Removal of gallstones, removal of stones from the gallbladder - laparoscopy. It includes several stages. How is surgery carried out

Removal of stones from the gallbladder is carried out if indicated. The method is chosen depending on various aspects, including the size of the stones. Drug dissolution is of limited use: it is effective only for certain types and small stones. Surgical treatment is more effective, while there are various methods. Following the removal of stones remains important diet.

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Indications for stone removal

Surgical removal of stones is usually performed in cases that are accompanied by the following symptoms:

unbearable pain, localized on the right in the abdomen, which does not allow living with stones;
increase in body temperature;
constant feeling of nausea and bloating.

When these symptoms occur, you should not hesitate. They usually indicate blockage of the bile ducts by stones.

Ways

The scheme and method of stone removal is determined by the attending physician based on the severity of gallstone disease and the results of the diagnosis. The size of the stones can also affect the choice.

With small dimensions of the formations, special medications can be used that contribute to their dissolution and removal. naturally. Also allocate operational methods treatment, including without removal of the gallbladder.

Medicines

Treatment with medications is called a chemical method of removing stones. It is effective for cholesterol formations, but cannot help in the presence of calcareous and bilirubin calculi.

Treatment with drugs has its advantages and disadvantages. The first can be attributed full preservation organ and no need for surgical intervention. However, this method requires significant financial costs, since the dissolution of stones in this way takes a long time, sometimes several years. Also any drug therapy can provoke an exacerbation of chronic diseases as a side effect.

Allocate drugs based on ursodeoxycholic and chendosexycholic acids. The first group includes Ursohol, Ursosan, Ursofalk, and the second - Henohol, Henofalk, Henosan. Medicines for splitting stones, it is more effective to use after physiotherapy procedures.

Operation

There are several options for surgical treatment of gallstone disease:

cholecystectomy - removal of the gallbladder;
cholecystolithotomy - a minimally invasive intervention with the preservation of the organ and the elimination of only deposits;
lithotripsy - crushing stones with ultrasound or laser and removing crushed particles;
contact litholysis - dissolution of stones with acid in the cavity of the gallbladder.

Usually they resort to the removal of the organ. For cholecystectomy, it is sufficient to detect stones in the gallbladder and the presence of such characteristic symptoms, How strong pain and disruptions at work gastrointestinal tract. This type of operation is used in without fail with acute cholecystitis (purulent inflammation) or choledocholithiasis (formation of stones in the bile ducts).

Intervention can be carried out even if symptoms do not occur, however:

found polyps in the gallbladder;
there are deposits of calcium salts on the walls of the organ - calcification;
stones larger than 3 cm.

Between cholecystectomy and cholecystolithotomy, specialists choose the first option, since if the organ is preserved, new stones are formed with a 50% probability. Therefore, the second type of operation is resorted to only if the removal of the gallbladder is associated with a risk to the patient's life.

Both of these methods of surgical intervention can be carried out in two ways: by abdominal (open) access or laparoscopically. The second allows you to keep the body cavity intact, while all manipulations are carried out through small punctures. It is used more often than open surgery.

Cholecystectomy

In the open form of the operation, an incision is made in the area under the ribs or along the midline in the navel. The surgeon, using metal clips, clamps or sews up the ducts and vessels associated with the gallbladder with self-dissolving threads.

The organ is separated in a blunt way from the liver, connective and adipose tissue. This is necessary to avoid cuts. The ligated ducts and vessels are excised, the gallbladder is removed from the body. Then a drain is installed in the wound, through which blood and other fluids flow. It is necessary to prevent the development of a purulent process in the body cavity. If the postoperative period is favorable, then it is removed every other day.

After that, all tissues are tightly sutured, and the patient is transferred to the intensive care unit. The pulse and pressure of the operated patient are monitored until the effect of anesthesia ends. For the first time after regaining consciousness, the patient is forbidden to try to move and get up.

Laparoscopic access is performed under general anesthesia. But with it, the procedure takes less time. In comparison, open cholecystectomy requires 30 to 90 minutes. With the laparoscopic method, several punctures are performed in the wall to cut off and extract the gallbladder abdominal cavity and enter special tools, one of which is a camera. It is necessary to visualize the clipping process.

For a successful operation, carbon dioxide is injected into the abdominal cavity, which creates pressure and allows you to increase the space for surgical manipulations. During the operation, the doctor tilts the table with the patient at least 2 times. First, he does this to move the organs to reduce the risk of damage, and then to move down the intestines.

The bubble is isolated with a special automatic clamp and the duct and organ are separated. A catheter is inserted into the duct, which is necessary to prevent its compression or ejection of its contents into the abdominal cavity.

Then the surgeon examines the function of the sphincter, checks the area of operation for the absence of stones. After that, an incision is made in the duct with microscissors, the same is done with blood vessels. The bubble is carefully separated from its place, and the damaged areas of the vessels are coagulated. After complete removal of the organ, aspiration is performed. The abdominal cavity is cleared of accumulated fluid - blood and secretion from the glands.

With cholecystolithotomy, the actions are almost identical, except that the organ is preserved. Therefore, the gallbladder is opened and all stones are removed, after which the walls are sewn up, and the damaged vessels are coagulated. The ducts are not cut.

Lithotripsy

Lithotripsy as a method of removing stones from the gallbladder is used for single small stones (up to 2 cm), the patient's stable health and no history of complications. The full name of the procedure is extracorporeal shock wave lithotripsy (ESWL). Its essence lies in the impact on the stone by a certain wave, emanating externally, outside the body, and allowing it to be destroyed. This is possible due to the fact that ultrasound travels in different media at different speeds: soft tissues it spreads rapidly without causing damage, and in solid structures causes vibrational stresses that contribute to the formation of cracks and the destruction of the calculus.

Lithotripsy is used in approximately 20% of cases. It is contraindicated if there are any solid formations along the path of the ultrasonic wave or the patient needs to constantly use anticoagulants.

For the operation, epidural anesthesia is used, that is, an anesthetic is injected directly into the spine, or intravenously. Before the procedure, the doctor during the endoscopic ultrasound determines the optimal position of the patient and brings to the selected area an apparatus that emits a shock-sound wave. During lithotripsy, a person may feel slight jolts or soreness. It is important that the person being operated on is motionless at this time. Crushed stones in the form of sand come out naturally.

Often to get effective result it is necessary to conduct several sessions of lithotripsy. The procedure is considered successful if there are no calculi and their parts larger than 0.5 cm. After lithotripsy, the patient is prescribed bile acids that help dissolve the remaining fragments. Oral litholysis can last up to 12-18 months.

One of the options for lithotripsy is the dissolution of stones with a laser. This technique differs in that in order to focus the beam, it is necessary to perform a puncture in the gallbladder area. Removal of crushed stones occurs naturally.

Contact litholysis

Contact litholysis is an alternative method of removing gallstones when other methods are ineffective or cannot be applied. It is used to dissolve only cholesterol formations, but the big plus is that it is applicable for any location, number and size of calculi.

It is carried out in several stages:

1. A microcholecystotomy is applied - a drainage tube to remove the contents of the gallbladder.
2. An assessment of the size and number of stones is carried out by introducing a contrast agent. This allows you to calculate the exact volume of the solvent and avoid it getting into the intestines.
3. Methyl tert-butyl ether is introduced into the cavity of the gallbladder. It dissolves deposits, but is dangerous for the mucous membranes of neighboring organs.
4. Bile is excreted from the gallbladder along with litholytic.
5. An anti-inflammatory drug is poured into the organ cavity to restore the mucous membrane of the walls.

Diet

After surgery or medical removal stones in cholelithiasis, a diet is necessary to achieve 2 main goals:

minimization of the process of re-formation of calculi in bile;
adaptation digestive tract to the absence of the gallbladder.

When the organ is removed, diarrhea often occurs. It is the result of a constant flow into the intestines of bile, previously ejected by periodic contractions of the gallbladder. For elimination similar consequences adjust the mode and quality of nutrition.

The diet should be observed for the first six months after surgery, then it is necessary to prevent the recurrence of the disease. Postoperative nutrition should not be ignored, as this can reverse the outcome of the treatment. With re-formation, the stones will be located already in the liver.

Food should be taken at least 5-6 times a day, and portions should be made small. The amount of liquid consumed during the day should be at least 1.5-2 liters, and it is desirable to give preference to low-mineralized water, decoctions of chamomile, rose hips, lemon balm, mint and linden. Allowed and prohibited foods when removing the gallbladder:

Recommended	Forbidden
Boiled food, steamed food	Smoked, fried, baked
Dishes without seasonings and salt	Pickled, salted, spicy seasonings and spices
Lean meats (beef, rabbit, veal) and poultry (turkey and chicken)	Fatty meats (lamb, pork), poultry (duck), sausages, bacon and ham
Sea and river fish, boiled or steamed	Smoked, fried and salted fish
Dairy products, unsweetened yogurts and low-fat cheeses	Sour cream, whole milk, full fat cheeses and cream
Vegetable unrefined oils (linseed, olive, sunflower, pumpkin, etc.)	Butter
Stale wholemeal bread, croutons and toast	Fresh and white bread, cakes, rolls, cakes and other rich products
Oatmeal, barley, buckwheat and lentil porridge	Puree, pasta
Fresh vegetables and fruits, herbs, dried fruits	Marinades and canned vegetables, horseradish, adjika, tomato ketchup
Green and herbal tea, mineral water, natural juices	Coffee and black tea, alcohol and carbonated drinks

Gallstone disease is a fairly common pathology that affects about 10% of the adult population in Russia, Western Europe and the United States, and in age group older than 70 years, this figure reaches 30%. It occurs mainly in industrialized countries, where people in in large numbers eat food rich in animal proteins and fats. According to statistics, cholelithiasis is diagnosed in women 3-8 times more often than in men. The gallbladder is an organ adjacent to the liver and acts as a reservoir for storing bile, which is produced by the liver. Bile is necessary for the proper digestion of food and has a complex composition. Its main components are cholesterol and bilirubin (a pigment produced by the liver). The main causes of cholelithiasis include an increased content of cholesterol in the composition of bile, violations of its outflow and stagnation, as well as infection of the gallbladder.

With prolonged stagnation of bile, cholesterol precipitates, which gradually leads to the formation of microscopic elements ("sand"), which eventually increase in size and combine into larger formations (calculi). The size of gallstones varies over a very wide range, from a few millimeters to several centimeters. In some cases, one stone can occupy the entire cavity of the distended gallbladder. Stones with a diameter of 1-2 mm can pass through the bile ducts, the presence of larger stones leads to the appearance clinical signs ZhKB.

In most cases, the disease is asymptomatic, but if there are pronounced clinical manifestations often have to resort to emergency measures. Typical symptoms of cholelithiasis include sudden attacks of biliary (hepatic) colic, which are accompanied by pain in the right hypochondrium, nausea, heartburn, vomiting, bloating, fever, signs of jaundice. Prolonged course of the disease leads to narrowing of the bile ducts, infection of the gallbladder and the development of chronic inflammatory processes (cholecystitis, hepatitis, pancreatitis, duodenitis). To date, there are the following methods of treatment of GSD:

Non-surgical stone removal:

Dissolution of drugs;
Remote ultrasonic lithotripsy;
Removal with minimal invasiveness:
Crushing stones with a laser;
Contact chemical litholysis;

Surgical intervention:

Laparoscopic removal of stones from the gallbladder;
Endoscopic cholecystectomy;
Open cavity operation.

The current standard of care for patients with gallstone disease is as follows: When stones are found, their composition is analyzed. According to the chemical composition, cholesterol, lime, pigment and mixed stones are distinguished. They try to dissolve cholesterol stones with the help of bile acid preparations (ursodeoxycholic and chenodeoxycholic). A more radical method is the crushing of stones using ultrasound or a laser and the subsequent dissolution of their small particles and "sand" with acids. However, the main treatment for gallstone disease is still cholecystectomy (removal of the gallbladder along with stones). At the same time, abdominal operations are gradually giving way to endoscopic removal.

Medical dissolution of stones. Only cholesterol stones with a diameter of up to 2 cm can be dissolved (this method does not work on calcareous and pigment stones). For this purpose, analogs of bile acids Ursosan, Henofalk, Urofalk, Henohol, etc. are used. In parallel, the contractile function of the gallbladder and bile production can be stimulated with the help of Allochol, Holosas, Zixorin, Lyobil.

Contraindications:

Various accompanying illnesses Gastrointestinal tract (ulcer, gastritis) and kidneys;
Reception oral contraceptives containing estrogens;
Pregnancy.

Flaws:

High recurrence rate (10-70%), since after stopping the drugs, the level of cholesterol in the bile rises again;
Long duration of treatment (from 6 months to 3 years);
Such side effects like diarrhea (10% of cases), changes in liver function tests (ALT and AST);
The high cost of drugs.

Crushing stones with ultrasound. This method is based on the grinding of stones under the influence of high pressure and vibration of the regenerated shock wave. Ultrasound destroys stones and crushes them into smaller particles with sizes not exceeding 3 mm, which are subsequently excreted through the bile ducts into the duodenum. Ultrasonic lithotripsy is suitable for patients who have a small amount (up to 4 pieces) of rather large cholesterol stones (up to 3 cm in diameter), without lime impurities in their composition.

Contraindications:

Blood clotting disorders;
Chronic inflammatory diseases of the gastrointestinal tract (cholecystitis, pancreatitis, ulcer);
Pregnancy.

Flaws:

Possible blockage of the bile ducts as a result of vibration;
Damage to the walls of the gallbladder with sharp edges of stone fragments.

Crushing stones with a laser. Access to the gallbladder is through a puncture in the anterior abdominal wall. The laser beam is brought directly into the impact zone and splits the existing stones. The duration of the procedure is no more than 20 minutes.

Contraindications:

The patient's weight exceeds 120 kg;
Age over 60;
Severe general condition.

Flaws:

The likelihood of a burn of the mucous membrane, which in the future can lead to the development of an ulcer;
Injury to the walls of the gallbladder with sharp edges of stones and obstruction of the bile ducts;
The need for special equipment.

Contact chemical cholelitholysis. This method was developed as part of current trend development of organ-preserving methods of treatment. With its help, not only cholesterol stones are dissolved, but also any other types of stones. The size and number of stones also do not matter. This method can be used at any stage of the disease, and, unlike the previous two, not only in the asymptomatic course of the disease, but also in the presence of its pronounced clinical signs.

Its essence is as follows: a thin catheter is inserted into the gallbladder through the skin and liver under ultrasound control, through which a special drug dissolving stones is dripped. The efficiency of the method is 90%. Methyl tert-butyl ether, which is a strong organic solvent, is usually used as the drug. It has been proven that the gallbladder is resistant to the cytotoxic effect of methyl tert-butyl ether.

The disadvantage of the method is invasiveness.

Laparoscopy. Laparoscopy is performed under general anesthesia. Stones are removed using trocars (metal guides) that are inserted into incisions in the abdomen. The peritoneum is filled with carbon dioxide, a tube of the apparatus is inserted into one of the incisions to transfer the image to the monitor screen. Focusing on the image, the doctor finds and removes the stones. After the end of the operation, staples are applied to the ducts and vessels of the gallbladder. The duration of the operation is about an hour, the hospital stay is 1 week. The indication for laparoscopy is calculous cholecystitis.

Contraindications:

Obesity;
Too large stones;
The presence of adhesions after surgical interventions;
gallbladder abscess,
Diseases of the heart and respiratory system.

Cholecystectomy. Both laparoscopy and laparotomy involve this case removal of the gallbladder itself. Surgical treatment is indicated for large stones and frequent relapses, which are accompanied by severe pain attacks, high temperature and various complications.

Laparoscopic cholecystectomy. During laparoscopic cholecystectomy, gallstones are removed along with the bladder through a small incision up to 1.5 cm in diameter on the anterior surface of the abdomen. In total, 3-4 such incisions are performed. Through another incision, a laparoscope (a small tube with a video camera) is inserted to monitor the operation. The advantages of laparoscopy over abdominal surgery are short recovery period, no noticeable scars and lower cost.

Cavity open operation. Open cholecystectomy is performed when there are stones in the gallbladder large sizes, as well as at different kind complications of cholelithiasis and inflammatory processes in internal organs. With open surgery gallbladder is removed through an incision of 15-30 cm, going from the right hypochondrium to the navel.

Flaws:

High degree of invasiveness;
The need for anesthesia;
Risk of internal bleeding or infection; Possibility of death in case of emergency surgery.

Why can't the gallbladder be removed? Removal of the gallbladder leads to a chain of biochemical changes, during which the regulation of bile flow is lost. Motility of the muscles of the duodenum is disturbed, bile acquires a more liquid consistency and weakly protects the organ from pathogenic microorganisms that begin to multiply, destroying the normal microflora of the digestive organs. As a result, bile acids strongly irritate the mucous membranes, which can lead to duodenitis (inflammation of the duodenum), as well as gastritis, esophagitis (inflammation of the intestinal mucosa), enteritis (inflammation of the small intestine), and colitis.

Additionally, secondary absorption disorders occur: bile is usually used 5-6 times, making turns between the liver and intestines, and in the absence of the gallbladder, bile acids are quickly excreted, which negatively affects the digestion process. After cholecystectomy, patients often complain that pain in the right hypochondrium and in the liver region persists, bitterness in the mouth often appears, food has a metallic taste. Surgery does not eliminate the symptoms of gallstone disease. Stones after removal of the gallbladder can form in the bile ducts, and so-called choledocholithiasis occurs.

The removal of the bladder is carried out due to the formation of stones in it, the cause of which is pathological change chemical composition bile, and after the operation this reason remains. The secretion of "bad" stone-forming bile continues, the amount of which increases, which has Negative influence not only on the state of the gastrointestinal tract, but also on other body systems. Based on the foregoing, it can be concluded that non-invasive and minimally invasive methods can be used in the treatment of young people with initial stages development of the disease, stones of small size and with no serious contraindications. However, in all other cases, it should be remembered that cholecystectomy is the last way out, and it should be resorted to when all other methods have been ineffective.

What is desirable to exclude from the diet? The composition of the diet is great importance with this disease. With stones in the gallbladder, it is recommended to exclude the following foods and dishes from the menu:

Fatty meat (pork, lamb, beef) and fish;
Sausages, smoked meats, pickles;
Eggs;
Butter;
Legumes, radishes, radishes, eggplants, cucumbers, artichokes, asparagus, onions, garlic;
Fried, sour and spicy dishes;
Rich broths;
Coffee, cocoa and alcohol.

Buckwheat and oatmeal;
Fruits vegetables;
Milk and dairy products with a fat content of not more than 5%;
Lean meat and fish;
compotes, fruit drinks, mineral water up to 2 liters per day.

Gallstone disease is a fairly common pathology associated with a violation of the metabolism of cholesterol or bilirubin and the formation of stones in the gallbladder. The disease is widespread in industrialized countries, where people pay little attention to their diet, giving preference to fried, fatty and spicy foods.

This disease is hard to conservative treatment Therefore, in the presence of calculi, many experts recommend surgical intervention, the "gold" standard of which is laparoscopy of gallbladder stones and cholecystectomy. However, before moving on to therapeutic tactics, it is necessary to study the mechanism of the occurrence of stones.

Where do gallstones come from

Liver bile is a special liquid that resembles plasma in its composition. It has such important components as water, cholesterol, bilirubin and bile acids. As long as these components are in balance with each other, this liquid promotes the binding of fats to water and their breakdown, the absorption of fatty acids and cholesterol in the intestines, prevents the development of putrefactive processes in the final sections of the digestive tract, stimulates its peristalsis (unidirectional contractions to promote the food bolus) .

If the secretion of cholesterol into bile increases or the concentration of bile acids decreases, as well as the contractility of the gallbladder (GB), stagnation and crystallization of its contents occur with the formation of large and small stones.

Predisposing factors for stone formation and the development of cholecystitis are:

High body mass index.
Insufficient physical activity.
Eating foods rich in cholesterol and depleted in plant fiber.
Anomalies in the development of the gallbladder, for example, a congenital inflection of its neck.
Elderly age.
Female.
Pregnancy.
endocrine disorders.
Chronic infectious diseases bile ducts.
Alcohol abuse.
Surgical interventions on the stomach and intestines in history.

Proper nutrition and an active lifestyle are excellent prevention of stone formation.

Surgical method for removing stones

There are several types of surgical interventions used for cholelithiasis:

Laparoscopic removal of stones from the gallbladder.
Endoscopic cholecystectomy.
Open cavity operation.

Currently, the laparoscopic method of removing stones from the gallbladder is gaining more and more popularity. Thanks to the latest technologies possible to minimize damage human body during surgery and reduce its duration.

Surgeons and patients themselves prefer laparoscopic gallbladder removal due to the following advantages:

Low risk of complications.
Short rehabilitation period.
High cosmetic effect (scars after surgery are almost invisible).
Little injury.
Pain after surgery is minimized.
The ability to walk and take care of yourself already on the first day after surgery.

Preparing for the operation

Before any surgical intervention, it is necessary to undergo a series of examinations that will help assess the readiness of the patient's body for the procedure, as well as identify other chronic diseases and prevent the occurrence of related complications. They include general analysis blood and urine, biochemistry, blood glucose, Wasserman reaction, hepatitis test, coagulogram, blood type and Rh factor, abdominal ultrasound, ECG, X-ray of organs chest. It is also necessary to consult a therapist and an anesthesiologist.

Ultrasound diagnosis is an important part of preoperative preparation

If the operation is allowed, the next stage of preparation is the refusal to eat 10-12 hours before the procedure and the appointment of a cleansing enema on the eve of the intervention. The nurse also removes hair in the area of the surgical field with a razor. The anesthesiologist performs premedication medical preparation patient to anesthesia.

How is surgery carried out

Laparoscopic surgery is performed under general anesthesia. First, carbon dioxide is injected into the abdominal cavity through a special needle, which raises the anterior abdominal wall and creates a place for surgeons to work. Then, through small incisions, trocars are inserted, which are hollow tubes with valves.

Through them, various surgical instruments can be installed and removed into the abdomen, an important part of which is the laparoscope (optical system). Next, the gallbladder is directly separated from other anatomical structures and removed through a small incision at the xiphoid process or near the navel.

The laparoscope allows you to display the image on the screen, as well as zoom in and out for the convenience of surgeons.

After extracting the gallbladder, surgeons sew up the surgical openings made and remove a special drain to remove liquid contents from the abdominal cavity, which may accumulate there as a result of inevitable soft tissue injury during the intervention. The duration of the operation is, on average, 45 minutes, but its duration may vary within certain limits depending on the prevalence. pathological process and anatomical features of a particular person.

Period after surgery

Patients receive further treatment after cholecystectomy in the surgical department. After coming out of anesthesia in the first 5-6 hours, the patient is forbidden to get out of bed and drink water. After this time, you can consume the liquid in small portions and try to get up. The first time it is better to do this under the supervision of medical personnel, so as not to lose consciousness and not fall due to a sharp short-term decrease in pressure when changing body position.

During next day Patients are allowed to move independently around the department and drink water in normal quantities.

Dietary recommendations in postoperative period include avoiding coffee, strong tea, alcoholic beverages, sweet foods, greasy and fried food. Diet food allowed dairy products, bananas, baked apples, etc. If the operation went without complications, patients are discharged from the hospital on the 3rd day.

Organ-preserving operations

The gallbladder is the same organ of our body as all the others, so its removal entails certain inconveniences and limitations. Consider the chain of biochemical changes caused by impaired bile flow:

More fluid consistency of bile.
Violation of the protection of the duodenum from pathogenic microorganisms.
Active reproduction of harmful bacteria.
Gradual inhibition of the growth of "useful" microflora.
The development of inflammatory processes in various parts of the gastrointestinal tract.
Violation of the movement of food and its absorption.

Today, there is an alternative to traditional cholecystectomy - laparoscopic cholecystolithotomy. As a result of surgical intervention, the calculus is removed from the gallbladder, while the organ itself is preserved. The list of indications for such an operation is rather narrow and includes a number of prerequisites:

Absence of any symptoms with stone bearing.
Single calculi up to 3 centimeters in size, which are in a free state.
Preserved contractility of the organ.
No signs of inflammation of the gallbladder and duodenum.
Absence congenital anomalies structures of the HP.
No history of adhesive disease.

Cholecystolithotomy is allowed only in the presence of small calculi

How is the surgery and postoperative period going?

The beginning of the operation coincides with the classical laparoscopic cholecystectomy. After the introduction of the instruments, the gallbladder is incised and the calculus is removed with a special clamp. Next, the incision is sutured with absorbable suture, the instruments are removed, and the surgical wounds are sutured with a cosmetic suture.

After surgery, patients are advised to eat small meals 4 or more times a day to restore normal bile flow. Such patients are also prescribed litholytic drugs to prevent recurrent bile formation. Carry out procedures to restore the contractility of the gallbladder. Monitoring the state of the body with the help ultrasound diagnostics at least 2 times a year.

The formation of stones in the gallbladder is considered a fairly common disease. It is difficult to diagnose the disease, an examination, including ultrasound, is required, often the patient is unaware of the development of pathology, the disease rarely manifests itself. Sometimes a person lives for several years. Perhaps for the rest of your life.

The reasons for the formation are varied: excessive consumption of food saturated with cholesterol, overweight, heredity, provoking established diseases of the digestive system or a complication, bad habits, psychological stress.

There is a known risk of moving stones from the gallbladder into the ducts, exacerbating the situation. There are unbearable pains, the person feels bad. On initial stage the formation of stones initially occurs thickening of bile, there is a biliary sludge. Then impurities are formed in the stones that settle on the walls of the organ: cholesterol, bilirubin, calcium salts. The process takes years, but gallbladder dysfunction has already begun. The correct solution would be the removal of gallstones.

Early diagnosis of the disease provides an opportunity to carry out the procedure in a gentle way. Many patients choose to continue living with stones with an appropriate diet. But in selected patients, there is a manifestation of an acute disease with attacks of biliary colic. At difficult situation surgery will be required with the removal of the organ, depending on the patient's condition, the stage of development of the disease. Non-surgical removal of stones allows you to keep the body in a relatively stable state. Methods applied:

splitting stones with special medications;
remote lithotripsy;
removal of stones by ultrasound;
laparoscopy;
cholecystectomy.

The last two points involve an operation to remove the gallbladder along with stones. The rest allow you to do without surgery.

Removal of stones without surgery

When there is an opportunity to save the organ, doctors will try to fulfill their plan. The gallbladder may not be removed if the formed stones turn out to be cholesterol. Small stones, not exceeding 2-3 cm, display in a medical way, lithotripsy and crushing by laser or ultrasound.

The dissolution of gallstones is carried out using medical preparations, which are an alternative to gallbladder acids. Means involve the splitting of existing stones. It will be possible to remove the formations along with the intake of drugs that help the production of bile. Calculi dissolve, exit with urine and feces. This method is suitable for people with healthy kidneys and no gastrointestinal diseases. The procedure is prohibited for people with large body weight, pregnant women.

Sometimes patients use a folk remedy in the treatment. Most doctors are against such practice. Self-medication must be excluded, or an aggravation of the situation with undesirable consequences is possible.

Other methods of stone removal are widely used, being considered modern methods.

Removal of stones by ultrasound

Removal of stones from the gallbladder by ultrasound is considered a completely painless method. Shows a high percentage in a positive outcome. The meaning of the method lies in the use of special equipment that, through the direction of vibration and shock wave, is capable of breaking stones into small pieces, which are excreted naturally through the intestines. For the effectiveness of the procedure, the use of special preparations is added. It is necessary to observe a number of conditions for the application of the method:

If no more than 4 stones are found;
Lack of pregnancy;
Stone no larger than 3 cm without lime particles;
Availability of special equipment;
Absence of chronic diseases of the digestive system.

A big plus is the minimum mechanical impact.

Consequences of using the ultrasound method

Carrying out a method for removing stones from the gallbladder using ultrasound reveals a number of disadvantages. During the procedure, injury to the organ with sharp edges is possible. During vibration, clogging of the bile ducts can occur. After the process is completed, there is a chance for backfire. This includes the risk of re-formation of stones, provoking pancreatitis, cholecystitis.

An important fact is the recovery period, in which diet is mandatory. To exclude the recurrence of the disease, periodic examinations and health monitoring are recommended.

Laser Stone Removal

A new method of non-surgical intervention. laser removal stones in the gallbladder is a bit similar to the previous method. It's called lithotripsy. In this case, the effect on the stones produces a laser beam, crushing to the state of sand, which is removed from the body on its own.

Removal of stones from the gallbladder with a laser allows you to use the tool without the possibility of performing surgery due to the patient's health. The process takes little time, saving the organ. You will need to follow the rules:

stones no larger than 3 cm;
the allowable amount for crushing stones with a laser is 3 pieces;
the patient's body weight does not exceed 120 kg;
general health without fear;
age up to 60 years;
availability of special equipment and a qualified doctor.

Removal of stones in the gallbladder with a laser fast way, Not painful. For achievement best result medication is prescribed.

Consequences of using laser therapy

During the procedure, the risk of burns is considered; during crushing, particles with sharp corners. The consequences are unpredictable, including the appearance of an ulcer. In addition, the likelihood of the formation of new stones, the occurrence of concomitant diseases of the gastrointestinal tract remains.

The recommended diet must be strictly observed, control over well-being too. Rehabilitation is not required. To carry out the procedure, the patient should make an informed decision; the patient is not insured against accidents during the process. A little carelessness can lead to serious consequences.

Ways to remove stones without surgery can save the gallbladder. Surgeons advise to go to the hospital at the initial stage of the disease. With due observance of the recommendations, a successful procedure, constant monitoring, and a balanced diet, it will be possible to eliminate the occurrence of a relapse. There are situations when you have to use surgical intervention.

Removal of the gallbladder with stones

Difficult exacerbated situations involve surgery to remove the gallbladder with stones. The impossibility of using non-surgical methods is determined by a number of reasons. Accompanied attacks of biliary colic, large stones, the presence of chronic diseases will contribute to surgical intervention.

The operation to remove stones together with the organ is divided into types.

Laparoscopy

The most common method, more often used by surgeons. It involves endoscopic removal of the gallbladder. If possible, it is possible to save the organ.

The operation is performed under general anesthesia and takes 1 hour. The method is not suitable for people with a lot of weight, pathologies of the heart and respiratory system. Laparoscopy is not performed if large stones are found. The process of suppuration and inflammation becomes an obstacle.

The operation is performed by inserting a trocar. Three incisions are made in the shape of a triangle. In one, a device is introduced that provides control over the operation. A picture unfolds on the monitor. Gallbladder stones are removed. The surgeon finds deposits and captures. If the organ can be saved, staples are applied to the ducts and vessels.

If the gallbladder already has chronic illness, possible severe consequences for other organs, it is simply removed along with the stones.

The advantage of the method is accessibility and efficiency. A few hours after the operation, you are allowed to move freely. Painful sensations colic is almost gone. Patient reviews indicate full life after the operation. In order to avoid violations, the need for a systematic examination of internal organs is considered. Do not do without an appropriate diet. Recommended special gymnastics for better resorption of sutures and prevention of adhesion formation. If the operation is performed without removal of the gallbladder, special therapy is prescribed to maintain the functioning of the organ.

Gallbladder removal surgery

A neglected situation accompanied by an exacerbation of other diseases involves the removal of an organ. The operation is called a cholecystectomy. It is carried out in the absence of the opportunity to conduct alternative methods treatment, there are overgrown stones, pancreatitis, cholecystitis, diabetes. The disease is accompanied by persistent bouts of pain. The described indicates the inability of the normal functioning of the organ, damage to others is possible. The best way out is the removal of the damaged gallbladder.

Before the operation, the intestines are cleaned as much as possible. Under general anesthesia, an incision is made in the abdominal wall. The organ and the cystic ducts, vessels and arteries connected to it are cut out. After removal of the gallbladder, it is required to check the common bile duct for the presence of stones. At times, the wound is left open for several days with a special tube to drain the fluid completely to avoid inflammation. Then the incision is sutured. The operation is considered difficult, it will be necessary to remove the negative formations that have arisen. The procedure takes almost two hours. Then the patient is admitted to the intensive care unit.

The recovery takes a lot of time, the duration is a month and a half. When the gallbladder is removed, a strict diet, almost starvation, occurs for a week. Contraindicated physical exercise. Will have to stay in the hospital for a week further actions performed under the strict supervision of a physician.

Surgeons try to resort to such a traumatic method only in emergency cases. Modern methods are aimed at less severe consequences and the recovery period.

More often, patients prefer non-surgical treatment methods. Many people want to keep their gallbladder. Statistics indicate that the formation of stones shows an upward trend. Running the situation can subsequently lead to oncology.

Gallstone disease is a fairly common pathology that affects about 10% of the adult population in Russia, Western Europe and the United States, and in the age group over 70 years this figure reaches 30%. It occurs mainly in industrialized countries, where people consume large quantities of food rich in animal proteins and fats. According to statistics, cholelithiasis is diagnosed in women 3-8 times more often than in men.

The gallbladder is an organ adjacent to the liver and acts as a reservoir for storing bile, which is produced by the liver. Bile is necessary for the proper digestion of food and has a complex composition. Its main components are cholesterol and bilirubin (a pigment produced by the liver). The main causes of cholelithiasis include an increased content of cholesterol in the composition of bile, violations of its outflow and stagnation, as well as infection of the gallbladder.

The size of gallstones varies over a very wide range, from a few millimeters to several centimeters. In some cases, one stone can occupy the entire cavity of the distended gallbladder. Stones with a diameter of 1-2 mm can pass through the bile ducts, the presence of larger stones leads to the appearance of clinical signs of cholelithiasis.

In most cases, the disease is asymptomatic, but when there are pronounced clinical manifestations, it is often necessary to resort to emergency measures.

Typical symptoms of cholelithiasis include sudden attacks of biliary (hepatic) colic, which are accompanied by pain in the right hypochondrium, nausea, heartburn, vomiting, bloating, fever, signs of jaundice.

Prolonged course of the disease leads to narrowing of the bile ducts, infection of the gallbladder and the development of chronic inflammatory processes (cholecystitis, hepatitis, pancreatitis, duodenitis).

To date, there are the following methods of treatment of GSD:

Non-surgical stone removal:

Dissolution of drugs;

Remote ultrasonic lithotripsy;

Removal with minimal invasiveness:

Crushing stones with a laser;

Contact chemical litholysis;

Surgical intervention:

Laparoscopic removal of stones from the gallbladder;

Endoscopic cholecystectomy;

Open cavity operation.

The current standard of care for patients with gallstone disease is as follows:

When stones are found, their composition is analyzed. According to the chemical composition, cholesterol, lime, pigment and mixed stones are distinguished. They try to dissolve cholesterol stones with the help of bile acid preparations (ursodeoxycholic and chenodeoxycholic). A more radical method is the crushing of stones using ultrasound or a laser and the subsequent dissolution of their small particles and "sand" with acids.

However, the main treatment for gallstone disease is still cholecystectomy (removal of the gallbladder along with stones). At the same time, abdominal operations are gradually giving way to endoscopic removal.

Only cholesterol stones with a diameter of up to 2 cm can be dissolved (this method does not work on calcareous and pigment stones). For this purpose, analogues of bile acids Ursosan, Henofalk, Urofalk, Henohol, etc. are used.

In parallel, stimulation of the contractile function of the gallbladder and bile production can be carried out with the help of Allochol, Holosas, Zixorin, Liobil.

Contraindications:

Various concomitant diseases of the gastrointestinal tract (ulcer, gastritis) and kidneys;

Taking oral contraceptives containing estrogens;

Obesity;

Pregnancy.

Flaws:

High recurrence rate (10-70%), since after stopping the drugs, the level of cholesterol in the bile rises again;

Long duration of treatment (from 6 months to 3 years);

Side effects such as diarrhea (10% of cases), changes in liver tests (ALT and AST);

The high cost of drugs.

crushing stones with ultrasound

This method is based on crushing stones under the influence of high pressure and vibration of a regenerated shock wave. Ultrasound destroys stones and crushes them into smaller particles with sizes not exceeding 3 mm, which are subsequently excreted through the bile ducts into the duodenum. Ultrasonic lithotripsy is suitable for patients who have a small amount (up to 4 pieces) of rather large cholesterol stones (up to 3 cm in diameter), without lime impurities in their composition.

Contraindications:

Blood clotting disorders;

Chronic inflammatory diseases of the gastrointestinal tract (cholecystitis, pancreatitis, ulcer);

Pregnancy.

Flaws:

Possible blockage of the bile ducts as a result of vibration;

Damage to the walls of the gallbladder with sharp edges of stone fragments.

Crushing stones with a laser

Access to the gallbladder is through a puncture in the anterior abdominal wall. The laser beam is brought directly into the impact zone and splits the existing stones. The duration of the procedure is no more than 20 minutes.

Contraindications:

The patient's weight exceeds 120 kg;

Age over 60;

Severe general condition.

Flaws:

The likelihood of a burn of the mucous membrane, which in the future can lead to the development of an ulcer;

Injury to the walls of the gallbladder with sharp edges of stones and obstruction of the bile ducts;

The need for special equipment.

Contact chemical cholelitholysis

This method was developed as part of the current trend in the development of organ-preserving methods of treatment. With its help, not only cholesterol stones are dissolved, but also any other types of stones. The size and number of stones also do not matter. This method can be used at any stage of the disease, and, unlike the two previous ones, not only in the asymptomatic course of the disease, but also in the presence of its pronounced clinical signs.

Methyl tert-butyl ether, which is a strong organic solvent, is usually used as the drug. It has been proven that the gallbladder is resistant to the cytotoxic effect of methyl tert-butyl ether.

The disadvantage of the method is invasiveness.

Laparoscopy is performed under general anesthesia. Stones are removed using trocars (metal guides) that are inserted into incisions in the abdomen. The peritoneum is filled with carbon dioxide, a tube of the apparatus is inserted into one of the incisions to transfer the image to the monitor screen. Focusing on the image, the doctor finds and removes the stones. After the end of the operation, staples are applied to the ducts and vessels of the gallbladder. The duration of the operation is about an hour, the hospital stay is 1 week.

The indication for laparoscopy is calculous cholecystitis.

Contraindications:

Obesity;

Too large stones;

The presence of adhesions after surgical interventions;

gallbladder abscess,

Diseases of the heart and respiratory system.

Cholecystectomy

Both laparoscopy and laparotomy mean in this case the removal of the gallbladder itself. Surgical treatment is indicated for large stones and frequent relapses, which are accompanied by severe pain attacks, high fever and various complications.

Laparoscopic cholecystectomy

During laparoscopic cholecystectomy, gallstones are removed along with the bladder through a small incision up to 1.5 cm in diameter on the anterior surface of the abdomen. In total, 3-4 such incisions are performed. Through another incision, a laparoscope (a small tube with a video camera) is inserted to monitor the operation. The advantages of laparoscopy over abdominal surgery are a short recovery period, no visible scars, and lower cost.

open surgery

Open cholecystectomy is performed in the presence of very large stones in the gallbladder, as well as in various complications of cholelithiasis and inflammatory processes in the internal organs. In open surgery, the gallbladder is removed through a 15-30 cm incision that runs from the right hypochondrium to the navel.

Flaws:

High degree of invasiveness;

The need for anesthesia;

Risk of internal bleeding or infection; Possibility of death in case of emergency surgery.

Why can't the gallbladder be removed?

Removal of the gallbladder leads to a chain of biochemical changes, during which the regulation of bile flow is lost. Motility of the muscles of the duodenum is disturbed, bile acquires a more liquid consistency and weakly protects the organ from pathogenic microorganisms that begin to multiply, destroying the normal microflora of the digestive organs. As a result, bile acids strongly irritate the mucous membranes, which can lead to duodenitis (inflammation of the duodenum), as well as gastritis, esophagitis (inflammation of the intestinal mucosa), enteritis (inflammation of the small intestine), and colitis.

After cholecystectomy, patients often complain that pain in the right hypochondrium and in the liver region persists, bitterness in the mouth often appears, food has a metallic taste.

Surgery does not eliminate the symptoms of gallstone disease. Stones after removal of the gallbladder can form in the bile ducts, and so-called choledocholithiasis occurs.

The removal of the bladder is carried out due to the formation of stones in it, the cause of which is a pathological change in the chemical composition of bile, and after the operation this reason remains. The secretion of “bad” stone-forming bile continues, the amount of which increases, which has a negative impact not only on the state of the gastrointestinal tract, but also on other body systems.

Based on the foregoing, it can be concluded that non-invasive and minimally invasive methods can be used in the treatment of young people with the initial stages of the development of the disease, stones of small size and with no serious contraindications. However, in all other cases, it should be remembered that cholecystectomy is the last way out, and it should be resorted to when all other methods have been ineffective.