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Many patients are concerned about the question of how to live after gallbladder removal. Will their life be just as fulfilling, or are they doomed to a disability? Is it possible to fully recover after gallbladder removal? There are no superfluous organs in our body, but all of them are conditionally divided into those without which further existence is simply impossible and those in the absence of which the body can function.

The process in which the gallbladder is removed is a forced procedure, it is a consequence of the formation of stones and a malfunction in the body, after which the gallbladder ceases to function normally. Stones that appear in the gallbladder begin to form due to chronic cholecystitis.

Diet after removal of the gallbladder will prevent the occurrence of postcholecystectomy syndrome.

Can:		It is forbidden:
wheat and rye bread (yesterday);	bread and bakery products	sweet dough;
any cereals, especially oatmeal and buckwheat; pasta, vermicelli;	cereals and pasta
lean meat (beef, chicken, turkey, rabbit) boiled, baked or steamed: meatballs, dumplings, steam cutlets;		fatty meats (pork, lamb) and poultry (goose, duck);
boiled lean fish;		fried fish;
cereal, fruit, dairy soups; weak broths (meat and fish); borscht, cabbage soup vegetarian;		fish and mushroom broths;
cottage cheese, kefir, lactic acid products; mild cheese (including processed cheese);	Milk products
butter in limited quantities; vegetable oil (sunflower, corn, olive) - 20-30 g per day;		animal fats;
any vegetables in boiled, baked and raw form; fruits and berries (except sour ones) raw and boiled;	vegetables and fruits	spinach, onion, radish, radish, cranberry;
cracker;	confectionery	cakes, cream, ice cream; carbonated drinks; chocolate;
	Snacks, canned foods
juices vegetable, fruit; compotes, jelly, rosehip broth		alcoholic drinks; strong tea; strong coffee
Essentuki No. 4, No. 17, Smirnovskaya, Slavyanovskaya, sulfate Narzan 100-200 ml warm (40-45 °) 3 times a day for 30-60 minutes, before meals	Mineral water

Postoperative period - stay in the hospital.

After a conventional uncomplicated laparoscopic cholecystectomy, the patient is admitted from the operating room to the intensive care unit, where he spends the next 2 hours of the postoperative period to monitor an adequate recovery from anesthesia. In the presence of concomitant pathology or features of the disease and surgical intervention, the length of stay in the intensive care unit may be increased.

the patient is transferred to the ward, where he receives the prescribed postoperative treatment. During the first 4-6 hours after the operation, the patient should not drink and get out of bed. Until the morning of the next day after the operation, you can drink plain water without gas, in portions of 1-2 sips every 10-20 minutes with a total volume of up to 500 ml. The patient can get up 4-6 hours after the operation. You should get out of bed gradually, first sit for a while, and, in the absence of weakness and dizziness, you can get up and walk around the bed. It is recommended to get up for the first time in the presence of medical personnel (after a long stay in a horizontal position and after the action of medications, orthostatic collapse is possible - fainting).

The next day after the operation, the patient can freely move around the hospital, start taking liquid food: kefir, oatmeal, diet soup and switch to the usual mode of drinking liquids. In the first 7 days after surgery, the use of any alcoholic beverages, coffee, strong tea, drinks with sugar, chocolate, sweets, fatty and fried foods is strictly prohibited. The patient's nutrition in the first days after laparoscopic cholecystectomy may include fermented milk products: low-fat cottage cheese, kefir, yogurt; porridge on the water (oatmeal, buckwheat); bananas, baked apples; mashed potatoes, vegetable soups; boiled meat: lean beef or chicken breast.

In the normal course of the postoperative period, drainage from abdominal cavity removed the next day after surgery. Drainage removal is a painless procedure, carried out during dressing and takes a few seconds.

Young patients after surgery for chronic calculous cholecystitis can be allowed to go home the next day after surgery, the rest of the patients are usually in the hospital for 2 days. Upon discharge, you will be given a sick leave (if you need one) and an extract from the inpatient card, which will set out your diagnosis and features of the operation, as well as recommendations on diet, exercise and drug treatment. The sick leave is issued for the duration of the patient's stay in the hospital and for 3 days after discharge, after which it must be renewed by the surgeon of the polyclinic.

The postoperative period is the first month after the operation.

In the first month after the operation, the functions and general condition of the body are restored. Careful adherence to medical recommendations is the key to a full recovery of health. The main directions of rehabilitation are - compliance with the regime of physical activity, diet, drug treatment, wound care.

Compliance with the regime of physical activity.

Any surgical intervention is accompanied by tissue trauma, anesthesia, which requires the restoration of the body. The usual rehabilitation period after laparoscopic cholecystectomy is from 7 to 28 days (depending on the nature of the patient's activity). Despite the fact that 2-3 days after the operation, the patient feels satisfactory and can freely walk, walk on the street, even drive a car, we recommend staying at home and not going to work for at least 7 days after the operation, which the body needs to recover . At this time, the patient may feel weak, fatigued.

After surgery, it is recommended to limit physical activity for a period of 1 month (do not carry weights of more than 3-4 kilograms, exclude physical exercises that require tension in the abdominal muscles). This recommendation is due to the peculiarities of the formation of the process of the scar of the muscular-aponeurotic layer of the abdominal wall, which reaches sufficient strength within 28 days from the moment of surgery. 1 month after the operation, there are no restrictions on physical activity.

Diet.

Compliance with the diet is required up to 1 month after laparoscopic cholecystectomy. Recommended exclusion of alcohol, easily digestible carbohydrates, fatty, spicy, fried, spicy foods, regular meals 4-6 times a day. New foods should be introduced into the diet gradually, after 1 month after the operation, it is possible to remove dietary restrictions on the recommendation of a gastroenterologist.

Medical treatment.

After laparoscopic cholecystectomy, minimal medical treatment is usually required. Pain after surgery is usually mild, but some patients require the use of analgesics for 2-3 days. Usually it is ketanov, paracetamol, etol-fort.

In some patients, it is possible to use antispasmodics (no-shpa or drotaverine, buscopan) for 7-10 days.

Taking ursodeoxycholic acid preparations (Ursofalk) improves the lithogenicity of bile, eliminates possible microcholelithiasis.

Reception medications should be carried out strictly according to the instructions of the attending physician in an individual dosage.

Care of postoperative wounds.

In the hospital, postoperative wounds located at the insertion sites of the instruments will be covered with special stickers. It is possible to take a shower in Tegaderm stickers (they look like a transparent film), Medipor stickers (white plaster) must be removed before taking a shower. Showers can be taken from 48 hours after surgery. The ingress of water on the seams is not contraindicated, however, do not wash the wounds with gels or soap and rub with a washcloth. After taking a shower, lubricate the wounds with a 5% iodine solution (either betadine solution, or brilliant green, or 70% ethyl alcohol). Wounds can be made open method, without bandages. Bathing or swimming in pools and ponds is prohibited until the removal of the stitches and for 5 days after the stitches are removed.

Stitches after laparoscopic cholecystectomy are removed 7-8 days after surgery. This is an outpatient procedure, the removal of sutures is performed by a doctor or dressing nurse, the procedure is painless.

Possible complications of cholecystectomy.

Any operation can be accompanied by undesirable effects and complications. Complications are possible after any technology of cholecystectomy.

Complications from wounds.

These may be subcutaneous hemorrhages (bruises) that disappear on their own within 7-10 days. Special treatment is not required.

There may be reddening of the skin around the wound, the appearance of painful seals in the wound area. Most often it is associated with a wound infection. Despite the ongoing prevention of such complications, the frequency of wound infection is 1-2%. If these symptoms appear, you should consult a doctor as soon as possible. Late treatment may lead to wound festering, which usually requires surgical intervention under local anesthesia (debridement of the festering wound), followed by dressings and possible antibiotic therapy.

Despite the fact that our clinic uses modern high-quality and high-tech instruments and modern suture material, in which wounds are sutured with cosmetic sutures, however, hypertrophic or keloid scars may form in 5-7% of patients. This complication is associated with the individual characteristics of the reaction of the patient's tissue and, if the patient is dissatisfied with the cosmetic result, may require special treatment.

In 0.1-0.3% of patients, hernias may develop in places of trocar wounds. This complication is most often associated with connective tissue patient and may require surgical correction in the long term.

Complications from the abdominal cavity.

Very rarely, complications from the abdominal cavity are possible, which may require repeated interventions: either minimally invasive punctures under the control of ultrasonography, or repeated laparoscopies, or even laparotomies (open abdominal operations). The frequency of such complications does not exceed 1:1000 operations. These can be intra-abdominal bleeding, hematomas, purulent complications in the abdominal cavity (subhepatic, subdiaphragmatic abscesses, liver abscesses, peritonitis).

Residual choledocholithiasis.

According to statistics, from 5 to 20% of patients with cholelithiasis also have concomitant stones in the bile ducts (choledocholithiasis). A complex of examinations carried out in the preoperative period is aimed at identifying such a complication and using adequate treatment methods (this can be retrograde papillosphincterotomy - dissection of the mouth of the common bile duct endoscopically before surgery, or intraoperative revision of the bile ducts with removal of calculi). Unfortunately, none of the methods of preoperative diagnosis and intraoperative evaluation is 100% effective in detecting stones. In 0.3-0.5% of patients, stones in the bile ducts may not be detected before and during surgery and cause complications in the postoperative period (the most common of which is obstructive jaundice). The occurrence of such a complication requires an endoscopic (with the help of a gastroduodenoscope inserted through the mouth into the stomach and duodenum) intervention - retrograde papilosphinctoromia and transpapillary sanitation of the bile ducts. In exceptional cases, a second laparoscopic or open operation is possible.

Bile leakage.

The outflow of bile through the drainage in the postoperative period occurs in 1:200-1:300 patients, most often it is a consequence of the release of bile from the gallbladder bed on the liver and stops on its own after 2-3 days. This complication may require an extended hospital stay. However, bile leakage through the drainage can also be a symptom of damage to the bile ducts.

Bile duct injury.

Bile duct injuries are one of the most severe complications in all types of cholecystectomy, including laparoscopic. In traditional open surgery, the incidence of severe bile duct injury was 1 in 1500 operations. In the first years of mastering laparoscopic technology, the frequency of this complication increased by 3 times - up to 1:500 operations, but with the growth of surgeons' experience and the development of technology, it stabilized at the level of 1 per 1000 operations. Famous Russian specialist on this problem, Eduard Izrailevich Galperin wrote in 2004: “... Neither the duration of the disease, nor the nature of the operation (urgent or planned), nor the diameter of the duct, and even the professional experience of the surgeon affect the possibility of damage to the ducts ... ". The occurrence of such a complication may require repeated surgical intervention and a long period of rehabilitation.

Allergic reactions to medicines.

The trend of the modern world is an increasing increase in the allergization of the population, therefore, allergic reactions to medications (both relatively mild - urticaria, allergic dermatitis) and more severe (Quincke's edema, anaphylactic shock). Despite the fact that in our clinic allergological tests are carried out before prescribing medications, however, the occurrence of allergic reactions is possible, and additional medication is required. Please, if you know about your personal intolerance to any medications, be sure to tell your doctor about it.

thromboembolic complications.

Venous thrombosis and pulmonary embolism are life-threatening complications of any surgical procedure. That is why much attention is paid to the prevention of these complications. Depending on the degree of risk determined by your doctor, you will be prescribed preventive actions: bandaging of the lower extremities, the introduction of low molecular weight heparins.

Exacerbation of peptic ulcer of the stomach and duodenum.

Any, even minimally invasive, operation is stressful for the body, and can provoke an exacerbation of peptic ulcer of the stomach and duodenum. Therefore, in patients at risk of such a complication, prophylaxis with antiulcer drugs in the postoperative period is possible.

Despite the fact that any surgical intervention carries a certain risk of complications, however, refusal of the operation or delay in its implementation also has a risk of developing severe illness or complications. Despite the fact that the doctors of the clinic give great attention prevention possible complications, the patient plays a significant role in this. Performing cholecystectomy in a planned manner, with undeveloped forms of the disease, carries a much lower risk of undesirable deviations from the normal course of the operation and the postoperative period. Great importance also has the responsibility of the patient for strict adherence to the regimen and recommendations of doctors.

Rehabilitation in the long term after cholecystectomy.

Most patients after cholecystectomy completely recover from the symptoms that bothered them and return to normal life 1-6 months after the operation. If cholecystectomy is performed on time, before the occurrence of concomitant pathology from other organs of the digestive system, the patient can eat without restrictions (which does not eliminate the need for proper healthy eating), do not limit yourself in physical activity, do not take special drugs.

If the patient has already developed concomitant pathology from the digestive system (gastritis, chronic pancreatitis, dyskinesia), he should be under the supervision of a gastroenterologist in order to correct this pathology. A gastroenterologist will advise you on lifestyle, diet, dietary habits and, if necessary, medication.

krasgmu.net

Fundamentals of recovery after cholecystectomy

Rehabilitation of patients after removal of the gallbladder does not require numerous therapeutic measures. Its basis is scrupulous adherence to the doctor's recommendations. Full recovery provides a set of measures, including:

• medical procedures;
• regime moments and dosing loads;
• correction of eating habits.
• The rehabilitation process itself can be primary, post-hospital and remote.

early recovery

Primary rehabilitation after removal of the organ takes place in a hospital. Here its foundations are laid, the patient is informed about the measures that must be taken after the operation.

Depending on the type of operation and the dynamics of recovery, the hospital period lasts from 2 to 7 days.

The bladder removal operation is carried out by traditional and laparoscopic methods. With a planned surgical intervention, preference is given to the second. Open surgery is performed in emergency, life-threatening complicated cases, or if during laparoscopy, previously undetected complications are detected.

The postoperative period after removal of the gallbladder by a less invasive method of laparoscopy demonstrates the advantages of this type of intervention:

• intensive care takes a minimum of time (up to 2 hours);
• a small surface of wounds heals well;
• prolonged bed rest is not required after removal of the organ;
• a small percentage of complications from the digestive tract;
• the stationary recovery period is significantly reduced;
• the patient's return to active life occurs quite quickly.

Events in the hospital

Inpatient observation provides for 3 phases: intensive care, general regimen, discharge for outpatient treatment.

Intensive therapy

Immediately after the operation to remove the bladder, the patient is observed until complete recovery from anesthesia, on average, 2 hours. At the same time, the final stage of antibiotic therapy (administration of antibiotics) is carried out, examination of wound surfaces or applied bandages to identify excessive secretions. If the temperature and stitches are normal, the patient is adequate, can talk about his state of health and describe the sensations, then the intensive period is over, the patient is transferred to the general mode.

General Mode

The main goal of recovery after removal of the gallbladder in the hospital is as soon as possible and complete inclusion of the operated biliary tract in the digestive system. This prevents the formation of adhesions in the abdominal cavity and inside the ducts. To achieve this goal, the filling of the stomach emptied before the operation and motor activity are required. Therefore, with an uncomplicated postoperative period, bed rest is canceled after a few hours.

On the first day after the gallbladder removal surgery, it is recommended to drink water in small portions. This not only "turns on" digestion, but also promotes the removal of anesthetic drugs from the body, provides the beginning of recovery. On the second day, fractional nutrition in liquid form is added.

On the same day, the drainage tube is removed, which removes fluid from the abdominal cavity, because. by this time the problem with drainage is usually solved.

By the end of the first day, it is recommended to get out of bed. For the first time, the patient gets up under the supervision of health workers, because. sudden movements can lead to fainting. In the absence of side effects, the patient moves further independently.

Daily during recovery in the hospital, the sutures are examined and processed.

Extract

The condition after uncomplicated removal does not require constant monitoring by a doctor, therefore, with normal recovery rates, the patient is transferred to outpatient monitoring. In his hands he receives a sick leave (if required), an extract with data on the size of the intervention (for the local surgeon) and written recommendations for recovery.

outpatient period

After discharge, you must register with the surgeon at the place of residence. It is he who oversees the rehabilitation process, removes postoperative sutures, corrects medical appointments. This period can last from 2 weeks to 1 month.

Important! Visits to the doctor are mandatory not only for those who need to close the sick leave: at this postoperative moment, small, but significant complications for later life are very likely. Their timely detection and prevention of consequences can only be done by a specialist.

Lifestyle changes

The most important thing in rehabilitation after removal of an organ is the correct actions of the patient. No doctor guarantees a favorable outcome if the patient does not fulfill all the requirements of this recovery period.

Diet and catering

The production of bile by the liver is restored in the hospital. But since the situation when an excessive portion of it is not excreted, but stagnates in the ducts, is extremely undesirable, it is required to ensure its unhindered movement. This is achieved:

• meals - each serving stimulates the movement of bile from the liver to the intestines;
• physical activity - the necessary peristalsis of the ducts and intestines is provided;
• elimination of spasms and expansion of the lumen of the biliary tract - this is facilitated by antispasmodic drugs prescribed by a doctor;
• elimination of mechanical obstacles - you can not sit for a long time, especially after eating, wear tight clothes in the waist and abdomen.

Nutrition Features

Proper nutrition is one of the key moments of rehabilitation after cholecystectomy surgery. The quality, quantity of bile, its inclusion in the general metabolism directly depends on the regularity of intake and composition of food.

Eating mode

The basic rule of nutrition after removal of the gallbladder is fragmentation and regularity. The daily volume of products is divided into 5 - 6 doses. You need to eat every 3-3.5 hours. Perhaps, for this you will have to change the daily routine, and make adjustments to the organization of work.

Important! It is required to reduce the size of the usual portions: if you keep the volume of one-time food intake as with three or four meals a day, then weight gain is almost inevitable.

Quality composition of food

• do not include fried and smoked in the diet;
• limit the intake of animal fats, sweets, pastries, spicy and salty foods;
• prefer natural products to canned ones;
• exclude alcohol, strong tea and coffee;
• do not reheat dishes, but cook immediately before use.

Special conditions

Immediately after discharge, during the first month, puree-like food is prepared. Expand the diet gradually, no more than 1 product for each meal (to identify the causes of complications, if any). Vegetables and fruits are subjected to heat treatment - stew or bake.

From the second month to six months of recovery after surgery, they gradually switch to chopped food, with time the size of the pieces increases. Vegetables and fruits are taken fresh.

From the second half of the year of rehabilitation, the composition of the products becomes complete.

Important! The principles of healthy eating during this period are observed in most cases - exceptions, although they are possible with good health but should not become the norm.

Possible digestive problems

In the first days and weeks after the operation, there are troubles with bowel movements. Most often, convalescents are concerned about constipation. Quite understandable from the point of view of physiology, the situation does not add optimism. Recommended:

• increase the amount of vegetables in the diet;
• regularly consume fresh dairy products;
• dose physical activity - its excessive increase or decrease can cause constipation;
• on the recommendation of a doctor, take a laxative that does not reduce peristalsis in the future;
• do not abuse enemas - in addition to overstretching the large intestine, this can cause depletion of the microflora, which is already unstable in the early stages of rehabilitation.

Another nuisance is diarrhea or frequent loose stools, diarrhea. In this case, you should:

1. return to the heat treatment of vegetables and fruits (but do not exclude them from the diet);
2. eat porridge regularly;
3. consult a doctor about the possibility of taking special supplements (lactobacilli, bifidumbacterin, etc.), which inseminate the intestines with beneficial microorganisms.

At first, other dyspeptic disorders are possible: belching, heartburn, bitterness in the mouth, nausea. If observation by a doctor does not reveal concomitant diseases of the digestive system, then these phenomena are temporary. Usually, each person understands which product caused this or that undesirable reaction of the body, and draws conclusions about the advisability of using it.

Physical activity

Neglect of physical activity can negate all measures to achieve a high quality of life after gallbladder surgery. A sedentary lifestyle is the cause of many troubles, including those associated with the movement of bile.

From the first days after the operation, the body is given a feasible load.

Regular (and preferably daily) walks should be. Their duration and intensity increase gradually, you can add jogging over time. But intensive running is not recommended.

Swimming is very helpful. This is the most gentle way to activate muscles and metabolic processes.

Weightlifting, traumatic sports (wrestling, boxing, team contact games), rowing are contraindicated after removal of the gallbladder.

Results

In the vast majority of cases, these simple rules provides successful rehabilitation after surgery to remove the gallbladder. Do not forget about scheduled examinations by a doctor, as well as the need for a consultation in case of new symptoms, if your health changes for the worse.

Approximately 1 year after removal, the body gets used to a new way of life, learns to secrete the bile secretion of the desired composition and density, the digestion process stabilizes. A patient who has undergone a successful operation and no less successful rehabilitation ceases to be convalescent, but moves into the category of practically healthy people. This prospect is all the more likely, the more carefully the recommendations of doctors are followed at the initial stages.

postleudaleniya.ru

Advantages of laparoscopy

Removal of the gallbladder by laparoscopy is modern way treatment of GSD. Such an operation requires certain skills and abilities of the surgeon, since minimally invasive access reduces the range of arm movements and there is no view of the abdominal cavity in three-dimensional space. However, laparoscopic intervention, when performed correctly, is a more gentle method of treating cholelithiasis for several reasons:

• reduced likelihood of postoperative hernias, which is associated with the small size of the incisions;
• rapid healing of the postoperative wound;
• less pronounced pain syndrome;
• fast recovery;
• reduction in the number of days spent in the hospital;
• more aesthetic appearance of scars.

Indications and contraindications for surgery

Currently, laparoscopic removal of stones from the gallbladder is used very rarely. This phenomenon is due to the fact that the chronic course of cholelithiasis is associated with disorders in cholesterol metabolism and the operation does not make much sense, since a relapse will occur after a certain period of time.

Cholecystectomy is used in the treatment of diseases such as:

• chronic calculous inflammation of the gallbladder;
• cholesterosis;
• polyposis of the gallbladder;
• acute inflammation of the gallbladder;
• asymptomatic stone bearing.

General contraindications to laparoscopy are diseases such as malignant tumors, cardiac and pulmonary decompensation, diffuse peritonitis. The minimally invasive method is not used in people who are overweight and in pregnant women in late gestation.

Also, laparoscopic cholecystectomy is not performed for people who have an abscess (purulent inflammation with the formation of a limited infiltrate) of the gallbladder, with severe scars in the organ area, with acute pancreatitis (inflammation of the pancreas. The operation is not indicated for people with a pacemaker and obstructive jaundice.

Preparing for the operation

Laparoscopy, despite not a small injury, is a serious surgical intervention, therefore, preparation for the removal of the gallbladder should be carried out before the operation. It includes a complete diagnostic examination of the state of the body. The patient must donate blood for a general and biochemical analysis, which evaluates the work of the liver, kidneys, pancreas and the presence of inflammatory reactions.

Also, the patient needs to give urine to general analysis, which helps analyze kidney function. Before the operation, the surgeon needs to know if the patient has blood-borne infections: AIDS and HIV, syphilis, hepatitis. Also, the patient must donate blood for a coagulogram - an analysis that characterizes the state of the blood coagulation system.

Among the instrumental methods of examination, an electrocardiogram (assessment of the work of the heart), fluorography (assessment of the condition of the lungs), FGS or EGDS (assessment of digestive function) are mandatory. The patient is carefully examined by a surgeon, therapist, anesthetist. If he has chronic diseases, it is obligatory to see a doctor who treats the affected organ.

The day before the operation, eating after six in the evening is prohibited. The patient should not drink 8 hours before the upcoming laparoscopy. With a planned admission, the patient is given two enemas: in the evening the day before the intervention and in the morning before the operation. Blood-thinning and non-steroidal anti-inflammatory drugs should be stopped 7 days before the proposed laparoscopy, which will help to avoid bleeding.

Operation progress

Cholecystectomy is usually performed under general anesthesia using a special mask. This type anesthesia helps to achieve a complete absence of discomfort and prevents unwanted movements of the patient during the operation.

After introducing the patient into anesthesia, the surgeon proceeds to the operation. First, he makes an incision in the supra-umbilical region, through which gas is injected, which increases the volume of the abdominal cavity. Next, a trocar (an instrument for penetrating the abdominal cavity) with a lighting device is inserted into the hole.

After the described manipulations, the surgeon makes 2-3 more holes along the edge of the right costal arch, into which trocars are inserted. Penetrating into the abdominal cavity, the operating doctor examines the gallbladder. If necessary, the surgeon dissects the adhesions, sucks the fluid.

When the gallbladder is ready for further manipulations, the doctor releases it from the artery and choledochus (bile duct). After that, the organ is separated from its "bed", cauterizing the exposed vessels. Next, the gallbladder is removed from the abdominal cavity through an opening above the navel.

After removing the gallbladder, the surgeon examines the peritoneal cavity, if necessary, sucks out the leaked bile and blood, cauterizes the vessels. Next, he washes the organs with an antiseptic solution to prevent the development of infection. After that, the doctor removes all the instruments, sutures the wounds, puts a drainage tube. Cholecystectomy takes about 45 minutes, this time can vary widely.

Carrying out laparoscopic cholecystectomy:

Postoperative period

After removal of the gallbladder, the patient is transported to the ward, where he departs from anesthesia. At this time, he may be disturbed by nausea, headaches, feeling unwell, feeling "broken". Recommended bed rest for 8 hours, then the patient can sit down, perform simple manipulations in the supine position. Doctors advise not to get out of bed until the end of the day. You can drink water 4-5 hours after laparoscopy.

The first few days the patient is often disturbed by pain in the area of ​​surgical wounds, usually they disappear after 3-5 days. Any physical activity after removal of the gallbladder is allowed only after a week, until this moment the patient is forbidden to lift weights.

In the absence of complications, the temperature after removal of the gallbladder remains normal, or rises to 37.5 degrees on the first day, and then drops to 36.6.

As a prophylaxis of postoperative infectious complications, the patient is prescribed broad-spectrum antibiotics. Non-narcotic analgesics are used to relieve pain. According to indications, doctors may prescribe intravenous infusions. The time for removing the sutures depends on the type of material, most often this manipulation is performed after 1-2 weeks.

During the stay in the hospital, the patient repeatedly donates blood and urine for tests to monitor the state of the body. If all indicators are normal, the wounds heal well, the temperature does not exceed 37 degrees and there are no complaints, after 3-5 days the patient is discharged from the hospital home.

Consequences of gallbladder removal

Usually, laparoscopic cholecystectomy ends with an improvement in the patient's condition, which gets rid of the symptoms of cholelithiasis. Following all the recommendations, a person continues normal life, forgetting about past problems.

According to various sources, the frequency of complications after surgery reaches from 1 to 10 percent. Most often, patients experience bleeding. It appears from a postoperative wound or cystic artery. In the first case, additional sutures are applied to the patient. If the source of blood is in the abdominal cavity, doctors have to do a second operation to eliminate the complication.

Another consequence of cholecystectomy is bile leakage. It is diagnosed by examining the drainage tube, in which a greenish discharge appears. Bile flow must be eliminated with a second operation, since it can lead to peritonitis.

During the violation of the sterility of the abdominal cavity, the patient develops purulent inflammation - abscesses and phlegmon. These complications are manifested by fever, chills, sweating, deterioration. If left untreated, local inflammation becomes widespread and the patient develops peritonitis. At the initial stages, the patient is shown antibiotic therapy, if it is ineffective, doctors perform an operation to remove necrotic (dead) tissues.

Nutrition after gallbladder removal

Within 5 hours after the cholecystectomy, you can not drink, then pure non-carbonated water is allowed. The next day, you can gradually return to a normal diet. The nutrition of the second postoperative day during the removal of the gallbladder by laparoscopy includes dietary broth, liquid jelly, kefir 0% fat.

On the third day, the patient is allowed to eat buckwheat porridge on the water, stewed vegetable puree, fermented milk products with a low fat content. On the fifth postoperative day, the diet for removal of the gallbladder by laparoscopy includes soups on the secondary broth, egg white, rye crackers. After a week, the patient can eat boiled fish, rabbit, beef, chicken and milk.

For the next month and a half, the patient should follow a sparing diet. It consists of easily digestible dishes made without oil and spices. Meals should be separate and frequent, and portions should be small. At this stage, the patient's diet includes vegetables, lean meat, dairy and sour-milk products, cereals, black bread, fish, and bananas. In no case should you eat fried, smoked, spicy, pickled.

After a month and a half, the patient switches to diet number 5. In addition to the above products, it includes fruits, berries, honey, cheese, sour cream. 3 months after the operation, the patient returns to a normal diet, but doctors advise to refrain from smoked, spicy, canned food.

Bibliography

1. Methodological development for practical lesson"Cholelithiasis" Ed. USMA, Yekaterinburg, 2011 - 28 p.

mypochka.ru

Features of the anatomy of the gallbladder

The gallbladder is a hollow organ that resembles a sac. It is under the liver.

Parts of the gallbladder:

• Bottom- a wide end that protrudes slightly from under the lower edge of the liver.
• Body- the main part of the gallbladder.
• Neck- the narrow end of the body, opposite the bottom.
• gallbladder duct- continuation of the neck, having a length of 3.5 cm.

Then the gallbladder duct connects with the hepatic duct, and together they form the common bile duct - choledochus. It is 7 cm long and empties into the duodenum. At the confluence there is a muscle pulp, the sphincter, which regulates the flow of bile into the intestine.

The upper part of the gallbladder is adjacent to the liver, and its lower part is covered by the peritoneum - a thin film of connective tissue. middle layer the wall of the organ consists of muscles, thanks to which the gallbladder is able to contract and expel bile.

From the inside, the wall of the gallbladder is lined with a mucous membrane, which contains many glands that secrete mucus.

The bottom of the gallbladder is adjacent from the inside to the anterior wall of the abdomen.

The main function of the gallbladder is that it stores bile, which is produced in the liver, and then, as needed, releases it into the duodenum. Usually, the emptying of the gallbladder occurs reflexively when food enters the stomach.

The gallbladder is not vital important body. A person can do without it. But the quality of life is reduced, certain restrictions are imposed on the diet.

bile ducts and pancreatic duct in different people they can have different lengths, connect with each other and flow into the duodenum in different ways. Sometimes, in addition to the main duct, additional ones depart from the body of the gallbladder. The doctor has to take into account these features during laparoscopy.

Bile duct connection options.

The blood supply to the gallbladder comes from the cystic artery, which branches off from the artery that supplies the liver.

What are the advantages of laparoscopy of the gallbladder over surgery through the incision?

Advantages	Laparoscopy of the gallbladder	Operation through an incision
Less invasive intervention	4 punctures of 1 cm.	The cut is 20 cm long.
lower blood loss	During laparoscopy of the gallbladder, the patient loses an average of 30-40 ml of blood.	The blood loss is much greater.
Shorter rehabilitation times	The patient is discharged from the hospital after 1-3 days.	The patient is discharged from the hospital after 1-2 weeks
Faster recovery time	Performance is fully restored in a week.	Recovery takes 3-6 weeks.
Less pain after surgery.	As a rule, ordinary painkillers are sufficient to relieve pain.	Sometimes the pain is so severe that it is necessary to prescribe drugs to the patient.
Lower rate of postoperative complications.	Adhesions and hernias after laparoscopy are formed much less frequently.

What is a laparoscope? How is laparoscopy of the gallbladder performed?

Endoscopic equipment used by the surgeon during laparoscopy of the gallbladder:

How is the preparation for laparoscopy of the gallbladder?

Investigations that may be prescribed by a doctor before laparoscopy:

• Complete blood count and urinalysis - 7-10 days before surgery.
• Biochemical blood test - 7-10 days before surgery.
• Determination of blood group and Rh factor.
• Blood test for RW (for syphilis) - 3 months before surgery.
• Rapid blood test for hepatitis B, C.
• Blood test for HIV.

Liver and gallbladder tests may also be ordered before surgery.:

Preparation for laparoscopy of the gallbladder

Before a surgical intervention in a hospital, a surgeon and an anesthesiologist approach the patient. They talk about the upcoming operation and anesthesia, provide information about possible consequences and complications, answer patient questions. At the end, they ask for written confirmation of consent to the operation and anesthesia.

It is desirable that the patient begins to prepare for laparoscopy in advance, before admission to the hospital. The doctor gives advice on diet and exercise. This will help make the operation easier.

Chronic diseases should be treated before laparoscopy.

Hospital preparation:

• On the eve of the operation, the patient is prescribed a light meal. Her last reception takes place at 19.00 - after that you can’t eat.
• On the day of the operation in the morning it is forbidden to eat and drink.
• The night before and in the morning before laparoscopy make a cleansing enema. The day before the intervention, the doctor may prescribe a laxative.
• In the evening or in the morning you need to take a shower, shave off the hair from the abdomen.
• If you are taking medication, ask your doctor if you can drink it on the day of your laparoscopy.
• The night before and shortly before the operation, the patient is given special sedatives.
• Before you go to the operating room, you need to take off your glasses, contact lenses, jewelry.

Anesthesia for laparoscopy of the gallbladder

During laparoscopy of the gallbladder, general endotracheal anesthesia is used. First, the anesthesiologist puts the patient to sleep using mask anesthesia or intravenous injection. When consciousness is turned off, the doctor inserts a special tube into the trachea and delivers gas for anesthesia through it - this way you can better control breathing.

How is the operation performed?

The patient is placed on operating table on the back. Possible positions:

Each doctor chooses a method that is more convenient from his point of view.

During laparoscopic operations on the gallbladder on the abdomen, 4 punctures are usually made strictly in the prescribed sequence:

• First- just below the navel (sometimes - a little higher). A laparoscope is inserted through it, the abdominal cavity is filled with carbon dioxide using an insufflator. All other punctures are made under the control of a video camera - this helps not to damage the internal organs.
• Second- in the middle just below the sternum.
• The third- 4-5 cm below the costal arch on the right on a vertical line mentally drawn through the middle of the clavicle.
• Fourth- at the level of the navel, on a vertical line mentally drawn through the front edge of the armpit.

Sometimes, if the liver is enlarged, a fifth hole has to be made. Today, cosmetic surgery on the gallbladder has been developed, which is done through three punctures.

First, the surgeon always examines the gallbladder and liver, determines the existing pathological changes. If a diagnostic laparoscopy was originally planned, then it can end there or, if necessary, move to a treatment one.

If the operation cannot be performed laparoscopically, then the surgeon makes an incision.

After the laparoscopy of the gallbladder is completed, the puncture sites are sutured (usually one suture per puncture). In the future, in these places there are slightly noticeable scars.

Indications for diagnostic laparoscopy of the gallbladder

• Suspicion of a malignant tumor of the liver or gallbladder when it cannot be detected using other diagnostic methods.
• Determination of the stage of a malignant tumor, its germination in neighboring organs.
• Liver disease that cannot be accurately diagnosed without laparoscopy.
• Accumulation of fluid in the abdomen, the cause of which cannot be determined.

Laparoscopic surgery on the gallbladder

Currently, for diseases of the gallbladder, the following types surgical interventions:

• Laparoscopic cholecystectomy- removal of the gallbladder laparoscopically. This is one of the most common interventions in endoscopic surgery.
• Choledochotomy- Dissection of the common bile duct.
• Anastomoses- creating messages between the bile ducts and other organs of the digestive system to improve the outflow of bile.

Indications for laparoscopic cholecystectomy

Indication	Description
Chronic calculous cholecystitis	The disease is characterized by inflammation in the wall of the gallbladder and the formation of stones in its lumen. In fact, this is one of the manifestations of cholelithiasis. Chronic calculous cholecystitis develops as a result of metabolic disorders, eating large amounts of fatty foods. Symptoms: soreness and feeling of heaviness under the right rib; feeling of bitterness in the mouth; nausea; periodic attacks of biliary colic - severe pain under the right rib, usually occurring after dietary errors. To clarify the diagnosis, the doctor prescribes an ultrasound examination, radiography with contrast.
gallbladder cholesterosis	A very rare disease in which fats accumulate in the wall of the gallbladder. Pathology often occurs in young people. The causes of cholesterosis of the gallbladder have not been fully established. The disease occurs against the background of metabolic disorders and is often combined with cholelithiasis. Symptoms: paroxysmal pain under the right rib; indigestion. Since cholesterosis of the gallbladder is often combined with chronic calculous cholecystitis, it often manifests itself with similar symptoms. Diagnosing the disease is quite difficult. Most often, such patients are treated with a diagnosis of cholelithiasis. Cholesterosis of the gallbladder can be detected using ultrasound, radiography with contrast enhancement. Sometimes the diagnosis is established after surgery, when a fragment of the gallbladder is sent for a biopsy.
Polyposis of the gallbladder	A polyp is a benign tumor of the gallbladder wall that protrudes above the surface of its mucous membrane. It can occur as a result of metabolic disorders, genetic predisposition, autoimmune reactions, consumption of large amounts of fatty, fried, spicy foods. Gallbladder polyps occur in 3-4% of people. 80% of patients are women over the age of 35 years. Often, gallbladder polyps do not manifest themselves in any way. Dull pains under the right rib may disturb. Indications for cholecystectomy in gallbladder polyposis: a combination of polyps and cholelithiasis; polyps larger than 1 cm; severe pain and other symptoms that greatly disturb a person, reduce his quality of life; detection of gallbladder polyps in a person suffering from familial intestinal polyposis - a hereditary disease; a rapid increase in the size of the polyp - this increases the risk of its malignant rebirth.
Acute cholecystitis	The disease is characterized by acute inflammation in the wall of the gallbladder. Possible reasons: Cholelithiasis. In this case, acute calculous (stone) cholecystitis is diagnosed. Violation of blood circulation in the gallbladder in the elderly. Acute non-calculous (calculous) cholecystitis is diagnosed. In severe cases, destruction of the gallbladder wall occurs. Inflammation can spread to neighboring organs, the abdominal cavity. There is a risk of developing peritonitis. In all cases, with acute cholecystitis, removal of the gallbladder is indicated. Most often this is done laparoscopically. Symptoms: severe pain under the right rib; nausea, vomiting; an increase in body temperature up to 38 ° C; after taking painkillers and antispasmodics, there is no improvement. Treatment: when the patient enters the hospital, he is prescribed intravenous infusion of fluid through a dropper; if this does not help, then laparoscopic cholecystectomy is performed on an emergency basis; if after intravenous infusions the condition improves, then the patient begins to prepare for a planned operation.

Indications for choledochotomy:

Indications for the imposition of anastomoses:

• Cholelithiasis. After removing the gallbladder, the surgeon sutures the bile duct to the duodenum.
• Narrowing of the bile ducts.

Contraindications to laparoscopic interventions on the gallbladder

• Myocardial infarction in the acute period. The patient's heart may not withstand the stress during the operation.
• Stroke, acute cerebrovascular accident. A patient in this condition should not be given general anesthesia.
• A bleeding disorder that cannot be corrected in any way.
• Peritonitis is an inflammation of the abdominal cavity, covering a large area.
• Obesity III and IV degree. At the same time, laparoscopy of the gallbladder becomes difficult, complications occur more often.
• Late pregnancy.
• Gallbladder cancer. Diagnostic laparoscopy may be performed, but bladder removal is contraindicated.
• Seal in the neck of the gallbladder, which greatly complicates surgical procedures.

Relative contraindications(under certain circumstances, the doctor may still prescribe surgery):

• inflammation of the common bile duct;
• jaundice as a result of blockage of the bile ducts by a stone or tumor and a violation of the outflow of bile;
• acute pancreatitis - inflammation of the pancreas;
• Mirizzi syndrome - inflammation and destruction of the walls of the neck of the gallbladder as a result of compression of its lumen by a stone, narrowing and fistula formation;
• compaction (sclerosis) and reduction in size (atrophy) of the gallbladder;
• cirrhosis of the liver;
• acute cholecystitis, if more than 3 days (72 hours) have passed since the onset of the first symptoms;
• operations in the upper abdomen, transferred less than 6 months ago;
• peptic ulcer of the stomach and duodenum.

In what cases will the surgeon be forced to stop laparoscopy and switch to open surgery?

Indications for incision and open surgery:

• severe swelling of the gallbladder and surrounding tissues, which does not allow for safe laparoscopic surgery;
• a large number of adhesions;
• suspicion of a malignant tumor of the gallbladder or bile ducts;
• fistula between the gallbladder and intestines;
• destruction of the wall of the gallbladder as a result of the inflammatory process, an abscess in the gallbladder;
• vascular damage and bleeding;
• damage to the bile ducts;
• damage to internal organs.

How is the postoperative period?

• On the day of surgery, the patient is usually allowed to get up, walk, and take liquid food.
• The next day you can eat normal food.
• Approximately 90% of patients can be discharged within 24 hours after surgery.
• Working capacity is restored within a week.
• Small bandages or special stickers are applied to postoperative wounds. The stitches are removed on the 7th day.
• After the operation, pain may be present for some time. To remove them, use conventional painkillers.

What complications are possible after laparoscopic gallbladder surgery?

Complications are possible with any operation, and laparoscopy of the gallbladder is no exception. Compared to open surgery through an incision, interventions using endoscopy have a very low risk of complications - only 0.5%, that is, in 5 out of 1000 operated on.

The main complications of laparoscopy of the gallbladder:

• Bleeding due to vascular injury. Bleeding at the trocar insertion site can most often be stopped with sutures. Bleeding from the liver can be stopped by electrocoagulation. If a large vessel is damaged, the surgeon is forced to make an incision and continue the operation in an open way.
• Bile duct injury. This also often requires a transition to open surgery. If bile remains in the abdominal cavity, this will lead to the development of inflammation. At the same time, after laparotomy, the patient is worried about severe pain under the right rib, the body temperature rises.
• Suppuration at the site of surgery. Occurs rarely. It is easy to deal with it due to the small size of the punctures. The doctor prescribes antibiotics. If an abscess forms under the skin, then it is opened.
• Damage to internal organs. Most often, during laparoscopy of the gallbladder, damage to the liver occurs. Slow bleeding occurs - it can be easily stopped with the help of an electrocoagulator.
• Damage to the intestine during the puncture of the abdominal wall with a trocar. In most cases, after this, it is necessary to make an incision and suture the damaged intestine.
• Subcutaneous emphysema- accumulation of gas under the skin. This happens if the trocar did not get into the abdominal cavity, but under the skin, and the doctor began to supply air with an insufflator. Most often, this complication occurs in overweight people. A swelling forms at the puncture site. This is not dangerous - usually the gas resolves itself. Sometimes it has to be removed with a needle.
• Spread of the tumor in the abdomen. If the patient has a malignant tumor of the liver or gallbladder, then during laparoscopy, tumor cells may spread throughout the abdominal cavity. The patient has symptoms that resemble inflammation. And only later, during the examination, metastases are detected.

Where does bile go from the liver after gallbladder removal? Can stones form in the bile ducts?

At healthy person From the liver, bile enters the gallbladder, where, accumulating, it reaches a certain concentration. As food arrives, concentrated bile from the bladder is released into the duodenum and is involved in the digestion and absorption of fats: butter and vegetable oil, meat fat, fish, sour cream, milk and other products.
After removal of the gallbladder, bile enters the duodenum directly from the liver through the hepatic and common bile ducts. Therefore, it is less concentrated and can act as digestive juice only in relation to small portions of food.
If a person does not comply correct mode nutrition, there is stagnation of bile in the liver. And then there is a danger of the development of an inflammatory process in the intrahepatic passages (cholangitis) and even, although rarely, the formation of stones in them. That is why after the operation the patient is supposed to eat a little, but often (6-7 times a day). After all, each meal is a kind of push that contributes to the active release of bile into the duodenum.

Is a special diet needed?

Answer:

In the first three to four months after surgery, the body gradually adapts to the new digestive conditions. During this period, a sparing diet is recommended: only boiled, pureed dishes. Then the diet is gradually expanded, including unpurified meat and fish, raw fruits and vegetables in the diet. Nutrition should be complete: a sufficient amount of protein - meat, fish, cheese, cottage cheese; carbohydrates - white bread, cereals, fruits and vegetables. Vitamins and mineral salts are needed, which for the most part come with food, but sometimes the doctor prescribes the patient and pharmaceutical preparations of vitamins.
Foods that contain a large amount of cholesterol are not recommended: it contributes to the formation of stones. They limit fats, completely exclude indigestible ones - pork, beef, mutton. Butter at first is allowed no more than 20 grams per day, vegetable oil, no more than 40 grams. Then, when the doctor allows you to expand the diet, the amount of fat can be brought to the norm - 80-100 grams. It should not be forgotten that fats are found in many foods. It must be borne in mind that refractory fats and even easily digestible, consumed in excess, suppress liver function. Pickles, smoked meats, marinades, alcoholic beverages are also excluded.

Is there a special gymnastics that prevents stagnation of bile?

One or two months after the operation (depending on the patient's well-being), the doctor allows a daily walk for 30-40 minutes. Walking in the fresh air is both a muscle load that helps fight bile stasis and an improvement in oxygen saturation of body tissues. And if there is no oxygen deficiency, then the metabolism will be intense, and the activity of the liver, in particular the process of bile secretion, will also normalize.
A few days after the start of daily walks, you should also start morning hygienic gymnastics. Physical exercise activates the function of the abdominal organs, including the liver, thereby facilitating the discharge of bile.
Classes are recommended to start with a quiet walk for one and a half to two minutes; breathing is voluntary. Then perform exercises in a standing position and lying down.
These exercises are not burdensome and bring undoubted benefits. It is possible to expand this complex and do exercises in which the abdominal muscles are intensively reduced (tilts, raising the legs and body from a prone position), not earlier than six months after the operation, if the state of health is quite satisfactory.
Within 6-12 months after surgery, heavy physical activity, especially associated with tension in the abdominal muscles, is not allowed. This can cause the formation of a postoperative hernia. For obese people whose abdominal muscles are weakened, doctors recommend wearing a special bandage. It is put on in the morning, without getting out of bed, and removed at night. The duration of wearing a bandage is largely determined by the well-being of a person and the course of the postoperative period.

Exercises
Standing, feet shoulder width apart. Turning the body to the right and left with simultaneous spreading of the arms to the sides - inhale. Lower your hands - exhale. Repeat 4-6 times.
Standing, feet shoulder-width apart, hands on the belt. Take your elbows back - inhale, return to the starting position - exhale. Repeat 6-8 times.
Lying on your back, legs extended, arms along the body. Bend the leg, bringing it as close to the stomach as possible, exhale, straighten the leg, inhale. The same with the other leg. Repeat 4-6 times.
Lying on your back, legs bent right hand on the stomach, left along the body - While inhaling, stick out the stomach, while exhaling, pull it in strongly. Repeat 4-6 times.
Lying on your back, legs straight, hands on the belt. Raise and take the straight leg to the side - exhale, lower - inhale. The same with the other leg. Repeat 4-6 times.
Lying on your back, legs bent, arms along the body. Sliding your heels on the floor, stretch your legs - inhale, just as slowly bend them - exhale. Repeat 4-6 times.
Lying on your side, legs straight. One hand is on the belt, the other is behind the head. Bend the leg lying on top - exhale, unbend - inhale. The same with the other leg, turning to the other side. Repeat 4-6 times.
Lying on your side, legs bent. While inhaling, stick out the stomach, while exhaling, pull it in strongly. Repeat 6-8 times.
Standing, feet shoulder-width apart, hands to the shoulders. Circular movements elbows 8-10 times forward and backward. Breathing is arbitrary.

Do I need to drink more and how much exactly so that bile does not stagnate in the liver?

You should not drink more than 1.7-2 liters of liquid, including soups, compotes, jelly. See if all the liquid you drink per day is excreted. To do this, you need to know how much you drank and how much urine was released.
It is useful to drink those drinks that have a choleretic effect - a decoction of wild rose, a decoction of barberry berries, fruit and vegetable, especially tomato, juices, compotes from dried apples, prunes, dried apricots.
Contribute to the dilution of bile and prevent its stagnation of mineral waters - Essentuki No. 4.20, Slavyanovskaya, Smirnovskaya, Naftusya and others. However, cholelithiasis is often accompanied by gastritis, pancreatitis. Therefore, what kind of mineral water, when and how much to drink, the doctor will tell.
Assign mineral water is usually half a cup in the form of heat 30-40 minutes before meals, but not more than three times a day. Pour water into an enamel mug and put it in a saucepan with boiling water, removed from heat, for 3-5 minutes. Drink warm water slowly, in small sips.
Mineral waters, as a rule, are used in courses. After a month of daily intake, it is recommended to take a break for two to three months, and then repeat the course of treatment again for a month.
Usually, after surgery, medicinal herbs are also widely used to stimulate the separation of bile.
Here one of the compositions of choleretic tea: immortelle flowers - 3 parts, yarrow grass - 5 parts, rhubarb roots - 2 parts. A tablespoon of the mixture is brewed with a glass of boiling water. Infuse tea in a closed enameled or glass bowl for 40-45 minutes. Drink warm half a glass two hours after eating.
For some patients, doctors recommend choleretic agents in the form of extracts, concentrates, tablets (liquid extract of corn stigmas, dry immortelle concentrate, and others).
One more well-known remedy - allochol. It contains extracts of nettle, garlic, dry bile, activated charcoal and not only enhances the separation of bile, but also increases the secretory and motor activity of the stomach and intestines, and this is very important. Constipation for those who have undergone an operation to remove the gallbladder is a great evil.
All these drugs are prescribed strictly individually.

How to do tubage? and what to use for this?

Answer:

In those who have undergone surgery, sometimes, despite observing the diet, bile stagnates in the liver. Such patients are recommended to periodically carry out the so-called probeless tubage. It can be made with mineral water and xylitol. Here is one of the options for such a tube.
In the morning on an empty stomach, after drinking a solution of xylitol (one or two teaspoons per half a glass of water), and then a glass of warm mineral water (Essentuki No. 4 or Borjomi, Slavyanovskaya, Naftusya, Arzni), you need to lie on your back for an hour. Only one mineral water can be used for tubeless tubage. Lying on his back, the patient drinks a bottle of warm water prescribed by the doctor for one to two hours.

How long after the operation can I go to the resort? When is it allowed to swim, ski?

Answer:

Spa treatment is necessary mainly for those who have had complicated calculous cholecystitis, as well as in the presence of concomitant diseases of the digestive system. Drinking resorts are recommended, which one will be advised by the attending physician. Usually it is allowed to go no earlier than six months after the operation.
Sea bathing is not contraindicated: swimming is even useful, as the water has a kind of massaging effect. You can go to the sea and swim six months to a year after surgery.
Skiing at a relaxed pace is not only allowed, but recommended. When to start these walks, the attending physician will tell. Of course, there can be no talk of any sports competitions, participation in cross-country races, since overloads are dangerous. Dosed physical activity is necessary.

***
Heartburn in people without gallstones occurs quite often due to digestive problems. The reason for this is a small reflux of bile into the stomach, which irritates the gastric mucosa. It turns out that the level of acidity rises and therefore heartburn occurs. In Moscow, at the Gastroenterological Institute, they are treated as follows:
use on an empty stomach in the morning and at night herculean jelly. Boil herculean porridge in water without salt and oil and then pass it through a fine sieve or in a blender, you get a thick mass (not very in appearance, but you can eat it), eat half a cup with a spoon, well, or how much it turns out - there will be no problems with heartburn . This jelly envelops the stomach and allows bile to leave the stomach, enveloping it, a very good prevention of gastritis. It is useful to sit on a boiled and soup diet, the main thing is that the food comes often and a little bit, it is better not hot, but warm, do not drink coffee, even with milk.

***
Diet from the book of Evgeny Snegir after removal of the gallbladder - healthy recipes, menus. Diet number 5.

Recipes of dietary dishes correspond to the principles of diet No. 5 and are used in the recovery period after removal of the gallbladder. It is very good when a dish prepared with love is not only healthy, but also uplifting, gives a charge of vivacity and strength. All this, of course, contributes to a speedy recovery.

Salads and appetizers

Sandwich "Chicken with egg". To prepare a sandwich, we need: 100 g of boiled chicken meat, 100 g of apples, 100 g of tomatoes, 100 g of yesterday's white bread, 50 ml of yogurt, 50 g of tomato puree, 3 hard-boiled eggs (we use only proteins), parsley and dill, onion, salt.

It is necessary to pass boiled meat, 2 egg whites, apples, tomatoes and onions through a meat grinder. Salt, then add yogurt and tomato puree, mix everything well. Then grease the slices of dry bread with the resulting mass, decorate with the remaining chopped egg white and finely chopped parsley and dill.

Tongue stuffed with cheese. Take: 200 g of tongue, 150 g of hard cheese, 50 g of mayonnaise, salt, herbs.

The tongue must be boiled until tender in salted water, then cleaned under cold water and cut into thin slices. On each slice, put minced meat from grated cheese seasoned with mayonnaise and roll up with an envelope. Put on a dish and sprinkle everything with chopped herbs before serving.

Meat salad with vegetables. We will need: 300 g of boiled beef or low-fat boiled sausage, 3-4 pcs. potatoes, 3-4 pickles, 3 eggs, 500 ml canned green peas, 1 onion, 250 g sour cream, salt.

Boil potatoes and eggs. Then we cut meat, potatoes, cucumbers, onions, eggs into small cubes, then add peas and mix everything well. Season with sour cream and salt to taste. To improve the taste, you can add boiled carrots or an apple to our salad.

New potato salad with dill. Take: 8 potatoes, 4 tomatoes, 2 fresh cucumbers, 4 tbsp. tablespoons finely chopped dill, salt.

New potatoes need to be boiled in their skins, peeled and then cut into cubes. Then cut cucumbers and tomatoes into slices, combine with potatoes and finely chopped dill, salt and mix everything well.

Sprouted wheat salad. We will need: 3 tablespoons of sprouted wheat, 2 tablespoons of walnuts, 1 tablespoon of honey, 1 apple, 50 g of dates, 50 g of raisins.

Pass the walnuts and wheat germ through a meat grinder or grind in a blender, then mix everything with honey. Put the resulting mixture on a plate with a pancake, put a layer of grated apples on top and sprinkle everything with dates and raisins on top.

Diet vinaigrette. Take: boiled potatoes - 1 piece, half boiled beets, half boiled carrots, 1 tablespoon of canned green peas, 1 tablespoon of vegetable oil, dill, salt

It is necessary to cut the vegetables into cubes, season the beets with part of the oil and let stand for 5 minutes. Then combine the chopped vegetables, add the peas, the remaining oil, salt everything and mix. Before serving, put the finished vinaigrette in a salad bowl and sprinkle with chopped dill.

Vinaigrette with fish. We will need: 300-400 g of fish (you can take horse mackerel, sardine, pollock), 1 beetroot, 1 carrot, 2 potatoes, 1-2 pickles, 100 g of mayonnaise, salt and ground black pepper to taste.

Carrots, beets, potatoes must be peeled, boiled and cut into cubes. Cucumbers cut into slices. Boil the fish in a small amount of water, adding spices, then cool and cut into small pieces. Then mix the cooked fish and vegetables with salt, pepper, finely chopped herbs and season with mayonnaise.

Vinaigrette with seaweed. Let's take: 100 g of canned seaweed, 1 carrot, 1 beetroot, 1 pickled cucumber, 2 potatoes, 1 onion, 4 tablespoons of vegetable oil, 1 teaspoon of vinegar, sugar, pepper and salt to taste.

Cut cucumber, boiled potatoes, beets and carrots into thin slices. Then add chopped onion and seaweed. Season everything with vegetable oil, vinegar, sugar, pepper, salt and mix well.

First meal

Soup puree from wheat bread and vegetables

To prepare the soup, we need: 2 liters of water, 200 g of wheat bread, 3 potatoes, 2 yolks, 3 tomatoes, half a glass of cream or milk, 3 tablespoons of butter, salt.

Peeled potatoes and tomatoes should be poured with hot water and boiled until tender. Then add slices of bread and cook for 3-5 minutes, then rub through a sieve. Bring the puree mass to a boil, then add salt, cream, or you can add milk with yolks. It is best served with butter on the table.

Beetroot. Let's take: beetroot broth - 250 g, beets - 55 g, fresh cucumbers - 65 g, green onions - 15 g, half an egg, sour cream - 15 g, greens - 4 g.

Beets must be boiled, cooled, chopped into thin strips or cubes, and green onions must be chopped and rubbed. Then pour the vegetables with beetroot broth, season to taste with citric acid and sugar. It is best served on the table with an egg, sour cream and herbs.

Mucous decoctions. You will need: cereals - 40 g, water - 400 ml.

To prepare a mucous decoction, you can take rice, millet, hercules, oatmeal or barley groats. Sort rice, millet, oatmeal, rinse with warm and then hot water. Barley and buckwheat groats should be washed with warm water, semolina, small wheat groats and oatmeal should not be washed.

Dip the grits in boiling water or broth and cook under the lid until soft. We cook semolina and oatmeal for 15 minutes, buckwheat and rice for one hour, and pearl barley, unflattened oatmeal and barley groats for 2.5 hours.

The cereals cooked in this way must be wiped through a hair sieve. To speed up the cooking of cereals, you can first grind it in a coffee grinder. To do this, the cereals need to be sorted out, washed and dried, then ground and sifted, and then boiled with stirring.

Carrot Rice Soup. Take: low-fat meat broth - 350 ml, carrots - 160 g, rice - 35 g, butter - 10 g. To prepare the lezon, you need: milk or cream - 100 ml, 1/8 of the yolk.

Carrots must be cut into thin slices and sautéed with butter for 5-6 minutes. Then pour 250 g of broth and add 25 g of washed rice, cook at a low boil for 40-45 minutes. Wipe the finished mass and add the remaining broth to the resulting puree, then heat everything, season with oil and ice cream to taste. For a side dish, it is better to boil rice in broth. Put rice in a bowl with soup, serve on the table along with dried croutons or dry biscuit.

Rosehip soup with apples. We will need: water - 400 ml, dry rose hips - 25 g, fresh apples - 70 g, sugar - 30 g, potato starch - 5 g, cream - 20 ml.

Rose hips should be washed, crushed and boiled in a sealed container for 5-7 minutes, then let it brew for 3-4 hours.

Peel the apples from the skin and seeds, grate on a grater with large holes, then sprinkle with sugar and put in the cold. Apple peels should be boiled for 10 minutes, let it brew, then strain.

Strain the rosehip broth and bring to a boil, put grated apples into it and at the same time pour in the starch diluted with the apple broth. The soup must be allowed to brew and immediately removed from the heat. It is better to serve on the table with small white breadcrumbs and sour cream.

Berry soup with semolina. Take: water - 350 ml, berries: raspberries, strawberries, black currants - 150 g, semolina - 15 g, sugar - 20 g, cream - 30 ml.

Soup can be made from each berry individually or a mixture of berries can be used. So, the berries need to be sorted out, washed and poured with hot water. Bring to a boil and leave for 10-15 minutes, then rub. Put sugar in the broth, bring everything to a boil again and then, while stirring, pour semolina in a thin stream. Boil the soup for 15 minutes over low heat. It is better to put cream in the soup before serving.
Main courses

Baked cutlets from boiled meat and vegetables. Take: beef meat - 150 g, half an egg, butter - 15 g, cauliflower - 30 g, carrots - 20 g, sour cream - 15 g, cheese - 5 g, wheat flour - 2 g.

It is better to boil meat and vegetables separately, then cool, removing from the broth. Then pass through a meat grinder, add an egg and 10 g of butter. The resulting mass must be knocked out and cut into cutlets. Put in a frying pan greased with butter, pour over sour cream mixed with flour, sprinkle with grated cheese and bake. It is better to serve on the table in the same dish.

Tongue boiled in jelly. To prepare the dish, we need: beef tongue - 120 g, broth - 80 ml, gelatin - 2 g.

The tongue must be thoroughly washed, then scalded with boiling water, scraped with a knife and washed again. Then cook until soft (3-4 hours). Pour hot tongue with cold water and immediately remove the skin, then cool in the broth. Cut the tongue into slices, arrange in molds and pour into the jelly prepared on the broth in which the tongue was boiled and let the dish harden. It is very good to decorate everything with greens, green peas, carrots cut into stars before pouring the jelly dish.

Meat steam cutlets with rice. Take: beef meat - 120 g, rice - 10 g, butter - 15 g.

The meat must be cleaned of fat and tendons and passed through a meat grinder with a fine grate 2-3 times. Sort the rice, rinse and cook a viscous porridge. Then cool, mix with chopped meat, mix everything well and make cutlets with wet hands. Then put on a greased steamer grate and, under the lid, steam until ready. Drizzle with melted butter before serving.

Eggplant stewed in sour cream. We will need: 4 eggplants, 2 tablespoons of butter, 1 cup of sour cream, parsley and salt.

Peel the eggplant, cut into small pieces and add 1 tablespoon of butter. Then fill with water, cover with a lid and cook until tender. Then salt, pour sour cream and boil. It is better to serve on the table with butter and chopped parsley.

Braised salad with green peas. Let's take: 400 g of lettuce, 2 cups of green peas, 4 tablespoons of butter, half a cup of sour cream, 1 cup of vegetable broth, 1 tablespoon of sugar, salt.

The salad must be washed, finely chopped and stewed with green peas, butter, vegetable broth until cooked, then add salt and sugar. Best served with sour cream.

Zucchini soufflé. We will need: 4 zucchini, 6 tablespoons of butter, 4 tablespoons of wheat flour, 2 cups of milk, 4 tablespoons of grated cheese, 4 eggs, 3 tablespoons of ground crackers, salt.

Peeled zucchini should be grated on a coarse grater, salted and left for 30 minutes in a sieve or colander to glass the liquid. Then simmer with 1 tablespoon of butter. From the remaining butter, flour and milk, you need to prepare the sauce, cool it, then add grated cheese, whipped yolks, stewed zucchini to the sauce, and only lastly add the whites whipped into foam. Place the prepared mass in a mold, previously greased with oil and sprinkled with breadcrumbs. Bake the dish in the oven.

Rabbit soufflé. Take: rabbit meat - 150 g, butter - 20 g, wheat flour - 5 g, milk - 75 ml, half an egg.

We separate the meat from the bones and clean it from the tendons, put it in a saucepan, add water to 1/3 of the height of the saucepan. Under the lid, let's start until half cooked, after which we will turn the meat through a meat grinder 2-3 times and, whisking with a wooden spoon, we will gradually add milk sauce. Then you need to put 5 g of melted butter and add whipped protein, mix everything thoroughly from bottom to top. Put the resulting mass into a mold, greased with oil, and heat it for a couple until cooked. On the table, the dish is best served with vegetable puree.

Pike boiled with milk. To prepare the dish, we need: pike - 120 g, milk - 60 ml, butter - 10 g, parsley - 5 g, roots - 5 g, onions - 10 g.

The fish must be cleaned and washed well. Then separate the fillet and cut into portions, pour milk diluted in half with water, add parsley root, parsnip, onion and cook over low heat under a lid for 10 minutes. Drizzle the fish with melted butter and sprinkle with herbs. It is better to serve the dish on the table with vegetable or mashed potatoes.

Boiled pike perch in Polish. Take: fresh pike perch - 125 g, butter - 25 g, half an egg, lemon juice - 3 g, parsley - 5 g.

The pike perch pulp must be separated from the bones and cut into portions, then dipped in boiling water, to which roots, bay leaf and onions are added. Cook over low heat for 10 minutes.

While the pike perch is cooking, prepare the sauce. To do this, chop a hard-boiled egg, parsley and add everything together with lemon juice to the butter.

We take out the boiled pike perch from the water and pour over the prepared sauce. Serve the dish on the table with boiled potatoes.

desserts

Carrot puree with honey. To prepare mashed potatoes, we need: 8 carrots, 2 tablespoons of honey, 2 tablespoons of butter, 1 glass of water and juice of one lemon.

Peeled carrots need to be grated on a coarse grater and pour water. Then simmer over low heat until tender and the water has evaporated. Then add lemon juice, honey and butter, mix everything well.

Stewed carrots with prunes. Take: carrots - 180 g, prunes - 40 g, oil - 5 g, honey - 30 g.

Wash the prunes, fill with cold water and let it swell. Then we remove the bones from the prunes. Peeled carrots cut into small slices and sticks. Simmer with the addition of water and oil until half cooked.

Add pre-cooked prunes to the carrots, put honey and simmer everything together until the dish is soft.

Apples stuffed with cottage cheese. We will need: apples - 150 g, fat-free cottage cheese - 100 g, raisins - 10 g, sugar - 15 g, semolina - 10 g, a third of an egg, sour cream - 30 g.

Two large apples must be cut across, core removed and shaped into cups. Pass cottage cheese through a meat grinder and mix with raisins, chopped apple pulp, eggs, sugar and semolina. Then fill the cups with the resulting mass and bake in the oven, making sure that the apples do not lose their shape. On the table, the dish is best served with sour cream.

Curd cheesecakes with fruits. Take: fat-free cottage cheese - 100 g, wheat flour - 15 g, a third of an egg, apples - 50 g, raisins - 10 g, butter - 5 g, sour cream - 40 g.

Pass the cottage cheese through a meat grinder, add 12 g of flour, sugar and eggs. The resulting mass is divided into 2-3 portions in the form of cups and put on a greased frying pan.

Finely chop the peeled apples, mix them with washed raisins, sugar (1/3 part) and fill the curd cups with the minced meat. In 15 g of sour cream, add 3 g of flour and pour the cheesecakes with the resulting sauce, after which we put them in the oven to bake. Serve with sour cream on the table.

Curd paste with apples and honey. We will need: cottage cheese - 75 g, honey - 20 g, apples - 30 g, sour cream - 20 g, butter - 10 g, sugar - 10 g.

Cottage cheese must be passed through a meat grinder or can be rubbed through a sieve. Add softened butter, raw grated peeled apples, sugar and sour cream to the cottage cheese, mix everything well. Put the cooked pasta on a plate and cool slightly. Drizzle with honey before serving.

curd pudding, baked with cheese. Take: fat-free cottage cheese - 120 g, semolina - 10 g, milk - 20 ml, cheese - 10 g, half an egg, butter - 5 g, sour cream - 30 g.

Pour the cereal with milk for 10 minutes. Pass the cottage cheese through a meat grinder and mix with 5 g of grated cheese, yolks, cooked semolina and carefully add whipped proteins, mix everything well. Put the resulting mass on a greased frying pan, sprinkle with the remaining cheese. Then you need to sprinkle with oil and put in the oven for baking. Best served with sour cream.

Rice pudding. We need: 1 cup rice, 4 cups milk, 3 tablespoons sugar, 1 tablespoon butter, 4 eggs, 2 tablespoons raisins, 1 tablespoon ground breadcrumbs, 2 tablespoons fruit syrup, salt.

You need to cook rice milk porridge, add sugar and butter. Cool the dish and mix with washed raisins, yolks and whipped whites. Then put the resulting mass into a mold, greased with oil and sprinkled with breadcrumbs. The oven can be in the oven or in a water bath. On the table, pudding is best served with fruit syrup.

The drinks

Pureed apple compote.

To prepare compote, we need: 2 apples, 20 g of sugar, 150 g of water.

Apples need to be washed, peeled and seeds, and then finely chopped. Then pour water and bring to a boil, then rub together with the liquid, add sugar and bring to a boil again.

Compote from a mixture of dried fruits Let's take: dried fruits, water, sugar.

Sort the dried fruits of dried fruits, rinse well, pour hot water and heat to a boil. Then add sugar and cook: pears - 1-2 hours, apples - 20-30 minutes, apricots, prunes and dried apricots - 10-20 minutes, raisins - 5-10 minutes.

Rosehip decoction. We will need: 200 ml of water and 20 g of dry rose hips.

Dried rose hips should be cleaned of seeds, hairs and sufficiently crushed. They must be washed with cold water and pour boiling water. Then boil for 10 minutes in a stainless steel bowl with a tightly closed lid. Then you need to insist 3-4 hours in a cool place and then strain.

Bon appetit!

I wish you all good health. Cook simple meals, best at home. Try to avoid everything harmful, fatty, smoked, salty, etc. Eat simply and heartily. Health to all. I hope this simple recipe will help you with this.

According to studies, with diabetes, the risk of gallstones increases by almost 2-3 times. They are found in 30% of patients with diabetes mellitus, with the majority of patients being women. In some cases, it becomes necessary to remove the calculus along with the gallbladder in order to prevent the risk of recurrence. After removal of the gallbladder, the patient's life changes dramatically, there is a risk of complications in the work of the gastrointestinal tract.

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  Complications after removal of the gallbladder

  The most severe consequence of the removal of the gallbladder is the "postcholecystectomy syndrome". Various research centers give a different probability of this complication - from 5 to 10%. Moreover, in 20-30% of cases, the cause of this is the remains of the stone.

  Symptoms of "postcholecystectomy syndrome"

  After certain period the time elapsed since the removal of the gallbladder, the patient may experience hepatic colic, pain in the side or obstructive jaundice.

  Complications can be treated surgically or conservatively. Surgical intervention is resorted to when the treatment of the causes of cholecystectomy is unsuccessful.

  

  Performing a second operation is more dangerous than the first, because it is more difficult for the patient. According to statistics, repeated surgical intervention helps patients in 79% of cases. If the patient refuses a second operation, which was recommended by the attending physician, this can lead to the development of severe complications.

  

  The consequences of the development of concomitant diseases

  If, after the first operation, the patient has a temperature, nausea and pain for a long time, then this may be caused by the developed concomitant diseases. For this reason, the patient before and after the operation is assigned to undergo a complete examination for the general condition of the body and the presence of other diseases.

  In the presence of the following diseases, the patient after removal of the gallbladder develops various ailments:

  • pathology of the biliary tract;
  • exacerbation of liver disease;
  • diseases of the pancreas;
  • reflux;
  • dysfunction of the sphincter of Oddi;
  • chronic hepatitis.

  

  Pain due to surgery

  After removal of the gallbladder, pain in the abdomen often occurs. The reason for this is not always manifested complications or diseases of other organs. Pain appears due to the characteristics of the surgical intervention.

  

  Emerging ailments can be characterized by several parameters:

  1. 1. Localization. Usually pain occurs under the right hypochondrium, at the site of the removed gallbladder and the location of the scar. Perhaps it will be felt in the subclavian zone.
  2. 2. Intensity. It can be different depending on the threshold of sensitivity of the operated.
  3. Duration. It can last from a couple of hours to several days after the operation. The duration is affected by the use of the following surgical methods:
     • abdominal or laparoscopic incision;
     • introduction carbon dioxide into the abdominal cavity to improve visibility by pushing the organs apart during the operation.

  If the surgeon performed a laparoscopy during the operation, then the patient may experience aching, dull and constant pain in the stomach area, which is usually aggravated by breathing or coughing. The duration of pain is about 1 month, because it is caused by the body's adaptation to functioning without a gallbladder.

  Biliary peritonitis

  The patient may develop biliary peritonitis or jaundice due to the accumulation of bile in the abdomen. The signs of this pathology are:

  • nausea;
  • pain in the navel area;
  • vomit;
  • chilliness with cold sweat.

  In the presence of such symptoms after removal of the gallbladder, it is urgent to consult a doctor and take tests.

  Diarrhea due to lack of gallbladder

  Due to surgical intervention in the abdominal cavity, the patient's digestive process is disturbed, the most serious complications occur in the intestines. When the gallbladder is removed, changes in the activity of the gastrointestinal tract can be of a different nature and severity.

  Due to the fact that the gallbladder is part of the gastrointestinal tract, many patients immediately experience malfunctions in the corresponding organs after the operation. They complain about:

  • increased gas formation;
  • bloating;
  • diarrhea.

  In 20% of cases, patients due to and intestinal disorders have bloody diarrhea and fever. To eliminate discomfort before discharge, patients are prescribed dietary therapy and medications. In rare cases, diarrhea may persist for several years after the removal of the gallbladder. In this case, a complication of cholecystectomy is commonly called hologenic diarrhea.

  

  Hologenic diarrhea can be characterized as follows:

  • liquid stools acquire a light yellow or greenish tint due to dilution with bile;
  • pain in the right side;
  • chronic course of the disease without tangible positive dynamics.

  With persistent hologenic diarrhea, the body becomes dehydrated, which causes jaundice. The situation can be aggravated by vomiting. It is necessary to undergo medical treatment, drink plenty of water and follow a diet to eliminate diarrhea.

  Heartburn

  The gallbladder in the gastrointestinal tract performs a special important function. The bile that has entered the bladder from the liver changes its composition and is sent to the gastrointestinal tract to break down proteins and fats that are absorbed in the duodenum.

  After removal of the gallbladder, bile from the liver enters the gastrointestinal tract without changing the composition and quantity, regardless of the presence of food in it. Under the influence of fluid in the choledochus (common bile duct) and pressure in the remaining channels, bile immediately enters the duodenum, causing epigastric heartburn of varying intensity. This weakens the sphincter between the stomach and small intestine.

  Gradually, the situation worsens, bile emissions become more intense, the level of pressure in the channels increases, weakening the lower esophageal sphincter. Subsequently, the patient has burning painful attacks, accompanied by eructations and a bitter taste in the mouth.

  Developed heartburn against the background of the absence of the gallbladder must be treated, since the content of bile in the gastrointestinal tract gradually increases. A lot of cholesterol is formed, the amount of useful bile acids and elements for restoring liver activity decreases. As a result, cirrhosis of the liver and stomach ulcers may develop.

  Life after gallbladder removal

  Both men and women after removal of the gallbladder are forced to make adjustments to their lifestyle. After the operation, the body needs to adapt, so from this moment a serious adjustment will be required.

  The methods of adjustment and the recovery process depend on the type of surgery. To remove large stones, the method of abdominal incision is used, for small stones, a laparoscopic incision is used. In the second case, recovery is faster.

  

  Diet changes

  Changes in nutrition after removal of the gallbladder do not depend on the presence of complications. Dieting is necessary to prevent postcholecystectomy syndrome, reduce gastrointestinal irritability, and accelerate bile excretion.

  After the operation, you can not eat:

  • fatty and fried foods;
  • alcohol and carbonated drinks;
  • flour and pasta (if you can not refuse - limit the use);
  • pepper, adjika, mayonnaise, spices, etc.;
  • peas, beans, sorrel, lentils, onions.
  • bread of yesterday's freshness;
  • meat, fish, poultry (low-fat varieties);
  • cereals in boiled form;
  • dairy products of low fat content.

  The main thing is to keep the diet. Each meal should have a constant value in calories, do not forget about the same time intervals between meals. It is advised to eat more often, because it prevents the formation of bile. It is highly not recommended to eat cold dishes - food should be warm (40-50 degrees).

  Before eating, it is recommended to drink 200 ml of water without gas. This is necessary to protect the mucous membrane of the stomach and duodenum from bile acids. Water will help patients with heartburn, as it prevents the passage of bile, provoked by the work of the duodenum.

  Physical activity

  For patients without a gallbladder, swimming in pools and open water will be useful, because water has a beneficial effect on the abdominal cavity. You can start swimming no earlier than 6-7 weeks after the operation.

  Passing examinations

  To establish the likelihood of re-formation of stones, it is necessary to undergo a biochemical examination of bile. To do this, the resulting bile is placed for 12 hours in a refrigeration unit.

  When precipitation occurs, the likelihood of re-formation of stones is diagnosed.

  Taking pills

  Medical treatment after removal of the gallbladder is minimal. With inflammation after surgery, a course of antibiotics is prescribed.

  Antibacterial therapy is carried out for only 3 days in the hospital mode to prevent complications.

  The effect of surgery on a woman's reproductive ability

  Removal of the gallbladder has virtually no effect on the reproductive capacity of women. Also, according to statistics, in 85% of cases in women, the absence of a gallbladder does not affect the functioning of other internal organs.

  Due to the excised gallbladder, a woman in the initial period of fetal development may have certain unpleasant symptoms:

  • digestion is disturbed;
  • early toxicosis appears with the resumption of pain and other symptoms of postcholecystectomy syndrome.

  At the same time, patients complain about:

  • pain on the right side under the ribs;
  • sharp pains with a transition to the hypochondrium on the left side, the right shoulder blade or the entire side;
  • feeling of heaviness;
  • discomfort in the side, which provoke nausea, heartburn and bitterness in the mouth;
  • slight pain during fetal movement.

  Treatment with special preparations helps to get rid of these unpleasant symptoms and sensations.

  Pathological changes in the biliary tract can cause complications in the course of pregnancy. When the gallbladder is removed, the risk decreases, but the severity of possible complications increases.

  1. 1. After removal of the gallbladder, pregnancy can proceed with a longer toxicosis (often it lasts up to 20-29 weeks of pregnancy).
  2. 2. During the rehabilitation period, patients are prescribed medications and procedures that can harm the developing fetus. Therefore, women are advised to refrain from conception for at least 6 months for the rehabilitation period.
  3. 3. The transferred operation causes shock in the body and can provoke premature birth.
  4. 4. If there are problems with the bile of the mother and because of the surgery in the newborn, the risk of jaundice increases.

  Disability after gallbladder removal

  Sometimes, after removal of the gallbladder, the patient faces a disability group, which can be any. The Medical and Social Expert Commission pays attention to many symptoms, on the basis of which it makes the following decisions:

  1. 1. The third group. Such patients are moderately limited in their abilities. This group includes patients with a developed chronic inflammatory or calculous process in the gallbladder or with a slight loss of bile through an external fistula.
  2. 2. The second group. It is assigned in case of transition of the disease to a severe stage, the occurrence of complications and the development of diseases of the digestive organs, as well as metabolic disorders. The second group can include patients with a significant loss of bile and a sharp loss of body weight.
  3. 3. The first group. These are sick with a lot handicapped that have arisen due to severe complications - these include anemia or cachexia (extreme exhaustion of the body). The first group of disabled people includes patients who require constant care, or those whose treatment has not brought the appropriate effect.

In a person who has undergone cholecystectomy, life is divided into two stages. The first refers to the preoperative period, the second - after it. The operation is not prescribed from scratch, therefore, the final stage of the first period of life was a certain kind of physical and psychological suffering associated with periodic pain, regular visits to the attending physician, doubts and worries about the upcoming surgical intervention. The postoperative period begins with the fact that “everything is behind us”, and ahead is a period of rehabilitation filled with some uncertainties. However, life after removal continues. The main task at this stage, which worries the patient, is the question of changes in the process of digestion.

The gallbladder, as an organ, is endowed with certain functions. In it, as in a reservoir, bile accumulates and concentrates. It tends to maintain optimal pressure in the bile ducts. But with the diagnosis of calculous cholecystitis, or cholelithiasis, the functions of the gallbladder are already limited, and it practically does not take part in the digestive process.

Throughout the course of the disease, the body independently removes the gallbladder from the digestive process. Using compensatory mechanisms, he fully adapts to new conditions in which the function of the gallbladder is already disabled. The function of bile secretion is assumed by other organs. Therefore, the removal of an organ that has already been removed from their life cycle does not cause a serious blow to the body, since adaptation has already taken place. Through the operation, the organ that contributes to the spread of infection, generating the inflammatory process, is removed. In this case, only relief can come for the patient.

Prompt decision-making on the part of the patient about the upcoming operation largely contributes to the successful outcome of the surgical intervention and a short period of rehabilitation. With timely decision-making, the patient protects himself from complications that may occur as a result of delaying the timing of surgical intervention, casting doubt on the satisfactory condition of the patient in the postoperative period.

Discharging from the hospital, the former patient, and now a person undergoing rehabilitation, is protected from constant visits to manipulation rooms and the constant care of the attending physician. Duodenal sounding and dubazh remained in the life that was before the operation.

True, there are exceptions when the patient does not agree to a surgical intervention for a long time, allowing the disease to affect the body for a long time. An inflammatory process spreading from the walls of the gallbladder can affect neighboring organs, causing complications that develop into concomitant diseases. As a rule, against the background there are problems in the form of gastric ulcer and duodenal ulcer, inflammation of the head of the pancreas, gastritis or colitis.

Patients with complications after gallbladder surgery need additional treatment after discharge from the hospital. The nature of the treatment and the duration of the procedures are prescribed by the leading patient's doctor. The main issue facing both the group of operated patients without obvious signs of complications and patients with complications is the process of nutrition. The diet in the postoperative period is not strict, but excludes animal fats that are difficult to digest by the body:

• pork fat
• lamb fried
• brisket.

Subject to a strict diet in the preoperative period, patients are allowed to gradually introduce new foods into the diet, excluding spicy canned food, strong tea, coffee, and the use of alcoholic beverages is strictly prohibited.

The occurrence of a relapse

Surgery does not affect the composition of bile produced by the body. The production of hepatocytes by stone-forming bile may continue. This phenomenon in medicine is called "Biliary insufficiency". It consists in a violation of physiological norms in an increase in the amount of bile produced by the body and its increasing pressure in the bile ducts. Under influence overpressure, a toxic liquid changes the structure of the mucous membranes of the stomach and intestines.

With a negative prognosis up to the formation of a low-quality tumor. Therefore, the main task in the postoperative period is a biochemical study of the composition of bile, carried out at regular intervals. As a rule, a duodenal examination of the duodenum is performed. It cannot be replaced by ultrasound, since ultrasound is unable to give an appropriate result.

A clear indicator of the occurrence of relapse, or secondary formation of stones, is the placement in the refrigerator of a 5 ml sample of fluid for analysis for a 12-hour period. If sedimentation is observed in the liquid within the allotted time, bile is capable of forming new stones. In this case, drug treatment is prescribed with drugs containing bile acids and bile, being stimulants of bile production:

1. lyobil
2. cholenzim
3. allahol
4. cyclovalon
5. osalmid.

All are used as replacement therapy for biliary insufficiency. A mandatory appointment in such cases is ursodeoxycholic acid, which does not cause intoxication and is harmless to the mucous membranes of the intestines and stomach. It is taken, depending on the prescription, from 250 to 500 mg, once a day, preferably at night. Preparations containing ursodeoxycholic acid:

• Ursosan
• Hepatosan
• Enterosan
• Ursofalk.

Stones can be re-formed, but not in the gallbladder, but in the bile ducts. An exclusion from the diet of foods containing high cholesterol in large quantities can serve as a reducing factor for relapse:

1. fried and spicy foods
2. concentrated broths
3. egg yolks
4. brain
5. fatty fish and meats
6. alcohol
7. beer.

All of the above products are a significant complication for the pancreas and liver.

Dietary nutrition in the postoperative period

Proper nutrition is the key to health after cholecysectomy

Nutrition during the rehabilitation period after removal of the gallbladder is given special attention. The main point is its regularity. The volume of food should be small, and the frequency of meals should be from 4 to 6 times a day. Food, as a stimulant of the bile-forming process, in this case is an irritant for the digestive organs, thus preventing the stagnation of bile. As a natural irritant, food contributes not only to the formation, but also to the excretion of bile from the bile ducts into the intestines.

The most powerful product that promotes bile distillation is. In general, all vegetable fats have a strong choleretic effect. For patients who are prone to fullness, it is advisable to limit or minimize the consumption of foods high in carbohydrates:

• sugar
• potato
• confectionery and pasta
• muffin.

Patients who have undergone surgery to remove the gallbladder are not recommended sanatorium treatment, with the exception of patients with complicated cholecystitis or other concomitant diseases. Depending on the severity of the operation, patients are not recommended to perform heavy physical exertion, or physical work that puts pressure on the abdominals, for 6 to 12 months after the operation. Heavy physical activity can initiate the formation of postoperative hernias. Full, and especially obese patients, it is recommended to wear a bandage during this period.

After the discharge of the patient from the hospital, medical specialists attach great importance to physiotherapy exercises. Specially designed exercises stimulate the abdominal organs to produce and drain bile. Such a “massage” with the help of physical exercises allows you to speed up the process of restoring the functions of damaged tissues of the abdominal region.

Possible consequences of surgery

As a rule, in patients in life after removal of the gallbladder, no negative consequences occur. This is ideal, but real world, a person who has undergone surgery is subject to a whole range of symptoms, in particular psychological ones, called "Postcholecystectomy syndrome".
The sensations accumulated over the years of the disease do not let the patient go even after such a fait accompli as an operation to remove the gallbladder. The former patient is also tormented by dryness and pain in the right hypochondrium, and the appearance of fatty foods also causes intolerance and nausea.

All of these symptoms are psychological state patient and have little to do with the internal processes occurring inside the patient, like a bad tooth that has already been removed, but it continues to give a painful sensation. But if such symptoms continue for a long time, and the operation was not performed in a timely manner, therefore, the causes may be hidden in the development of concomitant diseases. The main reasons leading to negative consequences after removal of the gallbladder:

• Diseases of the gastrointestinal tract
• Reflux
• Pathological changes in the bile ducts
• Poorly performed operation
• Exacerbated diseases of the pancreas and liver
• chronic hepatitis
• Dysfunction of the sphincter of Oddi.

To prevent postcholecystectomy syndrome, a thorough examination of the patient is carried out, both before surgery and in the postoperative period. Great importance is given to the general condition of the patient and the presence of concomitant or chronic diseases. A direct contraindication to surgical intervention to remove the gallbladder may be the presence of pathologies in the patient's body.

Basic diet in the postoperative period

Gallbladder removal is not a death sentence!

The possibility of certain nutritional problems associated with the removal of the gallbladder can be solved by an individual diet for the patient, avoiding the methods of drug exposure to the body. Such an approach to the patient can completely neutralize the postcholecystectomy syndrome that occurs after surgery.

The main point is not the products allowed for use during the rehabilitation period of post-surgical intervention, but the mode of the nutrition process. Food should be divided into small portions and taken frequently at regular intervals. If the patient before the operation ate food 2-3 times a day, then in the period after the operation, he needs to receive from 5 to 6 servings a day. Such nutrition is called fractional and is designed specifically for patients of this profile.

Excludes foods high in animal fats, fried and spicy foods. The focus is on the temperature of the cooked food. For patients, the use of highly chilled or highly heated food is not recommended. The use of carbonated drinks is strictly not recommended. Such recommendations are associated solely with the absence of the gallbladder. Special recommendations include the frequent use of drinking water. Before each meal, the patient is instructed to drink a glass of water, or 30 ml per kilogram of body weight. Water relieves the aggression of bile acids produced by the ducts and is the main source of protection for the mucous membranes of the duodenum and gastrointestinal tract.

In addition, water stops the passage of bile that occurs in initial moment after surgery, when a change in duodenal motility may occur and bile may return to the stomach. At such times, the patient may experience heartburn or bitterness in the mouth. Water resists this process, being a natural neutralizer. Dyspeptic disorders - flatulence, bloating, rumbling, constipation, diarrhea, can also be stopped by taking a glass. Visiting swimming pools, open reservoirs is very useful, because water is a source of soft natural massage for the muscles and internal organs of the abdominal cavity. Water procedures shown after 1-1.5 months after surgery.

In addition to swimming, walking is very useful for patients who have undergone gallbladder removal. A daily walk for 30-40 minutes helps to remove bile from the body and prevents its stagnation. Morning light physical exercises in the form of charging are also recommended. Press exercises are unacceptable, which can be started only a year after surgery.

• Bread. Yesterday's baking, coarse grinding, gray or rye. It is not recommended to eat muffins, pancakes, pancakes, puff pastries.
• Cereals. Buckwheat, oatmeal. Grains should be well boiled.
• Meat, fish, poultry. Low fat varieties. The cooking process is boiled, steamed or stewed.
• The fish is baked. The use of broths is excluded. Soups are prepared on vegetable broths.
• Spices, spices, seasonings, sauces are not recommended.
• Eggs. Only in the form of a protein omelet. The yolk must be excluded.
• except for whole milk. Sour cream - no more than 15% fat.
• Fats. Fats used in food should not be of animal origin.
• Vegetables. Fresh, boiled or baked. Particular preference is given to pumpkin and carrots. It is not recommended to use legumes, garlic, onions, radishes, sorrel.
• Berries and fruits. Preference is given to sweet varieties. Cranberries and Antonovka apples are not recommended for use.
• Sweets. Honey, molasses, natural marmalade on agar-agar, preserves, jams. It is completely necessary to abandon cocoa products, confectionery, ice cream.
• The drinks. The diet should not include carbonated, hot or cold drinks. Rosehip decoction, sweet juices, dried fruit compote are recommended.

In conclusion, it should be noted that prevention after surgery to remove the gallbladder consists in complex physiotherapy, which includes ozone therapy. Ozone, being a natural antibiotic, enhances immunity, destroys colonies of bacteria, viruses and fungal diseases. Ozone helps to correct the functioning of hepatocytes, which are responsible for the formation of bile.

About how people live after removal of the gallbladder, the thematic video will tell:

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Many patients are concerned about the question of how to live after gallbladder removal. Will their life be just as fulfilling, or are they doomed to a disability? Is it possible to fully recover after gallbladder removal? There are no superfluous organs in our body, but all of them are conditionally divided into those without which further existence is simply impossible and those in the absence of which the body can function.

The process in which the gallbladder is removed is a forced procedure, it is a consequence of the formation of stones and a malfunction in the body, after which the gallbladder ceases to function normally. Stones that appear in the gallbladder begin to form due to chronic cholecystitis.

Diet after removal of the gallbladder will prevent the occurrence of postcholecystectomy syndrome.

Can:		It is forbidden:
wheat and rye bread (yesterday);	bread and bakery products	sweet dough;
any cereals, especially oatmeal and buckwheat; pasta, vermicelli;	cereals and pasta
lean meat (beef, chicken, turkey, rabbit) boiled, baked or steamed: meatballs, dumplings, steam cutlets;	meat	fatty meats (pork, lamb) and poultry (goose, duck);
boiled lean fish;	fish	fried fish;
cereal, fruit, dairy soups; weak broths (meat and fish); borscht, cabbage soup vegetarian;	soups	fish and mushroom broths;
cottage cheese, kefir, lactic acid products; mild cheese (including processed cheese);	Milk products
butter in limited quantities; vegetable oil (sunflower, corn, olive) - 20-30 g per day;	fats	animal fats;
any vegetables in boiled, baked and raw form; fruits and berries (except sour ones) raw and boiled;	vegetables and fruits	spinach, onion, radish, radish, cranberry;
cracker;	confectionery	cakes, cream, ice cream; carbonated drinks; chocolate;
	Snacks, canned foods
juices vegetable, fruit; compotes, jelly, rosehip broth	the drinks	alcoholic drinks; strong tea; strong coffee
Essentuki No. 4, No. 17, Smirnovskaya, Slavyanovskaya, sulfate Narzan 100-200 ml warm (40-45 °) 3 times a day for 30-60 minutes, before meals	Mineral water

Postoperative period - stay in the hospital.

After a conventional uncomplicated laparoscopic cholecystectomy, the patient is admitted from the operating room to the intensive care unit, where he spends the next 2 hours of the postoperative period to monitor an adequate recovery from anesthesia. In the presence of concomitant pathology or features of the disease and surgical intervention, the length of stay in the intensive care unit may be increased. Then the patient is transferred to the ward, where he receives the prescribed postoperative treatment. During the first 4-6 hours after the operation, the patient should not drink and get out of bed. Until the morning of the next day after the operation, you can drink plain water without gas, in portions of 1-2 sips every 10-20 minutes with a total volume of up to 500 ml. The patient can get up 4-6 hours after the operation. You should get out of bed gradually, first sit for a while, and, in the absence of weakness and dizziness, you can get up and walk around the bed. It is recommended to get up for the first time in the presence of medical personnel (after a long stay in a horizontal position and after the action of medications, orthostatic collapse is possible - fainting).

The next day after the operation, the patient can freely move around the hospital, start taking liquid food: kefir, oatmeal, diet soup and switch to the usual mode of drinking liquids. In the first 7 days after surgery, the use of any alcoholic beverages, coffee, strong tea, drinks with sugar, chocolate, sweets, fatty and fried foods is strictly prohibited. The patient's nutrition in the first days after laparoscopic cholecystectomy may include fermented milk products: low-fat cottage cheese, kefir, yogurt; porridge on the water (oatmeal, buckwheat); bananas, baked apples; mashed potatoes, vegetable soups; boiled meat: lean beef or chicken breast.

In the normal course of the postoperative period, the drainage from the abdominal cavity is removed the next day after the operation. Drainage removal is a painless procedure, carried out during dressing and takes a few seconds.

Young patients after surgery for chronic calculous cholecystitis can be allowed to go home the next day after surgery, the rest of the patients are usually in the hospital for 2 days. Upon discharge, you will be given a sick leave (if you need one) and an extract from the inpatient card, which will set out your diagnosis and features of the operation, as well as recommendations on diet, exercise and drug treatment. The sick leave is issued for the duration of the patient's stay in the hospital and for 3 days after discharge, after which it must be renewed by the surgeon of the polyclinic.

The postoperative period is the first month after the operation.

In the first month after the operation, the functions and general condition of the body are restored. Careful adherence to medical recommendations is the key to a full recovery of health. The main directions of rehabilitation are - compliance with the regime of physical activity, diet, drug treatment, wound care.

Compliance with the regime of physical activity.

Any surgical intervention is accompanied by tissue trauma, anesthesia, which requires the restoration of the body. The usual rehabilitation period after laparoscopic cholecystectomy is from 7 to 28 days (depending on the nature of the patient's activity). Despite the fact that 2-3 days after the operation, the patient feels satisfactory and can freely walk, walk on the street, even drive a car, we recommend staying at home and not going to work for at least 7 days after the operation, which the body needs to recover . At this time, the patient may feel weak, fatigued.

After surgery, it is recommended to limit physical activity for a period of 1 month (do not carry weights of more than 3-4 kilograms, exclude physical exercises that require tension in the abdominal muscles). This recommendation is due to the peculiarities of the formation of the process of the scar of the muscular-aponeurotic layer of the abdominal wall, which reaches sufficient strength within 28 days from the moment of surgery. 1 month after the operation, there are no restrictions on physical activity.

Diet.

Compliance with the diet is required up to 1 month after laparoscopic cholecystectomy. Recommended exclusion of alcohol, easily digestible carbohydrates, fatty, spicy, fried, spicy foods, regular meals 4-6 times a day. New foods should be introduced into the diet gradually, after 1 month after the operation, it is possible to remove dietary restrictions on the recommendation of a gastroenterologist.

Medical treatment.

After laparoscopic cholecystectomy, minimal medical treatment is usually required. Pain after surgery is usually mild, but some patients require the use of analgesics for 2-3 days. Usually it is ketanov, paracetamol, etol-fort.

In some patients, it is possible to use antispasmodics (no-shpa or drotaverine, buscopan) for 7-10 days.

Taking ursodeoxycholic acid preparations (Ursofalk) improves the lithogenicity of bile, eliminates possible microcholelithiasis.

Taking medications should be carried out strictly according to the instructions of the attending physician in an individual dosage.

Care of postoperative wounds.

In the hospital, postoperative wounds located at the insertion sites of the instruments will be covered with special stickers. It is possible to take a shower in Tegaderm stickers (they look like a transparent film), Medipor stickers (white plaster) must be removed before taking a shower. Showers can be taken from 48 hours after surgery. The ingress of water on the seams is not contraindicated, however, do not wash the wounds with gels or soap and rub with a washcloth. After taking a shower, lubricate the wounds with a 5% iodine solution (either betadine solution, or brilliant green, or 70% ethyl alcohol). Wounds can be treated with an open method, without dressings. Bathing or swimming in pools and ponds is prohibited until the removal of the stitches and for 5 days after the stitches are removed.

Stitches after laparoscopic cholecystectomy are removed 7-8 days after surgery. This is an outpatient procedure, the removal of sutures is performed by a doctor or dressing nurse, the procedure is painless.

Possible complications of cholecystectomy.

Any operation can be accompanied by undesirable effects and complications. Complications are possible after any technology of cholecystectomy.

Complications from wounds.

These may be subcutaneous hemorrhages (bruises) that disappear on their own within 7-10 days. Special treatment is not required.

There may be reddening of the skin around the wound, the appearance of painful seals in the wound area. Most often it is associated with a wound infection. Despite the ongoing prevention of such complications, the frequency of wound infection is 1-2%. If these symptoms appear, you should consult a doctor as soon as possible. Late treatment may lead to wound festering, which usually requires surgical intervention under local anesthesia (debridement of the festering wound), followed by dressings and possible antibiotic therapy.

Despite the fact that our clinic uses modern high-quality and high-tech instruments and modern suture material, in which wounds are sutured with cosmetic sutures, however, hypertrophic or keloid scars may form in 5-7% of patients. This complication is associated with the individual characteristics of the reaction of the patient's tissue and, if the patient is dissatisfied with the cosmetic result, may require special treatment.

In 0.1-0.3% of patients, hernias may develop in places of trocar wounds. This complication is most often associated with the characteristics of the patient's connective tissue and may require surgical correction in the long term.

Complications from the abdominal cavity.

Very rarely, complications from the abdominal cavity are possible, which may require repeated interventions: either minimally invasive punctures under the control of ultrasonography, or repeated laparoscopies, or even laparotomies (open abdominal operations). The frequency of such complications does not exceed 1:1000 operations. These can be intra-abdominal bleeding, hematomas, purulent complications in the abdominal cavity (subhepatic, subdiaphragmatic abscesses, liver abscesses, peritonitis).

Residual choledocholithiasis.

According to statistics, from 5 to 20% of patients with cholelithiasis also have concomitant stones in the bile ducts (choledocholithiasis). A complex of examinations carried out in the preoperative period is aimed at identifying such a complication and using adequate treatment methods (this can be retrograde papillosphincterotomy - dissection of the mouth of the common bile duct endoscopically before surgery, or intraoperative revision of the bile ducts with removal of calculi). Unfortunately, none of the methods of preoperative diagnosis and intraoperative evaluation is 100% effective in detecting stones. In 0.3-0.5% of patients, stones in the bile ducts may not be detected before and during surgery and cause complications in the postoperative period (the most common of which is obstructive jaundice). The occurrence of such a complication requires an endoscopic (with the help of a gastroduodenoscope inserted through the mouth into the stomach and duodenum) intervention - retrograde papilosphinctoromia and transpapillary sanitation of the bile ducts. In exceptional cases, a second laparoscopic or open operation is possible.

Bile leakage.

The outflow of bile through the drainage in the postoperative period occurs in 1:200-1:300 patients, most often it is a consequence of the release of bile from the gallbladder bed on the liver and stops on its own after 2-3 days. This complication may require an extended hospital stay. However, bile leakage through the drainage can also be a symptom of damage to the bile ducts.

Bile duct injury.

Bile duct injuries are one of the most severe complications in all types of cholecystectomy, including laparoscopic. In traditional open surgery, the incidence of severe bile duct injury was 1 in 1500 operations. In the first years of mastering laparoscopic technology, the frequency of this complication increased by 3 times - up to 1:500 operations, but with the growth of surgeons' experience and the development of technology, it stabilized at the level of 1 per 1000 operations. A well-known Russian specialist on this problem, Eduard Izrailevich Galperin, wrote in 2004: “... Neither the duration of the disease, nor the nature of the operation (emergency or planned), nor the diameter of the duct, and even the professional experience of the surgeon affect the possibility of damage to the ducts ... ". The occurrence of such a complication may require repeated surgical intervention and a long period of rehabilitation.

Allergic reactions to medicines.

The trend of the modern world is an increasing increase in the allergization of the population, therefore, allergic reactions to medications (both relatively mild - urticaria, allergic dermatitis) and more severe (Quincke's edema, anaphylactic shock). Despite the fact that in our clinic allergological tests are carried out before prescribing medications, however, the occurrence of allergic reactions is possible, and additional medication is required. Please, if you know about your personal intolerance to any medications, be sure to tell your doctor about it.

thromboembolic complications.

Venous thrombosis and pulmonary embolism are life-threatening complications of any surgical procedure. That is why much attention is paid to the prevention of these complications. Depending on the degree of risk determined by your doctor, preventive measures will be prescribed: bandaging of the lower extremities, administration of low molecular weight heparins.

Exacerbation of peptic ulcer of the stomach and duodenum.

Any, even minimally invasive, operation is stressful for the body, and can provoke an exacerbation of peptic ulcer of the stomach and duodenum. Therefore, in patients at risk of such a complication, prophylaxis with antiulcer drugs in the postoperative period is possible.

Despite the fact that any surgical intervention carries a certain risk of complications, however, the refusal of the operation or the delay in its implementation also carries the risk of developing serious illness or complications. Despite the fact that the doctors of the clinic pay great attention to the prevention of possible complications, a significant role in this belongs to the patient. Performing cholecystectomy in a planned manner, with undeveloped forms of the disease, carries a much lower risk of undesirable deviations from the normal course of the operation and the postoperative period. The responsibility of the patient for strict adherence to the regimen and recommendations of doctors is also of great importance.

Rehabilitation in the long term after cholecystectomy.

Most patients after cholecystectomy completely recover from the symptoms that bothered them and return to normal life 1-6 months after the operation. If cholecystectomy is performed on time, before the occurrence of concomitant pathology from other organs of the digestive system, the patient can eat without restrictions (which does not negate the need for proper healthy nutrition), do not limit himself in physical activity, and do not take special drugs.

If the patient has already developed concomitant pathology from the digestive system (gastritis, chronic pancreatitis, dyskinesia), he should be under the supervision of a gastroenterologist in order to correct this pathology. A gastroenterologist will advise you on lifestyle, diet, dietary habits and, if necessary, medication.