“See these kids? They were born at 24 and 25 weeks with a body weight of only 500 and 600 grams,” Oleg Ionov, head of the neonatal intensive care unit, points to two adjacent boxes.

“Imagine - the child had to remain in the mother’s womb for another half of its term. After birth, he is completely unadapted to life - he cannot breathe on his own, and all body systems are not ready to accept mother’s milk,” Oleg Ionov lifts the cape on the box, showing a tiny body, more reminiscent of a realistic doll than a living child.

Director of the Center Gennady Tikhonovich Sukhikh with colleagues

Oleg Ionov opens transparent boxes with babies especially for us. Most of the time they are covered with thick capes so that the visual system matures in the twilight. The environment on the other side of the glass should be as reminiscent as possible of a mother’s womb. The inside of the box should be dark, warm and quiet.

According to WHO recommendations, the viability limit of an infant begins at 500 g. Previously, this figure was twice as large - a fetus less than 1000 g, roughly speaking, was considered a miscarriage. However, today children who at birth did not even reach the coveted 500 grams are successfully discharged from the neonatal intensive care unit.

The neonatal intensive care ward is more like the location of a science fiction film. Here no one fusses or runs around with medications. Almost all the work is done by machines. Nurses enter the room to record physiological indicators and make sure everything is going according to plan. The plan itself is developed by a team of doctors - individual for each patient. And depending on physiological changes it is constantly being adjusted.

"Our center has good results not just because we use good medicines or good technique, but because we have developed the right system - in what case to use this or that method, when to switch from one to another, when to use this medicine and not another,” lists the components successful work Oleg Ionov.

Difficult breathing

As soon as the baby is born, a whole nursing technology is launched. Taking into account age and concomitant pathologies for a tiny patient, possible risks and a number of appropriate medications, because without the help of doctors, premature babies cannot even take their first breath.

“We immediately give him pulmonary surfactant - this natural preparation, which partially transforms immature lungs into mature ones. This is a complex mechanism that allows the child’s lungs to open, because they bear little resemblance to the lungs of an adult,” says Oleg Ionov.

The child is brought from the delivery room to the intensive care room on respiratory support and then, depending on the severity, he is switched either to a device artificial ventilation lungs (when the breathing tube is located directly in the trachea), or are transferred to non-invasive respiratory support.

“It looks like this,” Oleg Ionov points to one of the boxes. – You see, the baby breathes on his own, but he has cannulas in his nose, through which he also breathes in and out, but at the same time the child controls most of the work of breathing himself. Moreover, now the devices are smart; using special sensors, they sense how the child wants to breathe and adapt to it.”

Instead of mom

Just imagine: the child received all the necessary amino acids, fats, carbohydrates, microelements in the womb - and suddenly this connection was broken. The task of doctors is to calculate what substances and in what volume the baby should receive now, and how these data should change as they grow (or, conversely, lack thereof). This painstaking analysis is the art of neonatologists.

“In the department, under sterile conditions, we create special combined nutritional mixtures, which are then connected to the child. Then we examine his blood to see if the child is absorbing everything well. After this, we make a correction, and if everything goes well, we try to feed the child by mouth,” explains Oleg Ionov. – Gradually we adapt the child to premature formulas or breast milk, that is, we increase the dose of what is given by mouth and reduce the dosage of what is given through the veins. We evaluate how the baby is growing and compare it with certain tables.” “We can adjust the calorie content and even the protein concentration in milk. There are special technologies and preparations that enrich breast milk, because breast milk during prematurity has a very low protein content,” says Oleg Ionov and points to a structure hanging on the wall. – For example, feeding has already ended. You see special syringe pumps, they are tilted, because in breast milk, this is also a whole technology, fat floats up. And in order for the child to receive everything, including fats, so that they do not remain in the adapter, you need to know at what angle to place this syringe.”

The task of doctors is to constantly monitor the condition of small patients and check growth charts, adjust the ratio nutrients in mixtures, monitor the development of all organs and systems, track pain impulses and many other aspects that make up the work of a neonatologist. The work is titanic, but the results are more than worth the effort, especially when another patient is discharged from the department.

Many patients are concerned about the question of how to live after removal of the gallbladder. Will their lives be as fulfilling, or are they doomed to disability? Is it possible to full recovery after gallbladder removal? There are no unnecessary organs in our body, but they are all 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 gallbladder, begin to form as a result of chronic cholecystitis.

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

Can:		It is forbidden:
wheat and rye bread (yesterday's);	bread and bakery products	butter dough;
any porridge, 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 varieties meat (pork, lamb) and poultry (goose, duck);
boiled lean fish;	fish	fried fish;
cereal, fruit, milk soups; weak broths (meat and fish); borscht, vegetarian cabbage soup;	soups	fish and mushroom broths;
cottage cheese, kefir, lactic acid products; mild cheese (including processed cheese);	Dairy
butter in limited quantities; vegetable oil(sunflower, corn, olive) - 20-30 g per day;	fats	animal fats;
any vegetables, boiled, baked or raw; 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
vegetable and fruit juices; compotes, jelly, rosehip decoction	beverages	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 30-60 minutes before meals	Mineral water

The postoperative period is a stay in the hospital.

After a routine uncomplicated laparoscopic cholecystectomy, the patient is transferred from the operating room to the intensive care unit, where he spends the next 2 hours of the postoperative period to monitor adequate recovery from the state of anesthesia. In the presence of concomitant pathology or characteristics of the disease and surgical intervention The length of stay in the intensive care unit may be increased. The patient is then transferred to a ward where he receives the prescribed postoperative treatment. During the first 4-6 hours after surgery, the patient should not drink or get out of bed. Until morning next day You can drink after surgery 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 surgery. 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 horizontal position and after action medical supplies available orthostatic collapse- fainting).

The next day after the operation, the patient can move freely around the hospital and begin taking liquid foods: kefir, oatmeal, diet soup and go back to your normal fluid intake. In the first 7 days after surgery, the consumption of any alcoholic beverages, coffee, strong tea, drinks with sugar, chocolate, sweets, fatty and fried foods is strictly prohibited. The patient's diet in the first days after laparoscopic cholecystectomy may include fermented milk products: low-fat cottage cheese, kefir, yogurt; porridge with 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 surgery. Removing the drain painless procedure, is carried out during dressing and takes a few seconds.

Patients young, after surgery for chronic calculous cholecystitis can be sent home the next day after surgery, other patients usually stay in the hospital for 2 days. Upon discharge, you will be given a sick leave certificate (if you need one) and an extract from the inpatient card, which will outline your diagnosis and features of the operation, as well as recommendations on diet, exercise and medication. A sick leave certificate is issued for the duration of the patient’s stay in the hospital and for 3 days after discharge, after which it must be extended by the clinic surgeon.

The postoperative period is the first month after surgery.

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

Compliance with physical activity regimen.

Any surgical intervention is accompanied by tissue trauma and anesthesia, which requires restoration of the body. The usual rehabilitation period after laparoscopic cholecystectomy ranges 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 walk freely, 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 is required for the body to recover. . At this time, the patient may feel weakness and increased fatigue.

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 scar process of the muscular aponeurotic layer abdominal wall, which reaches sufficient strength within 28 days from the date of surgery. 1 month after surgery there are no restrictions on physical activity.

Diet.

Compliance with the diet is required for up to 1 month after laparoscopic cholecystectomy. It is recommended to exclude 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; 1 month after surgery, dietary restrictions may be lifted on the recommendation of a gastroenterologist.

Drug treatment.

Minimal medical treatment is usually required after laparoscopic cholecystectomy. Pain syndrome after surgery it is usually mild, but some patients require the use of analgesics for 2-3 days. Usually these are ketanov, paracetamol, ethol fort.

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

Taking ursodeoxycholic acid (Ursofalk) can improve the lithogenicity of bile and eliminate possible microcholelithiasis.

Reception medications should be carried out strictly as directed by the attending physician in an individual dosage.

Care of postoperative wounds.

In hospital at postoperative wounds special stickers will be applied to the places where the instruments are inserted. In Tegaderm stickers (they look like transparencies) it is possible to take a shower, Medipore stickers (plaster white) must be removed before taking a shower. You can shower starting 48 hours after surgery. Getting water on the seams is not contraindicated, but you should not wash the wounds with gels or soaps or rub them with a washcloth. After taking a shower, you should lubricate the wounds with a 5% iodine solution (or Betadine solution, or brilliant green, or 70% ethyl alcohol). Wounds can be managed open method, without bandages. Taking baths or swimming in pools and ponds is prohibited before the sutures are removed and for 5 days after the sutures are removed.

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

Possible complications of cholecystectomy.

Any operation may be accompanied unwanted effects and complications. Complications are possible after any cholecystectomy technology.

Complications from wounds.

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

Possible redness of the skin around the wound, appearance painful lumps in the area of ​​wounds. Most often this is due to wound infection. Despite the ongoing prevention of such complications, the incidence of wound infection is 1-2%. If similar symptoms You should consult a doctor as soon as possible. Late treatment can lead to wounds that become suppurated, which usually requires surgical intervention under local anesthesia(sanitation of a 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 the wounds are sutured with cosmetic sutures, however, in 5-7% of patients, the formation of hypertrophic or keloid scars is possible. This complication is associated with the individual characteristics of the patient’s tissue reaction and, if the patient is dissatisfied with the cosmetic result, may require special treatment.

In 0.1-0.3% of patients, hernias may develop at the sites 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 ultrasonography guidance, or repeated laparoscopies or even laparotomies (open operations on the abdominal cavity). The frequency of such complications does not exceed 1:1000 operations. It can be intra-abdominal bleeding, hematomas, purulent complications in the abdominal cavity (subhepatic, subphrenic 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 set of examinations carried out in preoperative period, is aimed at identifying such a complication and using treatment methods adequate to it (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 stones). Unfortunately, none of the methods of preoperative diagnosis and intraoperative assessment is 100% effective in identifying 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 endoscopic (using a gastroduodenoscope inserted through the mouth into the stomach and duodenum) intervention - retrograde papilosphinctoromy and transpapillary sanitation of the bile ducts. In exceptional cases, repeated laparoscopic or open surgery is possible.

Bile leakage.

Bile leakage through 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 gall bladder 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 drainage can also be a symptom of damage to the bile ducts.

Damage to the bile ducts.

Damage to the bile ducts is one of the most severe complications for 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 3 times - up to 1:500 operations, however, with the growing experience of surgeons and the development of technology, it stabilized at the level of 1 in 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 surgery and a long period of rehabilitation.

Allergic reactions to medications.

The trend in the modern world is an ever-increasing allergization of the population, therefore allergic reactions to medications (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, allergic reactions are possible, and additional drug treatment 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 thromboembolism pulmonary artery are life-threatening complications of any surgical intervention. That is why great attention is paid to the prevention of these complications. Depending on your risk level determined by your attending physician, you will be prescribed preventive actions: bandaging lower limbs, 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 gastric ulcer 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, refusing the operation or delaying its implementation also carries a risk of developing severe illness or complications. Despite the fact that the clinic’s doctors pay great attention to the prevention of possible complications, the patient plays a significant role in this. Performing cholecystectomy in in a planned manner, with non-advanced forms of the disease carries a much lower risk of unwanted deviations from the normal course of the operation and the postoperative period. The patient's responsibility for strict adherence regimen and doctors' recommendations.

Long-term rehabilitation after cholecystectomy.

Most patients after cholecystectomy are completely cured of the symptoms that bothered them and return to normal 1-6 months after surgery. ordinary life. 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), and not limit himself in physical activity, do not take special medications.

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 give you recommendations on lifestyle, diet, dietary habits and, if necessary, drug treatment.

Articles about Health

How to live without a gallbladder?

In the structure of diseases, 13.7% are gallstone diseases. Typically, this disease leads to surgery to remove the stones. It is very rare that you can get rid of a stone using herbs. Of course, if the disease is not advanced and the stones are not large, then with the help of cleansing you can get rid of them. But at first we think that this is not very dangerous, we stubbornly do not change our lifestyle, we do not change our diet, many of our habits, and a period comes when surgery is inevitable, the gallbladder is removed.
How to live without a gallbladder?

Removal gallbladder– this is not yet getting rid of gallstone disease and is not a solution to liver slagging. From removal gallbladder waste products continue to accumulate in the liver. Your task for the immediate future after surgery is to: help the bile ducts of the liver take over the functions of the gallbladder.

And during this period, and in subsequent years of life, traditional methods of treatment require compliance with four main conditions:

Diet;
Compliance with diet;
Taking medications as prescribed by doctors;
Physiotherapy.

1. Dieting.
Bread and bakery products:You can use wheat and rye bread (yesterday’s bread).- butter dough, fried pies, pasties.

Cereals and pasta: any porridge, especially oatmeal and buckwheat, pasta, noodles.

Meat: possible– lean meat, beef, chicken, turkey, boiled, baked or steamed rabbit, meatballs, quenelles, steamed cutlets. It is forbidden- fatty meats - pork, lamb, poultry, goose, duck.

Fish: Yes boiled lean fish. No fried fish.

Soups: possible cereal soups, fruit soups, milk soups, weak broths (meat and fish), borscht, vegetarian cabbage soup. It is forbidden- fish and mushroom and strong meat broths. It is best to cook soups with a second broth. What does it mean? First boil the meat in one water, and then slightly simmer it in the main soup. With this method of cooking, the vessels are not clogged, the kidneys work well, and it is easier for the liver to carry out cleansing functions.

Dairy products: possible cottage cheese, kefir, lactic acid products, mild cheese (including processed cheese).

Fats: yes butter in limited quantities; vegetable oil - olive, sunflower, corn - 20-30 grams per day. It is forbidden - animal fats.

Vegetables and fruits– any vegetables, boiled, baked or raw; fruits and berries, except sour ones, raw and boiled. Not allowed: spinach, onions, radishes, radishes, cranberries.

Confectionery: possible- cracker; it is forbidden– cakes, cream, ice cream, carbonated drinks, chocolate, alcoholic drinks;

Snacks, canned foods: all savory snacks, fried, smoked products are best avoided.
Beverages: you can - vegetable, fruit juices, compotes, jelly, decoction or infusion of rose hips. Not allowed - alcoholic drinks, strong tea, strong coffee.

Mineral water: Essentuki No. 4, 17, Slavyanovskaya, Smirnovskaya, sulfate Narzan 100-200 ml warm (40-45) 3 times a day 30-60 minutes before meals.

I especially want to focus on sweets, as you can see, there is no sugar in the recommendations.
What did the doctors forget? I think no. He was not excluded, but he was not included in the list either.

2. Compliance with the diet.

The liver loves sweets, but if we want to purposefully influence metabolism, it is better to exclude and use honey instead of sugar, in the amounts that are recommended (no more than 80-100 grams). Metabolism improves over time, the load is removed from the pancreas, since the liver and pancreas are a common unit, and from proper operation One organ depends on the well-being of another. And in the future, health. Keep this in mind.

I would like to dwell on this thought: excessive consumption of cholesterol-containing foods leads to atherosclerosis, i.e. clogging of the bloodstream with cholesterol flakes and other problems with blood vessels, which should be removed by the liver, but the liver cannot cope, cholesterol precipitates in the liver. If you add stress here, congestion in the biliary tract, and if you add an infection, for example, with a cold, with an infection from an inflamed tooth, etc. cholecystitis and pebbles appear. Therefore, if we want to live after the operation, well, if not absolutely healthy, but at least in working condition, then we need to monitor our nutrition for the rest of our lives. The absence of a gallbladder is very a big problem, I myself underwent a similar operation 10 years ago.

Food should be consumed 4-5 times a day, not in large portions, chewing each piece of food thoroughly, so that the digestion that should be digested at the level of the oral cavity should be digested, thereby improving digestion. Chew all food, whatever it is, until it turns into liquid in your mouth! Only then swallow. Firstly, a person gets full faster.

Secondly, the stomach will not have to work to exhaustion, as happens after swallowing unchewed pieces. Thirdly, it will relieve constipation, which is the primary cause of hundreds of diseases, especially diabetes. This will prevent clogging of the body with toxins, poisoning of the liver with toxins from large cluster feces Always have salads before meals. After finishing solid food, never take liquid food (tea, juices, kefir). Only after at least one hour has passed.

Always start your meal with liquid food and end with solid food! Force yourself to chew your food for a long time! I am often asked which of all the commandments is the most important for the sick. I think this is exactly what it is - chewing food until it becomes liquid!

The most important thing when restoring liver function is to achieve daily stable stool, how long it will take you, six months, a year, or maybe more, it all depends on the state of slagging in your body. You should not stop, if you have removed the gallbladder, then there is nowhere to retreat further. Change your lifestyle in all its manifestations - nutrition, your psychology, your worldview, because according to our doctors, dyskinesia biliary tract, that is, spasms, these are, first of all, neurological problems, then poor nutrition, and already a disease that needs to be treated.

The recommendations of the attending physician should not be neglected, since they monitor not only the condition of the liver, but the pancreas, stomach, and intestines. But you shouldn’t rely on just pills either. You need to improve your knowledge in the field of health.

Physiotherapy. Physical Culture: Exercise is of great importance for the normal functioning of the liver. First of all, monitor the condition of the spine, the functioning of the spine, its nerve endings everyone's work depends internal organs, therefore, the entire complex of bringing the spine into normal condition must be done daily.

Therapeutic exercises for biliary dyskinesia with impaired bile outflow:

Lying on your back, lift right hand up and bend at the same time left leg, sliding your foot along the floor. Exhale and straighten your leg.

Lying on your back, place your hands on your waist. Raise your head and shoulders, look at your toes - exhale. Return to the starting position - inhale.

Lying on my back left hand on the chest, right on the stomach. The exercise involves diaphragmatic breathing with your stomach. As you inhale, raise both arms up, following the movement chest and the front wall of the abdomen, lower down as you exhale.

Take the starting position lying on your left side, with your left arm extended forward and your left leg bent. Raise your right arm - inhale, bend right leg, and pressing your knee to your chest with your right hand, exhale.

Starting position – lying on your left side. Raising your right arm and right leg, inhale, bending your leg and arm, pull your knee to your stomach, tilt your head - exhale.
Starting position - lying on your left side. Move your straight arm up and back - inhale, return to the starting position - exhale.

Starting position – lying on your left side. Take both legs back - inhale. Return to the starting position - exhale.

Starting position – standing on all fours. Raise your head, inhale, moving your right leg forward between your hands in a sliding motion, and exhale.
Return to the starting position and repeat the same with the other leg.

Starting position – standing on all fours. Raise your left straight arm to the side and up, inhale, return to the starting position, exhale.

Starting position – standing on all fours. Inhale, bending your arms, lie on your stomach, exhale, return to the starting position.

Starting position – standing on all fours. Raise your head, bend in the lumbar region - inhale, tilt your head and arch your back - exhale.

Particularly advanced, those who for some reason do not achieve desired effect From the above exercises, and for further improvement of the body and spirit, you can turn to yoga exercises (asanas, poses).

Maintain good hygiene while exercising physical culture- do them in the fresh air, or in a well-ventilated area, in a calm environment. Do them on an empty stomach. Do the exercises efficiently, slowly, achieving your goals. Watch your breathing. Clothes should be light, not restrict movement, and absorb sweat well. Increase the number of repetitions gradually.

During exercises, direct your thoughts to those muscles and organs to which the movements are directed. Do everything with love, because you are talking to your body. After the exercises there should be a joyful mood, in the liver area, right hypochondrium there should be a feeling of tone, but at the same time no tension, then you will achieve your goal. However, after class therapeutic exercises you will want to stretch other muscles and joints, which is not forbidden.

Of course, this doesn't end with the goal of achieving liver health. Traditional methods of treatment have great amount recipes for cleansing the liver and bile ducts from slagging and bile stagnation. I advise you to refer to the material " Traditional methods treatment of bile stagnation."

Life after gallbladder removal is divided into 2 periods - preoperative and postoperative. Before cholecystectomy, a person probably experienced suffering associated with pain and regular attacks, and doubted the need for surgical procedures.

But the procedure is over, the organ was removed. Ahead lies rehabilitation and new image life, quite full-fledged, but still different from what it was before.

The main goal is to adapt to the changes occurring in the digestive processes .

The gallbladder is a hollow organ for storing bile coming from the liver and releasing it under the influence of hormones in small intestine. It is connected to the liver, stomach and pancreas via bile ducts. The bladder has an elongated shape and can hold up to 70 cm 3 of bile.

It actively participates in the digestive processes, releasing a portion of bile every time a person consumes food. But chronic cholecystitis and cholelithiasis limit the functions of the organ. Compensatory mechanisms gradually develop, and the gallbladder “switches off” from active activity.

In such conditions, the absence of a gallbladder is not regarded by the body as a shock or a serious blow, because it has already managed to adapt to poor performance of functions.

At the same time, the liver works as before and the volume of bile production does not decrease. Only now it is not condensed and stored in a specific reservoir, but directly flows to the duodenum and pancreas through the ducts.

Attitude to the operation

IN prompt removal The gallbladder has its pros and cons. On the one hand, one organ with its important functions is completely removed from the biliary system. On the other hand, this organ no longer does its job and serves as a source of inflammation, a breeding ground for pathological microorganisms. With the removal of the gallbladder, the source of infection is also eliminated, and the body gets used to working in new conditions.

Many unpleasant medical manipulations and procedures that the patient had to endure before surgery are no longer necessary. The person feels relieved.

Cholecystectomy

The successful outcome of the operation is facilitated by timely decision to remove. In this case, the patient will be bypassed by such unpleasant consequences as complications and a long period rehabilitation.

If such a decision is delayed, inflammatory processes begin to spread to other organs, which negatively affects the functioning of the entire digestive system. Associated diseases develop: gastritis, colitis, peptic ulcer, pancreatitis.

Urgent surgery performed due to complications requires long-term recovery and additional drug treatment after discharge. But compliance with all requirements allows you to return to normal life. If, after removal of the pancreas, for example, a person is assigned a disability, then one can live a full life without a gallbladder.

One of the main requirements that doctors set for patients after surgery is adherence to a diet. It is based on the rejection of a number of foods and the rules of food consumption throughout the day.

Dangers after surgery

The work of the liver to produce bile continues as before and without the gallbladder. At the same time, the composition of bile produced by the body does not change. If the stone-forming ability of bile was high, it persists subsequently. May change and physiological norms produced bile, which means its pressure on the walls of the bile ducts will increase.

With excess pressure, bile is perceived by the mucous membrane of the intestines and stomach as a toxic liquid. If the duration negative impact becomes regular and long-lasting, organ structures may change, which is fraught with the development of diseases, including the formation of tumors.

Duodenal sounding

Due to the current circumstances, during the period after removal, it is important to periodically examine bile for biochemical composition. And also monitor the condition of the duodenum using a duodenal examination. In this case, you should not rely on ultrasound examination, since ultrasound is not able to show the real picture.

A high ability to form stones is determined by next analysis: the selected bile is placed in the refrigerator for 12 hours. If a precipitate forms during the period, the result is positive.

In this case, drugs that stimulate bile formation and contain bile acids are prescribed:

When biliary insufficiency is diagnosed, drugs with ursodeoxycholic acid, which is harmless to the mucous membrane, are prescribed:

• Hepatosan;
• Ursofalk.

To prevent the formation of stones in the bile ducts, sharply reduce the consumption of foods that are a source of cholesterol. These include fatty, fried foods, confectionery, lard, sausages, fatty meats, egg yolks, rich broths.

The listed products, as well as alcohol, worsen the condition and complicate the functioning of the liver and pancreas.

Nutrition rules

During postoperative rehabilitation It is recommended to strictly adhere to the principles of dietary nutrition. One of the important points is frequent use food in small portions. The optimal amount of serving can be determined by size - the volume of food should not exceed the size of your own fist.

Food entering in small portions into digestive tract, stimulates bile formation and excretion through the ducts into the intestines. To improve the process, you can consume foods and drinks with a choleretic effect. These include, for example, olive oil or infusions of certain herbs.

What should a patient eat immediately after surgery? The speed of recovery largely depends on the quality of nutrition. Nutritionists call the menu rehabilitation period"table number 5".

On the first day after removal, only liquid products are allowed:

• Diluted lean meat broth;
• Water without gas;
• Weak tea.

You can steam cutlets from chicken and lean meats, lean sea fish. Healthy drinks include fermented milk products, jelly, and dried fruit compotes.

Subsequently, you can make your diet varied, but consume limited vegetable fats and butter, focus on easily digestible foods. Eat more vegetables and fruits, avoid foods that increase gas formation and disrupt peristalsis (carbohydrate foods).

Very useful products with high content plant fibers, fiber (dried fruits, nuts, bread coarse, almost all vegetables, bran, legumes). They aid digestion and promote healthy stool.

The following should be excluded from the diet:

When consuming prohibited foods, there is an increased secretion of bile, and since there is no place to store it, this leads to stagnation in the ducts, metabolic problems, and impaired motility in the bile ducts.

Sufficient consumption can reduce the concentration of bile clean water. Good as drinks herbal teas and decoctions.

Recommendations for daily routine and physical activity

How to live when the gallbladder is removed? Immediately after the operation, physical rest and lack of stress are recommended. Do not overextend your abdominal muscles or carry heavy weights. After a month, you can start exercising moderately: walking, cycling, swimming, fitness.

Sports exercises will help tissues recover faster and strengthen muscles. Special tiring abdominal exercises should be avoided. They can be performed in full force only a few months after medical procedures. Owners of personal plots should refuse to dig beds for the entire rehabilitation period.

Physical therapy specialists especially note the benefits water procedures. This is the complex effect of water on skin and abdominal muscles. In summer you can regularly visit open water bodies, and in winter - swimming pools. Spa treatment has a positive effect on the speed of rehabilitation.

Pregnancy without gallbladder

Many women are interested in whether it is possible to give birth without a gallbladder. At healthy habits and proper attitude to nutrition, the absence of an organ does not have a negative impact on the functioning of other organs and systems. Therefore, for pregnancy and natural birth there are no contraindications.

However, if a pregnant woman gains weight quickly, there may be some disruption in the functioning of the digestive system. Therefore, it is recommended to strictly follow the rules of food intake and dietary principles throughout the entire gestation period.

It has been noted that toxicosis is more common in pregnant women without a gallbladder.

Choleretic herbs after surgery

Stabilizing liver function choleretic agents and hepatoprotectors should be prescribed by a doctor. They reduce discomfort and help maintain good health. To improve digestion and strengthen excretory functions You can use safe traditional medicine recipes.

Choleretic herbs are no less effective than medications. But the appointment also requires consultation with a specialist. Plants have a largely preventive effect. Therefore, you should drink them in long courses 2-3 times a year. Compound herbal infusions needs to be changed from time to time.

Coltsfoot

The leaf serves as a medicinal raw material. It is prepared in spring time and dry in the open air. The leaves contain mucus, which has a beneficial effect on digestive system. The plant also has an enveloping and emollient effect, preventing the development of inflammatory processes.

Birch buds and leaves

Decoctions and infusions are prepared from them, and then used as a bactericidal, diuretic, and wound-healing agent. Particularly effective during the rehabilitation period.

Rose hip

Renders choleretic effect, improves metabolic processes, nourishes with a complex of vitamins. The bactericidal and antioxidant properties of rose hips are especially appreciated. Decoctions, syrups, and extracts are prepared. Has a general strengthening effect.

Immortelle

Regulates bile formation and excretion, has antibacterial activity, and acts as an antispasmodic. Used for gastritis, colitis, gastrointestinal diseases. Improves the condition of the biliary tract. Prevents nausea and vomiting.

Corn silk

Harvested in summer and autumn, when the corn is ripe. Air dry, spreading out in a thin layer. choleretic and diuretic. Treat liver diseases. The extract is effective for hepatitis, cholecystitis, cholelithiasis.

The listed plants can be taken separately and in combination with chamomile, barberry berries, calendula, St. John's wort, valerian root, and wormwood leaves.

Pharmacy chains sell ready-made products based on plant extracts:

• Rose hip holosas;
• Flamin from immortelle;
• Berberis from barberry;
• Urolesan and herbal mixture.

To improve your general condition, in addition to plain water, you can drink mineral water, having previously relieved gases.

It is important in the postoperative period to make efforts to boost immunity, to exercise physical therapy, use physiotherapy methods. For example, ozone therapy protects the body from bacteria, fungi, viruses, and other pathological organisms, helps improve the functions of the liver and hepatic structures.

Judging by the fact that you are reading these lines now, victory in the fight against liver diseases is not yet on your side...

Have you already thought about surgery? This is understandable, because the liver is very important organ, and its proper functioning is the key to health and well-being. Nausea and vomiting, yellowish tint to the skin, bitterness in the mouth and bad smell, dark urine and diarrhea... All these symptoms are familiar to you firsthand.

But perhaps it would be more correct to treat not the effect, but the cause? We recommend reading the story of Olga Krichevskaya, how she cured her liver...

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

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  Complications after gallbladder removal

  The most serious consequence removal of the gallbladder - “postcholecystectomy syndrome”. Different research centers give different probability of occurrence of this complication - from 5 to 10%. Moreover, in 20-30% of cases, the cause of this is stone remains.

  Symptoms of “postcholecystectomy syndrome”

  After a certain period of time has passed since the gallbladder was removed, the patient may experience hepatic colic, flank pain, or obstructive jaundice.

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

  

  Performing a second operation is more dangerous than the first one, because it is more difficult for the patient. According to statistics, repeated surgery helps patients in 79% of cases. If the patient refuses a repeat operation recommended by the attending physician, this may lead to the development of severe forms complications.

  

  Consequences of the development of concomitant diseases

  If after the first operation the patient experiences fever, nausea and pain for a long time, this may be caused by developed concomitant diseases. For this reason, the patient is prescribed a full examination before and after surgery. general state body and the presence of other diseases.

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

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

  

  Pain due to surgery

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

  

  The ailments that arise can be characterized by several parameters:

  1. 1. Localization. Typically, pain occurs under the right hypochondrium, at the site of the removed gallbladder and the location of the scar. It may be noticeable in the subclavian area.
  2. 2. Intensity. May vary depending on the sensitivity threshold of the person being operated on.
  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 V abdominal cavity to improve visibility by moving organs apart during surgery.

  If the surgeon performed laparoscopy during the operation, the patient may experience aching, dull and constant pain in the stomach, which usually intensifies with breathing or coughing. Duration pain- about 1 month, because this 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 abdominal cavity. The signs of this pathology are:

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

  If you have such symptoms after removal of the gallbladder, you should urgently consult a doctor and get tested.

  Diarrhea due to absence of gallbladder

  Due to surgical intervention in the abdominal cavity, the patient’s digestive process is disrupted; the most serious complications arise in the intestines. When the gallbladder is removed, changes in gastrointestinal tract activity can vary in nature and severity.

  Due to the fact that the gallbladder is part of the gastrointestinal tract, many patients immediately experience disruptions in the functioning of the relevant organs after surgery. They complain about:

  • increased gas formation;
  • bloating;
  • diarrhea.

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

  

  Hologenic diarrhea can be characterized as follows:

  • loose stools acquire a light yellow or greenish tint due to dilution with bile;
  • painful sensations in the right side;
  • chronic course of the disease without noticeable positive dynamics.

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

  Heartburn

  The gallbladder performs a particularly important function in the gastrointestinal tract. Bile entering the bladder from the liver changes its composition and is sent to the gastrointestinal tract to break down proteins and fats, which are absorbed in the duodenum.

  After removal of the gallbladder, bile from the liver enters the gastrointestinal tract without changing its composition and quantity, regardless of the presence of food in it. Under the influence of fluid in the common bile duct (general 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 canals increases, weakening the lower esophageal sphincter. Subsequently, the patient experiences burning, painful attacks, accompanied by belching and a bitter taste in the mouth.

  Developed heartburn in the absence of a 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, liver cirrhosis and stomach ulcers may develop.

  Life after gallbladder removal

  Both men and women are forced to make lifestyle changes after gallbladder removal. After the operation, the body needs to adapt, so from now on serious adjustments will be required.

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

  

  Diet changes

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

  After surgery you cannot eat:

  • fatty and fried foods;
  • alcohol and carbonated drinks;
  • flour and pasta products (if you can’t refuse, limit consumption);
  • pepper, adjika, mayonnaise, spices, etc.;
  • peas, beans, sorrel, lentils, onions.
  • day-old bread;
  • meat, fish, poultry (low-fat varieties);
  • cooked cereals;
  • low fat fermented milk products.

  The main thing is to maintain your diet. Each meal should have a constant value in calories, and 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 discouraged to eat cold dishes - the food should be warm (40-50 degrees).

  Before eating, it is recommended to drink 200 ml of still water. 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 caused by the work of the duodenum.

  Physical activity

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

  Passing examinations

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

  If sediment falls out, the likelihood of re-formation of stones is diagnosed.

  Taking pills

  Drug treatment after gallbladder removal is minimal. For inflammation after surgery, a course of antibiotics is prescribed.

  Antibacterial therapy is carried out for only 3 days in a hospital setting to prevent complications.

  The effect of surgery on a woman’s reproductive ability

  Removing the gallbladder has virtually no effect on women's reproductive capacity. 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 may have certain unpleasant symptoms during the initial period of fetal development:

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

  At the same time, patients complain of:

  • painful sensations with right side under the ribs;
  • sharp pain moving to the hypochondrium on the left side, the right shoulder blade or the entire side;
  • feeling of heaviness;
  • discomfort in the side, which provokes nausea, heartburn and bitterness in the mouth;
  • slight pain when the fetus moves.

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

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

  1. 1. After removal of the gallbladder, pregnancy may occur with 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 recommended to refrain from conceiving for at least 6 months during the rehabilitation period.
  3. 3. The surgery causes shock to the body and can provoke premature birth.
  4. 4. For problems with maternal bile and due to undergone surgery the risk of jaundice increases in the newborn.

  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. 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. Second group. Assigned when the disease progresses to severe stage, the occurrence of complications and the development of diseases of the digestive organs, as well as violations metabolic processes. The second group may include patients with significant loss of bile and sudden loss of body weight.
  3. 3. First group. These are patients with severe disabilities arising 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.