What Is a Laparoscopic Cholecystectomy?

Laparoscopic cholecystectomy (LC) is a special catheter inserted into the peritoneal cavity, and then injected with about 2 to 5 liters of carbon dioxide. After reaching a certain pressure, 4 small holes of 0.5 to 1.5 cm are opened in the abdomen to dissect the triangle of the gallbladder. Structure, the gallbladder duct and gallbladder artery were cut and clamped, and then the entire gallbladder including stones was removed.

Basic Information

Chinese name: Laparoscopic cholecystectomy

Foreign name: laparoscopic cholecystectomy
Visiting department: General surgery

Laparoscopic cholecystectomy anesthesia and preoperative preparation

Anesthesia mode

general anesthesia.

2. Preoperative preparation

(1) Know the history of gallstone disease and pay attention to whether there is jaundice and gallstone pancreatitis during the attack.

(2) Blood biochemistry and other routine examinations.

(3) Imaging examination.

(4) Skin preparation.

(5) Intestinal preparation.

(6) Preoperative administration: Atropine is injected intramuscularly 30 to 60 minutes before the operation, and diazepam is given 5 to 10 mg to those who are overstressed.

Indications for laparoscopic cholecystectomy

Symptomatic gallbladder stones; Symptomatic chronic cholecystitis; Symptomatic and surgically induced gallbladder disease.

Contraindications for laparoscopic cholecystectomy

Acute cholecystitis with severe complications; obstructive jaundice; gallbladder disease is suspected of being cancerous; peritonitis; hemorrhagic disease or coagulopathy.

Laparoscopic cholecystectomy surgery steps

The general steps of surgery: manufacturing pneumoperitoneum. Establish operation holes. Deal with the gallbladder triangle. Strip the gallbladder. Remove the gallbladder. Eliminate pneumoperitoneum.

Postoperative complications of laparoscopic cholecystectomy

1. Bile duct injury.

2. Vascular injury.

3. Intestinal injury.

4. Postoperative abdominal cavity bleeding.

5. Subcutaneous emphysema.

6. Others such as incision hernia, incision infection, and abdominal abscess.

Nursing after laparoscopic cholecystectomy

General care

After the patient was removed from the supine position with his head tilted to one side to prevent nausea and vomiting from causing suffocation, he closely observed the changes in vital signs, observed the patient's complexion and mental state, and had bleeding or bleeding in the incision to facilitate early detection of internal bleeding. Because carbon dioxide pneumoperitoneum has the risk of causing hypercapnia and acidosis, special attention should be paid to oxygen inhalation to promote the discharge of carbon dioxide.

2. Observation and nursing of abdominal signs

Postoperative patients should pay close attention to changes in body temperature and the presence of abdominal pain, bloating and jaundice. Patients who place abdominal drainage tubes should pay attention to bile outflow. If the patient has severe abdominal pain, it should be timely judged whether complications such as internal bleeding and injury have occurred, so as to promptly notify the doctor in charge to deal with the related problems.

3. Nursing of drainage tube

Some patients have a drainage tube, which should be properly fixed and properly protected to avoid pulling or twisting, which may cause pull-out or poor drainage. Do local disinfection daily, pay attention to aseptic operation when replacing the drainage bag to prevent retrograde infection, and pay attention to observe the amount and color of the drainage fluid, and record the changes in detail for dynamic observation and comparison. If there is no abnormality, it can be removed 48 hours after surgery.

4. Care of the incision

Only 4 wounds with a size of 0.5cm to 1cm were left on the abdominal wall after operation. Band-aid closure was used to remove the band-aid after anti-inflammatory and hemostasis for about 1 week. The puncture in the abdominal wall was closely observed within 24 hours after the operation, and whether there were bleeding, exudate and bile. For spillage, change the dressing in time to prevent incision infection.

Laparoscopic cholecystectomy considerations

After the operation, there may be a short period of nausea or vomiting due to the effect of anesthetics. Drug treatment can be targeted under the guidance of a doctor. Pay attention to rest, work and rest, eat a low-fat, high-protein diet, avoid fried and greasy foods, avoid small meals and avoid overeating. You can eat normally after being discharged for half a month. Wounds usually do not need or only need one or two Change the medicine, if you find red, swollen, hot, painful symptoms or fever, abdominal distension, nausea, vomiting and other symptoms, see a doctor in time. Although the laparoscopic incision is small, in order to prevent infection, you can take a bath after being discharged for half a month.

Diet after laparoscopic cholecystectomy

8 hours after the operation, if there is no vomiting, you can drink 30 ~ 50ml of water first. If the medical staff does not inform of special restrictions, you can eat liquid foods, such as rice soup and clear porridge, but avoid whole milk. In the early postoperative period of the gallbladder, a low-fat, low-cholesterol, adequate diet with high-quality protein, vitamins, and trace elements should be used for at least 2 weeks. Postoperative fat intake does not exceed 30 g per day, cholesterol intake does not exceed 300 mg per day, and daily energy intake is preferably 20 to 25 kcal / kg. The dietary fiber should choose soluble fiber from pectin, algin, and soybean gum, and ensure adequate drinking water. Diet should use soft-slag soft rice prepared by stewing, steaming, etc. It is also important to avoid frying and frying.