Removal Of Stones From The Gallbladder (crushing Stones With Laser And Ultrasound)

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Modern methods of removing stones from the gallbladder

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

The gallbladder is an organ adjacent to the liver and acts as a storage reservoir for the bile that is produced by the liver. Bile is necessary for the complete digestion of food and has a complex composition. Its main components are cholesterol and bilirubin (a pigment produced by the liver). The main causes of gallstones include high cholesterol content in bile, disturbances in its outflow and stagnation, as well as infection of the gallbladder.

With prolonged stagnation of bile, cholesterol precipitates, which gradually leads to the formation of microscopic elements ("sand"), which eventually increase in size and combine into larger formations (calculi).

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

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

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

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

Today, there are the following methods of treating gallstones:

Non-surgical stone removal:

• Dissolution with medications;
• Remote ultrasound lithotripsy;

Minimally invasive removal:

• Laser crushing of stones;
• Contact chemical litholysis;

Surgical intervention:

• Laparoscopic removal of stones from the gallbladder;
• Endoscopic cholecystectomy;
• Open abdominal surgery.

The standard of management of patients with gallstones is currently as follows:

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

However, the main method of treating gallstones is still cholecystectomy (removal of the gallbladder together with stones). In this case, abdominal operations are gradually giving way to endoscopic removal.

Content:

• Medicated dissolution of stones
• Ultrasonic stone crushing
• Laser crushing stones
• Contact chemical cholelitolysis
• Laparoscopy
• Open cavity surgery
• Why can't the gallbladder be removed?
• What is desirable to exclude from the diet?

Medicated dissolution of stones

Only cholesterol stones with a diameter of up to 2 cm lend themselves to dissolution (this method does not work on lime and pigment stones). For this purpose, analogues of bile acids Ursosan, Henofalk, Urofalk, Henochol, etc. are used.

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

Contraindications:

• Various concomitant diseases of the gastrointestinal tract (ulcer, gastritis) and kidney;
• Taking oral contraceptives containing estrogens;
• Obesity;
• Pregnancy.

Disadvantages:

• A high relapse rate (10-70%), since after stopping the drug, the cholesterol level in the bile rises again;
• Long duration of the course of treatment (from 6 months to 3 years);
• Side effects such as diarrhea (10% of cases), changes in liver function tests (ALT and AST);
• The high cost of drugs.

On the subject: Preparations for dissolving stones in the gallbladder

Ultrasonic stone crushing

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

Contraindications:

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

Disadvantages:

• Possible blockage of the bile ducts due to vibration;
• Damage to the walls of the gallbladder with sharp edges of stone fragments.

Laser crushing stones

The gallbladder is accessed through a puncture on the anterior abdominal wall. The laser beam is directed directly into the affected area and splits the existing stones The duration of the procedure is no more than 20 minutes.

Contraindications:

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

Disadvantages:

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

Contact chemical cholelitolysis

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

Its essence is as follows: a thin catheter is inserted into the gallbladder through the skin and liver under the control of ultrasound, through which a special preparation dissolving stones is injected drip. The effectiveness of the method is 90%.

The drug commonly used is methyl tertiary butyl ether, which is a strong organic solvent. It has been proven that the gallbladder is resistant to the cytotoxic effect of methyl tertiary butyl ether.

The disadvantage of the method is invasiveness.

Laparoscopy

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

The indication for laparoscopy is calculous cholecystitis.

Contraindications:

• Obesity;
• Too large stones;
• The presence of adhesions after surgery;
• Gallbladder abscess
• Diseases of the heart and respiratory system.

Cholecystectomy

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

Laparoscopic cholecystectomy

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

Open cavity surgery

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

Disadvantages:

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

Why can't the gallbladder be removed?

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

In addition, there are violations of secondary absorption: usually bile is used 5-6 times, making turns between the liver and the intestines, and in the absence of the gallbladder, bile acids are quickly excreted, which negatively affects the digestion process.

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

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

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

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

On the subject: 10 folk remedies for removing stones from the gallbladder

What is desirable to exclude from the diet?

The composition of the diet is of great importance for this disease.

For stones in the gallbladder, it is recommended to exclude the following foods and dishes from the menu:

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

On the subject: Diet for gallstones, menu for a week

It is recommended to eat foods that stimulate the elimination of excess cholesterol:

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

The author of the article: Gorshenina Elena Ivanovna | Gastroenterologist

Education: Diploma in the specialty "General Medicine" received at the Russian State Medical University named after N. I. Pirogova (2005). Postgraduate studies in the specialty "Gastroenterology" - educational and scientific medical center.