Little trauma during surgery LCE, gentle instrumental technique provides easy postoperative period, short-term presence of the patient in hospital (3-5 days) and shorter rehabilitation (2,5-3 weeks). These factors determined by the low rate of postoperative complications in the surgical wound, abdominal and cardio-pulmonary system. LCE listed advantages make it a socially important and promising in the treatment of cholelithiasis.
Along with the undeniable advantages of LCE operation carries the risk of serious complications: bleeding into the abdominal cavity, the intersection of choledochal, internal injuries, zhelcheistechenie into the abdominal cavity, purulent processes in the areas of intervention. The reasons for their occurrence are most often adhesions and inflammation in gepatoduodenalnoy zone; violation of technology transactions and refusal to timely transition to a wider incision. At operation LCE postoperative mortality is low, it varies from 0,5 to 1,5%.
Cholecystectomy from the mini-laparotomic access
In our country a priority in the development of technology cholecystectomy from a small online access belongs ID Prudkovu and his followers.
This method of operation consists of an open cholecystectomy, a small real-time access to elements of Endosurgery. The operation was performed using a tool kit that includes a ring retractor, hinged retractors mirror (changing its geometry), lights and electrocoagulator.
To perform the operation of the mini-access transrectal produce vertical incision 4-5 cm in the right upper quadrant. Retractors, mirrors create a significant amount of operational brand viagra space to operate at a depth of 5-20 cm, to visually monitor the operation and free to manipulate tools. By changing the position retractors, mirrors and thereby increasing the operational space in the area of interest, we can produce not only an isolated cholecystectomy, but also to expand intervention: do holedoholitotomiyu, holedohoskopiyu, form supraduodenalny holedohoduodenoanastomoz.
The use of mini-laparotomic access for cholecystectomy useful in cases where there are contraindications for laparoscopic surgery. The technology of this operation can produce a removal of the gallbladder in the presence of inflammatory infiltration and adhesions in the area gepatoduodenalnoy ligament, with the previously deferred laparotomy, when can we expect spayaniya abdominal cavity from the abdominal wall, with obesity and intrahepatic location of the gallbladder. Mini-access is preferable in patients with concomitant diseases of cardiac and pulmonary systems, which is not desirable to create a tense pneumoperitoneum.
Cholecystectomy operation of the mini-access is not an alternative to the laparoscopic method. In many respects a medical nature of these operations means do not differ significantly from each other. However, the operation of the mini-access is inherent in the increased number of trauma because of the length of the incision of the abdominal wall, introducing tools and tampons into the abdominal cavity. Undoubted advantages of the operation of cholecystectomy minimum operational access are: the similarity of techniques and methods of operating with an open laparotomy and visual control of the phase of the operation, which reduces the risk of iatrogenic complications, allows the surgeon to easily overcome the psychological barrier and move quickly to open laparotomy if there are technical difficulties. In addition, the cost of the operation of the mini-access 2,5-3 times less than laparoscopic surgery. Listed advantages cholecystectomy operation of the mini-access using native tools make it attractive for surgeons. Currently, many hospitals in our country, this operation replaced the open method of surgical intervention.
Cholecystectomy in an open access laparotomic
Removal of the gallbladder from a standard wide laparotomic access refers to the category of traumatic surgery with an increased risk of complications. Despite this lack of broad-laparotomy, the need for its application remains in complicated gallstone disease when intervention is required on the extrahepatic bile ducts, as well as in surgery of acute cholecystitis. Forced to go to a wide laparotomy occurs during viagra how much you have enough operations of laparoscopic and mini-access, if in the course of surgery there are technical difficulties or iatrogenic complications.
Thus, the existing methods of treatment of cholelithiasis is the most effective surgical removal of the gallbladder. When planning operations in patients with uncomplicated gallstone disease postoperative mortality does not exceed 0,5%. It is important to promptly identify the indications for surgery, without waiting for development of complicated forms of the disease.
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vascular complications prevention
Genetics determines
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