Difficult cases
With a “wrinkled” bladder and dense infiltrate, safety is ensured by special techniques: subtotal cholecystectomy (leaving the posterior wall on the bed if safe isolation is impossible), access “from the bottom”, intraoperative cholangiography for mapping the ducts, drainage. Such operations are indicated for patients with a long-term history of cholelithiasis, after repeated attacks and refusals in other clinics. The risk of conversion and complications is higher than standard, but many times lower than with continued attacks; recovery - hospital 1-2 days, work after 2 weeks.
Indications
- cholelithiasis with attacks of biliary colic - planned removal;
- acute cholecystitis (phlegmonous, gangrenous) - urgent surgery;
- chronic calculous cholecystitis, “porcelain” bladder, polyps more than 10 mm;
- asymptomatic stones in diabetic and pre-bariatric patients (if indicated);
- condition after choledocholithiasis and pancreatitis caused by stones.
Why is the entire bubble removed?
It is impossible to remove “only stones”: the changed bladder forms them again within 1–2 years, so the world standard is cholecystectomy. After surgery, bile enters the intestines directly; digestion in the vast majority of patients completely adapts within a few weeks while following a diet in the first 1–2 months. Postponing planned surgery during repeated attacks is dangerous: each new episode threatens acute cholecystitis, pancreatitis and migration of stones into the duct, which complicates treatment.
Benefits of laparoscopy
Laparoscopic access is the standard of modern abdominal surgery: instead of a 10–20 cm incision, 3–4 punctures are left, the pain after surgery is much less, the patient gets up on the day of surgery and is discharged after 1–2 days, the risk of wound infection, hernias in the scar and adhesions is several times lower, and the enlargement of the camera allows you to operate more accurately. In the clinics below, operations are performed by surgeons with extensive laparoscopic experience; hospital (SKD) is included in the price according to the price list.
