Cholecystectomy

Fortunately the biliary vesicle is not an organ indispensable for the life nor represents significant changes in the digestive function of the person when it is extracted through surgery. The functions of the biliary vesicle after which this one is extirpated are compensated quickly by the biliary conduits, which increase their diameter slightly to allow to a greater capacity of availability and conduction of the bile towards the intestine and thus not to alter the digestion of foods.

Placement of Trocars

The patients who must be put under surgery of the biliary vesicle are those that they have had symptoms, that is to say, the biliary cólico call. The ideal is that the person is operated before this one initial manifestation because it allows that the surgery is planned. Once colelitiasis symptoms, the possibility that appear they resort is very high, with aggravating of which increases the frequency of complications and they generally demand surgery of urgency with a greater risk.

Really, the extraction of the biliary vesicle or cholecystectomy, is the election treatment. Nowadays it is made by the laparoscopia technique; a boarding very different from the one from the open surgery. The cholecystectomy is a surgery that is made since Langenbuch, a German surgeon practiced it in Berlin in 1882 but only until 1987 it is made by the laparoscopy technique by Mouret in Lemon, France and later the development and consolidation of the technique by Dubois in Paris. After this the technique has spread widely in the world.

The advantages of the cholecystectomy laparoscopy with respect to the open surgery are:

Less pain after the intervention? Faster recovery? Precocious the beginning of the labor routine? Smaller surgical wounds? Smaller aesthetic impact by surgical wounds? Faster tolerance to the ingestion? Smaller time of stay in the hospital | After the complete evaluation of the patient and the accomplishment of complementary studies according to is required, it goes to the valuation on the part of the anestesiólogo that makes a general evaluation again and makes emphasis in the associate diseases and the cardio-pulmonary state to prepare the patient and to formulate anesthetic a plan suitable.

The Cholecystectomy Laparoscopy is a procedure of short hospital stay; this means that the hard patient in average not more than 24 hours in the hospital. The patient must have an uninformed one of at least 8 hours before the intervention which is made under general anesthesia and it is made through 4 surgical wounds. 2 incisions of approximately 12 millimeters in length in the inferior edge of the navel and the other at level of epigastrio well-known zone like the "mouth of the stomach". The other 2 incisions are of 5 millimeters in length and they are located in right half of abdomen one underneath the other. Through these surgical wounds devices in form of hollow tubes or trócares are introduced, through which the necessary instruments and means go for the development of the Cholecystectomy Laparoscopy. As first measurement introduces a gas (CO2), in the abdominal cavity with the objective of distender the abdomen and thus to create space for the accomplishment of the procedure.

Later one introduces a lens that go connected to a camera of hi-res television and she to two special monitors by which she visualizes all the interior of the abdomen and the area to take part; it is to say to the biliary vesicle and all the organs and weaves that surround it. Once identified the vesicle one subjects with 2 special clamps and one begins the process of identification and individualización of the conduit of connection with the biliary route (cystic) and of the artery that the vesicle nourishes.

This phase of the procedure is made with another clamp specially designed for it. Once recognized these structures hooks or clips are placed metalists who occlude the light of the cystic conduit and the cystic artery to avoid bile flights or hemorrhage. Soon with a electrobisturí of blunt end the biliary vesicle is come off the inferior surface of the liver. This instrument sections the weave and it coagulates it so that the bled one is minimum. When the vesicle has been given off completely is extracted through the epigástrica wound and finally a systematic verification of the operated area is made, irrigating with saline serum and inhaling it in order to leave the completely free area of bile or blood in case that there will be it.

The surgery concludes extracting all the clamps and trocares under laparoscopy vision, draining all the insufflated gas and closing the small surgical wounds with suture threads. The patient is lead to the room of recovery, in where she is finished waking up of the anesthetic procedure. When this has happened, (approximately between one and two hours), it is taken to his room and foods six are offered to him later to twelve hours. Soon the patient is apt to return to house.