospitals, clinics, hospitals. Some medical institutions It is proposed to make an outpatient operation, but in this case you need to have a well-defined monitoring service for the patient at home. The patient should not have concomitant chronic diseases, which is usually simply impossible.

Anesthesia is the main question that concerns many patients. This type of operation occurs under general anesthesia. During the anesthesia, an indispensable condition is forced lung ventilation.

With laparoscopy operation, the patient's position on the operating table is also important. Before the start of the operation, when carbon dioxide is raised into the abdominal cavity, the patient lies on the back with the front end of the table at an angle of 10 degrees. Thus, the movement of the internal organs to the diaphragm is made, which allows you to safely start the needle, through which carbon dioxide is carried out into the pelvic cavity. After that, the position of the patient on the surgical table changes. The patient lies on the table, unfolding a bit left, with a 10-degree bias from the foot end of the table.

Pneumoperitoneum - This process is called the introduction of gas into the abdominal cavity of the person.

The needle with carbon dioxide passes through the navel, as the only subtle place of the abdominal cavity from the front. The bump cavity is filled with gas before the formation of pressure from 11-16 millimeters of a mercury pillar and is supported throughout the operation.

Further stage of operation - Troacarov input. Troacaras are plastic and metal tubes, the main task of which is the detention of carbon dioxide in the bug cavity. To perform laparoscopy operation, 3-4 trocar are installed, through which the tools and laparoscope are breeding into the abdominal cavity.

After the introduction of tools, the main stage of the operation occurs - cutting the body of the gallbladder. This is done with hooks, clamps, scissors and clips imposition devices that clamp the artery and bubble duct.

The surgeon displays a gallbladder for the bottom. So he has the opportunity to divide the peritoneum in the area of \u200b\u200bthe cervix, to highlight the artery and duct, where the clips are superimposed.

After that, the surgeon removes the body of the bubble from the liver using an electrosurgical hook. After cutting out the organ, the abdominal cavity is purified by water, dried with electric suction and drainage (small tube) is put on the location of the bubble. This is necessary to prevent the formation of infection in the cavity of the belly.

The optimal option is considered to remove the bubble through the navel, as muscles are notterable in this promote. The bubble is removed to the puncture in the navel area and is removed simultaneously with the Troacar installed here. The incision of the navel is sewn only with the help of one seam. After that, the laparoscopy operation is considered completed.

First time after cholecystectomy

The main advantage of the removal of laparoscopic cholecystectomy is considered to be a relatively easy course of rehabilitation. The patient is observed small pain In the area of \u200b\u200bthe introduction of Troacarov, as well as in the area of \u200b\u200bthe shoulder belt due to the introduction in the process of carbon dioxide operation.

In the postoperative time, the patient spends several hours in the separation of intensively therapy, and then it is transferred to the usual chamber. During the first 5-7 hours, the patient cannot be drunk, and it is also forbidden to get out of bed. After allowing to drink simple water without gas with small portions over a pair of sips, the total volume of fluid is not more than 0.5 liters. The patient can gently rise from bed, for the first time under the supervision of the nurse.

On the second day, after removal, the patient produces drainage from the abdominal cavity. This is a painless process that is done during a daily dressing.

Nutrition Patient first week after surgery

The patient's diet after removing cholecystectomy includes:

• vegetable soups;
• chicken breast and low-fat beef in boiled form;
• efficiency products: low-fat cottage cheese, yogurt, low-fat kefir;
• oatmeal and buckwheat porridge on water;
• bananas or baked apples.

In the diet are prohibited such types of products:

• drinks with sugar;
• salt and sharp products;
• fat and fried food;
• sweets, especially chocolate;
• boiled fish;
• alcohol;
• strong coffee or tea.

After the operation, laparoscopy must be monitored in the frequency of intestinal emptying. If problems appear with this, then you need to put a cleansing enema or drinking laxative natural origin (dishonal of Kushina, Seine List).

During the course of the rehabilitation period, complications should not appear. The physical activity is limited due to probable pain in the abdominal cavity, which end on the second day after the operation.

The patient's extract occurs on the third day if the rehabilitation period occurs without complications. During an extract, the patient gives a hospital sheet (if there is this need), as well as a card extract, in which the diagnosis will be given in detail and recommendations on further drug treatment, exercise and nutrition. Sick leave It is given at the time of staying in the hospital for three days after discharge, after it must be renewed from the surgeon in the municipal hospital.

Complications after cholecystectomy operation

As in any operation, complications may occur after cutting off the bubble. Their number is usually no more than 3-5% of the number of operations. The main complications are.

Damage or injury in the field of general gallway

This happens as a result of several reasons. Among which it is necessary to note the changes in the relationship between the bodies during the spike in the cavity of the belly, inflammatory changes in chronic cholecystitis and the anomalies of bile duct organs. It also occurs due to non-accurant manipulations by instruments in the gallway area.

If the cholecystectomy occurs damage to the bile pass, then, as a rule, they are transferred to the open operation and make the restoration of passability and integrity of the duct. There are cases when during the operation damage to the gallway remains unnoticed. In this case, the patient appears borpuspania to the cavity of the bug or jaundice and the patient is required to conduct a re-operation urgently. The percentage of this type of damage is no more than one.

Injured large vessels

The result of careless and improper administration of trocars in the bump cavity is the injury of large vessels, which is fraught with the appearance of abundant bleeding. The injury can be subjected to vessels both in the wall of the abdomen and in the abdominal cavity. But this complication is found in the process of laparoscopic cholecystectomy much less often, in contrast to open operations.

Wound infection

Entry and infection of the wound - Beach after surgical operation. Neither antiseptics nor antibiotics give the absolute warranty of avoiding this complication. Laparoscopic cholecystectomy has several advantages, unlike open operationIf infection and happens, it passes much easier and with small complications.

Violation of the internal organs

The usual series of complications after laparoscopic operations. But he meets very rarely. In the process of operation, you can damage the intestinal cavity, stomach, bladder, liver. Different damage to the internal organs are the result of several reasons, one of them is non-accurant manipulation with tools. But experienced doctors have a number of techniques and means to minimize the risk of these damage.

If after all the injury organ occurred, the main thing is to diagnose it in time, which will give an opportunity to remove complications without much effort.

During laparoscopic cholecystectomy, you will never receive such complications as the formation of keloid scars, the inconsistency of the seams, which are characteristic of open operations.

Life after surgery

The most important thing you must remember the operation is that after surgery you should feel happy and healthy person. For this you need to follow several recommendations regarding physical activity and power mode.

Diet

Over the past three months of the postoperative mode, the patient needs to be observed the rigid diet described above. Then your diet can be slowly expanded. But you need to not forget that after removing the bubble, the diet is your constituent life of the rest. You will be able to pamper something tasty, but you do not need to abuse these products. The main rule that must be observed is fractional food Small portions. List of products that can be used:

• dairy soups, cereal;
• efficiency products: kefir with befidoddadds, low-fat cottage cheese;
• meat of non-fat varieties (chicken, beef, turkey, rabbit);
• weak broths (meat and fish);
• vegetable oil (no more than 35 grams per day);
• eggs in the form of omelets;
• porridge;
• butter;
• fish is low-fat (in a vapor, boiled, stew);
• pasta;
• marshmallows, honey, dry cookies, marmalade;
• vegetables in boiled, chimney, raw form;
• sweet tea;
• compote.

List of prohibited products:

• fried fish;
• fatty meat;
• strong coffee;
• mushrooms;
• acidic fruits and berries;
• onions, spinach, garlic, radishes;
• carbonated drinks;
• ice cream, cakes;
• sharp snacks;
• pies, Chebureks, dough.

After the operation, the use of alcohol and smoking is contraindicated.

Sport classes

Physical activity is a guarantee of avoiding stagnation of bile, as well as a deposit of excellent well-being. After a few months, you need to introduce a weekly visit to the pool. Permanent hiking about an hour contribute to the comfort of bile, as well as the saturation of the organism oxygen.

A couple of days after walks, you can begin the morning gymnastics. Over the next 7-14 months, heavy loads are completely contraindicated with patients, as it can create the appearance of postoperative hernia.

Further control by the doctor after removing the gallbladder

After leaving the hospital, do not neglect the visits to the doctor for preventive Mer. It is advisable to attend the Doctors at least once every six months in the first year after removing the bubble, and once a year after that.

If after the operation of laparoscopic cholecystectomy you will be disturbed by unpleasant sensations or pain, immediately consult a doctor.

Laparoscopy, that is, the removal of the gallbladder is a modern operation, where the likelihood of complications after it is about 4%. After performing the operation, the patient must be observed a diet, as well as make a complex of gentle gymnastics required for the permanent outflow of bile. Very important to visit the pool and regular walks in the fresh air.

What is the laparoscopy of the gallbladder?

Under the concept of laparoscopy, an endoscopic operation is understood by the miniature tools through cuts up to 20 mm long. Now this is the most popular type of surgical intervention due to low invasiveness and minimizing postoperative complications. Unlike extensive methods of surgery, which are practiced by doctors more than a century, laparoscopy was first conducted by the French surgeon in 1987.

Laparoscopy and laparotomy

Laparotomy is an extension operation at which abdominal cutting and the removal of the gallbladder (LP) is carried out. Laparoscopy implies resection of the LSM through small cuts using several tools:

1. laparoscope is an optical thin tube with a miniature video camera, synchronized with a computer. The operation begins precisely with the introduction of this device into the abdominal cavity;
2. inseaffulatory is an instrument for supplying carbon dioxide, "spreading" internal organs and improving overview;
3. trocar - a hollow tube with sharp stilettos, with the help of which punctures are made on the abdominal wall;
4. aspirator is a device for removing unnecessary liquids from the abdominal cavity and its washing;
5. endoscopic tools are various scissors, clamps, nippers and other devices necessary to carry out a specific type of laparoscopy.

Before the laparoscopy of the gallbladder, the patient is given intravenous or endotracheal anesthesia with mandatory artificial ventilation of the lungs.

To the first "micro-opections", surgeons were very skeptical, but soon in practice it was shown that laparoscopy is more preferable for the patient due to the minimum number of postoperative complications. However, it is more difficult to spend such an operation, so it has its advantages and cons regarding laparotomy.

The number of advantages in the table determines the degree of manifestation of a specific parameter, for example, the severity pain sensations after operation.

The patient carries the Laparoscopy of the LPH much easier than extensive operation. It is experiencing less pain, does not need drugs and is restored faster. However, not every surgeon is able to spend it, and not all hospitals have the necessary equipment. Therefore, the main disadvantage remains the high cost of laparoscopy. In addition, through small cuts, it is impossible to remove large polyps and tumors that can be formed in the LDP, which explains the smaller list of indications compared to laparotomy.

Types of laparoscopy hp

Laparoscopy on the bustling bubble can be carried out with several goals. Small invasiveness of the operation allows it to be used as a diagnostic tool when dubious moments remained after a general examination. In some cases, during the diagnostic laparoscopy, the surgeon makes a decision immediately carry out a therapeutic operation, for example, resection of the LDP.

In fact, these operations differ little, therefore the list of contraindications to their conduct of the same. The absolute treats such diseases as a heart attack, stroke, violation of the coagulation factor, the obesity of the third and fourth degree, Cancer LP. In the latter case, you can conduct diagnostic laparoscopy, but it will not be possible to remove the organ. Sometimes it is more expedient to carry out laparotomy and safer, for example, when peritonitis, when inflammation covers a large amount of abdominal cavity.

Relative contraindications include sharp inflammatory processes (cholecystitis, ulcer, gastritis, pancreatitis, etc.). When yellow, the operation can also be carried out because it is a sign of the acute phase of hepatic pathology. The decision on the need for the operation is made on the basis of the individual characteristics of the history of a particular patient.

Preparation for the operation

In 90% of cases, resection is carried out in a planned manner. Therefore, it is possible to carry out such preparations for the laparoscopy of the gallbladder:

• surrender analyzes for general and biochemical studies, as well as cardiograms and coagulograms - 2 weeks before the operation;
• cancellation of drugs that reduce blood coagulation (aspirin, paracetamol, diclofenac, etc.) - in 7 days;
• refusal of alcohol, oily and heavy food - for 3 days;
• dry starvation (even water is prohibited) - in 12 hours;
• cleaning enema - for 12 hours.

Laparoscopic resection of the LADS

Each surgeon itself chooses how it is more convenient for it to work with the patient during laparoscopic resection of the LDP. In France, the surgeons put the patient on the table so that the doctor could stand between his legs (French method). American doctors prefer to be left From the patient (American method). In any case, it is necessary to make 3-5 punctures to remove the LDP:

1. in the aircraft region - a laparoscope and an inscription is injected through this incision;
2. under the sternum in the middle;
3. 4-5 cm below the extreme right rib - the puncture is made on a mental intersection with a vertical passing in the middle of the right clavicle;
4. at the intersection of the vertical, going to the edge of the right armpit, and horizontally at the navel level;
5. the fifth incision is made only if the patient has enhanced the liver and it is difficult to view the LDP with the help of the camera.

Methods for carrying out such an operation are constantly being improved. Already, some surgeons perform resection of the SBP with the help of three miniature cuts. As a result, tiny scars that can be seen only through the magnifying glass remain on the patient's body.

The cost of laparoscopic resection LPP varies from $ 300 to $ 2,000, depending on the clinic and skills of the surgeon.

When is laparoscopy goes into laparotomy?

Removing the LPG through small cuts usually takes about 30 minutes, but in some cases the surgeon decides to stop the laparoscopy and conduct an open extended operation. The grounds for this can be:

• damage to internal organs or vessels with concomitant bleeding;
• heavy inflammation and swelling of internal organs, preventing visualizing the "workspace" of the surgeon;
• high risk of peritonitis;
• purulent destruction of the wall of the SBP;
• swiss and multiple spikes in the biliary system.

Perforation of the gastrointestinal bodies (stomach, duodenal gut, Tolstoy intestine), as well as any internal damage accompanied by bleeding, is an indication for urgent laparotomy due to the risk of large blood loss. This is necessary to prevent breeching into the abdominal cavity and the prevention of peritonitis.

Possible complications

After laparoscopic resection, most patients feel weak moderate pain in the field of punctures, which are bought by analgesics. A week later, any discomfort will disappear and the recovery period will begin, although with physical activity, it is still necessary to postpone. People who suffer from constipation are recommended to use the laxative so as not to strain the muscles during defecation and not damage the inner seams.

It is officially believed that the probability of postoperative complications after laparoscopic cholecystectomy is the same as when conducting a bandwidth resection is 1-5%. However, only 1 of 5,000 patients develop such complications:

• internal bleeding as a result of damage to vessels;
• "Feeding" bile in the liver and abdominal cavity;
• the suppuration of the internal wounds and, as a result, the formation of subcutaneous ulices;
• the accumulation of gas under the skin due to the wrong puncture - this complication is more often observed in obese people, and it is not dangerous, since the "gas tubercle" is soon absorbed;
• the spread of oncological cells in the abdominal cavity, if any in the biliary system.

In 0.5-0.7% of patients after laparoscopy of the gallbladder, a bubble hernia is developing. The risk of the appearance of this complication is most susceptible to obese people and those that the operation was carried out urgently.

Meanwhile, 5-30% of people who have undergone resection develops the so-called postcholectomic syndrome, and regardless of the type of surgical intervention - laparoscopic or open. Under this syndrome it is understood as a state when, after resection, the patient does not feel changes or feels worse.

Only 10% of such people are diagnosed by a psychological problem due to personal fear before any surgery. In 20%, the deterioration of the state is associated with the accuracy of the surgeon. For example, a piece of gallbladder fabric remained in the human body, which is an excellent focus for secondary inflammation. Either the biliary duct was damaged as a result of the troller, which later began to narrow. In the remaining 70% of people postcholectectomic syndrome due to the activation of a previously non-diagnosed disease digestive system: pancreatitis, cholangitis, tumors, etc.

Removal of stones with the preservation of the LP

The removal of the gallbladder stones with the preservation of the organ is called cholecystolitomy. This operation cannot be called very specific, but it has its own nuances and is carried out in accordance with the stages:

1. the first incision is made, the laparoscope is introduced and an overview of the state of the gallbladder surrounding its tissues and organs is carried out;
2. the next incision is done for laparotomic access, most often transrectal;
3. the puncture of the abdominal cavity is done with the prevention of gaze;
4. by the control of the laparoscope, the peritoneum dishes, and the bottom of the gallbladder pulls up to the wound;
5. The LDP is laid with two threads to the wound and open;
6. by tamping, bleeding stop, and the aspirator is removed from the Bile LP;
7. through the clamp and special forceps, the surgeon captures one stone and derives it from the gallbladder; The procedure is repeated until all the accretions are removed;
8. cholecystocholangiography is performed for examination of the biliary tract for damage;
9. pneumocholecystoscopy is performed for inspecting the cavity of the LP and confirmation of the absence of concrections;
10. a sewing wounds of the RAS and the abdominal wall are carried out.

This type of operation has been used for a long time for the treatment of grooming disease, however, studies have shown that it is ineffective. First, the operation is harder, and secondly, 2 out of 3 people who have overlooking it occurs re-formation of the accretions in the LDP. Therefore, most surgeons hold the opinion that the reaction of the body is more effective tool in the treatment of boards.

The high risk of recurrence of the HCB and the development of postoperative peritonitis is the main reasons why the cholecystolitomy is now rarely carried out.

Nevertheless, some surgeons are still taken for such work, in particular, this type of operation is still practiced in Ukraine. But the "second breath" of cholecystolitomy opened the Chinese Physician Chao, having a huge number of regalia in the field of health in the PRC. Now he works in the clinic and research center in Guangzhou, as well as the founder of the brand of the Endoscopes "Chiao".

It should be noted that many intermediary firms are currently actively using the name of Chao those for the sale of "medical tours". In particular, a package is offered, including a patient's meeting at the airport, conducting all preliminary diagnostic surveys and the operation itself personally by Dr. Chao. All this will cost 36,000 yuan, which is approximately $ 5,000, plus flights in both directions.

Given that most European surgeons have long refused to perform cholecystolitomy, clinically proven its inefficiency, it is impractical to pay such huge money. Although each patient himself chooses that it is better for him - to remove the gallbladder or clean it with a high risk of recurrence of the HCR.