Edema after removal of the gallbladder

Their complications after removal of the gallbladdermost often there are various disorders of cardiac activity, especially in the elderly, postoperative pneumonia, functional liver failure with the phenomena of hepatorenal syndrome and cholemic hemorrhages, paresis of the stomach and intestines, suppuration of the wound, bile fistulas.

Complications after removal of the gallbladder candepend on various reasons. In carrying out these operations, the surgeon often has to meet with complex topographic and anatomical conditions, various organ changes that make it difficult to diagnose and perform the operation. Hence, often there are difficulties in correct recognition, incorrect choice of the method of operation, as well as severe complications in the form of accidental damage to the ducts or large vessels of this region.

Errors of operational diagnostics most oftenare associated with an inadequate survey. Without sufficient evidence, this or that operation is performed, and the actual cause of the disease remains unrecognized. The latter can take place:

  • with hidden bile duct stones, the presence of unrecognized narrowing of the bile ducts caused by obliterating cholangitis, chronic pancreatitis and especially stenosing inflammation of the fatker's nipple;
  • with dyskinesia of the biliary tract caused by sclerosis of the neck of the bladder, spasm or hypotension of the sphincter of Oddi, chronic duodenal obstruction, as well as neurogenic factors;
  • with diseases of neighboring organs, often causing secondary changes in the biliary tract;
  • with tumors of the bile ducts, gall bladder, pancreatoduodenal zone from difficulties of revealing and localization of these neoplasms.

Hence, starting the operation, for any pathologythe biliary tract always needs a thorough revision not only of the gallbladder, but also of the liver, duodenum, pancreas, stomach and other neighboring organs. In difficult and especially ambiguous cases, it is necessary to widen the use of additional methods of operational diagnostics, including modern methods of contrast X-ray research. Only this way allows the surgeon to avoid unnecessary operations and serious complications after removing the gallbladder from the wrong choice of the mode of operation.

Due to the complex topography, numerousvariants of development and extensive pathological changes that occur in cholecystectomy, gross technical errors are often observed leading to injury of the bile ducts and large vessels.

At the heart of the mistakes of surgeons most often lie:

  • absence of the proper organization of operative intervention (poor anesthesia, insufficient access, poor lighting);
  • insufficient experience of the surgeon and ignorance of the often encountered variants of the biliary tract and blood vessels of this region;
  • attempts to perform surgery without careful isolation of the bile ducts, poor hemostasis, which makes it difficult to orientate in the depth of the operating field.

Damage to the bile ducts is associated with coarsedissection, when the existing fractures are separated by an acute route, especially in the presence of extensive infiltration, adhesions or tumors. At the same time, there may be an occasional clamping of the bile duct during bleeding, as well as the imposition of a clamp instead of a cystic duct on the common bile or general hepatic duct. To avoid such complications after removal of the gallbladder, it should always be recommended to isolate the bile ducts first and, only after orienting in their topography, to perform further stages of the operation.

Complications after removal of the gallbladder in the mostThe first days after the intervention can most often be caused by the appearance of secondary bleeding as a result of the ligature leaking and the cholemic state. Prevention of this complication is achieved by correct preoperative preparation, which provides the fight against cholomics, as well as thorough hemostasis during the operation.

Another complication after removal of the gallbladderin the earliest postoperative period, there may be bile peritonitis associated with the release of bile into the abdomen when the ligature is leaped from the stump of the bladder duct, from the damaged liver bed. In order to prevent these complications, in addition to carefully observing the rules of operation, it is necessary at the end of the operation to always check that there is no leakage of bile from the area of ​​the operation, and if necessary, take the necessary measures to eliminate it. In doubtful cases or if leakage of bile can be expected, the operation should always result in draining or tamponade of the abdominal cavity.

When cardiovascular failure occursthe most vigorous treatment is needed, which should include the appointment of appropriate cardiac funds, glucose infusion, oxygen therapy and other measures. To combat pulmonary complications, antibiotics are prescribed. banks, expectorants, respiratory gymnastics and other means.

When a duct is injured, it is necessary to immediatelyto proceed to this or that reconstructive operation, providing free passableness of the damaged site, removal of bile to the intestine, since in the future carrying out of such operations is always considerable difficulties.

In some patients, duct damage is associatedwith an incorrect ligation of the stump of the vesicular duct, improper suturing of the site of the opening of the duct or an incorrect technique of introducing drainage. which leads to cicatricial narrowing and obstruction of the biliary tract. Therefore, one should attach great importance to the correct implementation of the details of the technique of these operations. At the same time, the bed after the gallbladder should be carefully sutured, since when it is removed and the hepatic parenchyma is damaged, an opening of the lumen of the intrahepatic bile ducts can be observed.

Very unpleasant complication after removalThe gallbladder is injured by the hepatic artery or portal vein. Damage to the hepatic artery or grasping it with ligation is possible because of the frequent variants of the development of this vessel, as a result of which it can be difficult to navigate in its position and to provide for where it is. Therefore, during the operation, you should first find the hepatic artery by probing and trace the direction of its course. When injuring the hepatic artery, it should be bandaged, since at present it is considered permissible with proper management of the postoperative period, in which significant doses of antibiotics and a set of remedies aimed at improving the liver condition are used.

Significantly more dangerous injury of the portal vein,which often causes fatal bleeding. Prevention of injuries of this vessel can be achieved only by careful observance of the rules of operation and knowledge of the location and course of the vessel. In doubtful cases, it is necessary to make a trial puncture, which makes it possible to establish that the existing education is a portal vein. If a portal vein is injured and severe bleeding occurs, first apply a finger compression of the bleeding site or compress the hepatic duodenal ligament, after which a vascular suture is applied to the wound site. The ligation of the portal vein is unacceptable and in extreme cases one should try to sew this vessel into the inferior vena cava, previously tying up its stump in the gates of the liver.

Other dangers and mistakes of gallbladder removalBubbles are mainly associated with the inability to recognize the location of ductal obstruction from their cicatricial narrowing, the presence of a hidden stone or tumor. Used in these conditions without an accurate determination of the level of the existing obstacle, the operations of drainage of the bile ducts or the imposition of bypass anastomoses may not provide biliary excretion. Therefore, when starting these operations, always be sure of the exact location of the existing obstruction by examining the bile ducts or using operating cholangiography. One should not forget that sometimes there can be a double obstacle to the current of bile in the biliary tract as a result of multiple stones, the narrowing of the ducts at different levels, as well as the metastases of the primary node of the tumor.

Among other complications after the removal of gallstonesa bubble can be indicated on the phenomena of mechanical jaundice that arise after the operation. which are associated with the abandonment of the stone, cicatricial narrowing of the duct or the presence of an unrecognized tumor. In such cases, it is necessary to conduct repeated operations to audit the biliary tract, remove the existing obstruction and ensure free bile management.

Some patients may have external biliaryfistulas caused by injury of the duct, insufficiency of the stump of the cystic duct. In these cases, it is necessary, by fistulography, to determine the location of the fistula and the patency of the ducts, after which a second operation is performed to close the fistula. If the bile fistula is formed after a cholecystostomy operation, it is usually necessary to remove the bladder and remove the obstruction.

Complications can be associated not only withtechnique of operation, but also be the result of underestimation of contraindications to surgery, especially in seriously ill patients. In such cases, heart failure events, complications from the lungs, as well as severe violations of the liver, kidneys with a picture of the hepatorenal syndrome can occur. Therefore, severe and debilitated patients must be preceded by careful preoperative preparation, using the most harmless methods of anesthesia, and the surgical intervention itself should be the simplest and least traumatic.

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