Disruption of the diet, genetic predisposition and congenital anomalies of the structure of the gallbladder and bile ducts lead to the formation of gallstones. The condition gives a lot of inconvenience, which causes people to look for ways to remove calculus. Today, the most common method for the treatment of calculous, that is, stone, cholecystitis is the removal of the gallbladder. But modern medicine has non-invasive methods that can be successfully used to treat certain groups of patients.
The list of techniques
Modern clinics have equipment and specialists to provide the following types of treatment:
- Stone splitting with the help of drugs.
- Extracorporeal shock wave lithotripsy.
- Laser crushing.
Each of the methods of treatment is indicated at a certain stage in the development of the disease; therefore, it is not always possible to dispense with the most gentle method of dissolving stones with chemicals. The choice of medical procedure remains for the doctor, but taking into account the wishes of the patient. It should also be remembered that the earlier gallstones are identified, the easier it is to extract them from there with less invasive intervention.
There are restrictions for admission to the process of crushing gallstones. The presence of the list of indications is due to the ratio of the benefits and harm of the treatment method for the patient. Crushing stones can be performed in the following categories of patients:
- When preserved, according to the ultrasound, contractility of the gallbladder. This is indicated by the normal size of the body. In case of overstretched walls due to the large number of stones, lithotripsy is contraindicated.
- With obstruction of the cystic and common bile duct. If the outflow of bile is disturbed, an emergency operation is indicated.
- The diameter of a single stone or the sum of the diameters of all stones should be no more than 2 cm. Stones larger can split into large fragments that will clog the bile ducts.
- The procedure is carried out only in the stage of remission of chronic cholecystitis. An acute attack is relieved until the symptoms subside. Lithotripsy should be performed as planned.
As the statistics show, patients eligible for the listed criteria are referred to a doctor no more than 15%. The rest come with larger stones and can only count on operational assistance or observation.
It should be noted that crushing does not exclude future recurrence of the disease, since the main cause of lithogenesis - inflammation of the gallbladder, changes in the chemical composition of bile, and obstruction of the bile duct - remains. According to various sources, the formation of new stones after crushing is observed with a frequency of 30% to 50%.
Today, when crushing stones, three main methods are used:
- extracorporeal shock wave lithotripsy,
- laser crushing,
- percutaneous cholecystolithotomy.
Extracorporeal shock wave lithotripsy
This is a non-invasive method of treating cholelithiasis, which is based on breaking stones with high-frequency waves directed at its area. Under their influence, large stones disintegrate into small fragments or even sand, which can pass through the biliary tract to the intestine and leave the body naturally.
Shock wave lithotripsy can be used in such cases:
- the presence of no more than three X-ray-negative lesions in the gallbladder,
- the total diameter of the formations is not more than 3 centimeters, which is determined by ultrasound,
- normal functional activity of the gallbladder.
Shock-wave fragmentation of gallstones also has a number of contraindications, including a woman’s pregnancy, congenital or acquired blood clotting disorders (as well as when drugs that slow down blood clotting — warfarin, heparins, etc.), inflammatory diseases of the hepatobiliary tract and gastrointestinal tract are taken. A very important point is the establishment of the patency of the bile duct before the operation, since the stones do not always break completely and in the case of narrow ducts or their bend, the remains can obscure the path, thereby causing subhepatic jaundice.
For the manipulation of the patient is placed on the table with a special lining that can pass waves. General anesthesia is not performed previously, as the procedure is absolutely painless, only patient sedation can be applied. Before the beginning of the manipulations, a control ultrasound (more often) or X-ray examination is carried out to clarify the placement of the stone, after which the apparatus is installed in such a position that the focus of the waves falls on the gallstone, and the crushing process begins. It takes one session about half an hour, sometimes they may take several.
Over time, small fragments pass through the biliary tract into the intestine, the rest can be dissolved using such preparations as, for example, ursodeoxycholic acid, which can be prescribed to increase efficiency even before the start of crushing.
The disadvantages of lithotripsy with ultrasound guidance or X-ray apparatus are that it acts not on the cause of the occurrence of the stones, but on the consequence:
- first of all, these are situations when stone fragments are too large to be able to pass into the intestines on their own. In this case, in subsequent ultrasound studies, several fragments of the “former” stone are determined in the cavity of the gallbladder, then lithotripsy is considered ineffectual.
- secondly, fragments can get stuck in the biliary tract, leading to the development of jaundice and other complications,
- damage to the walls of the bladder by the sharp edges of the newly formed fragments also occurs,
- but the most frequent side effects of shock lithotripsy are petechial rash on the skin at the point of passage of the waves, inflammation and swelling of the bladder wall due to exposure to the waves, which, fortunately, is completely reversible without treatment.
Laser stone crushing
Laser crushing is fundamentally different from the previous method in that it uses laser energy introduced into the cavity of the gallbladder. To do this, a small incision is made on the skin, through which, under the control of ultrasound imaging, the device is brought directly to the stone itself. Due to the high energy of the laser, the stone breaks up into very small fragments or even into sand, which then easily goes into the intestine. That is, the advantage of this method is that the fragments are not “stuck” in the biliary tract and will not cause jaundice.
A significant drawback of the method is that even a slight deviation of the laser beam can cause a severe burn of the bladder wall, and if the effect repeats, even neighboring organs, up to the formation of ulcers and perforations.
Special preparation for laser crushing is not required, except for a general health survey. The procedure takes about 20 minutes. After its termination the patient can be discharged home with the subsequent consultation of the doctor to control possible complications. Contraindications to crushing with a laser include obesity (the patient weighs more than 120 kilograms), old age (over 60 years) and the patient’s serious general condition.
The following criteria can be used to determine indications and contraindications for surgery:
- the absence of pronounced symptoms last 6 months,
- lack of signs of cholestatic syndrome according to laboratory research methods,
- single moving stones up to three centimeters in size,
- normal gallbladder size,
- preserved motility of the biliary tract,
- lack of adhesions in the area of surgery.
The difference from crushing with a shock wave or laser is that with this type of intervention, in addition to direct crushing, stone fragments are also removed through the opening of the anterior abdominal wall. Thus, complications associated with blockage of the biliary tract are completely excluded. Crush stones with cholecystolithotomy can be a laser or using electro-hydraulics. After the operation is completed, the bladder cavity is drained for 10 days, after which the person returns to his normal lifestyle.
Percutaneous cholecystolithotomy is not widespread in surgery, since it is more traumatic compared to other similar techniques.
Thus, minimally invasive interventions for cholelithiasis occupy an important niche in its treatment due to its simplicity, effectiveness, and a short recovery period after the treatment. The duration of the relapse-free period significantly increases with the continuation of treatment with the help of drugs and compliance with the principles of diet therapy.
What is gallstone disease?
Gallstone disease is a pathology in which stones form in the gallbladder.
Cholelithiasis (cholelithiasis) is a pathology in which stones form in the gallbladder or duct. The size of the stones can be from a couple of millimeters to several centimeters.
The reasons for the formation of the disease include taking foods that are high in animal fat and protein. Because of the uncontrolled use of these products in humans, the level of cholesterol in bile is severely increased, which leads to poor-quality performance of functions and stagnation.
Bile is a fluid located in the cavity of the gallbladder, which is responsible for the splitting and digestion of food. The gallbladder is located next to the liver, which produces the production of bile, namely its component - the pigment bilubin. The second major component of the bile fluid is cholesterol, an excess of which provokes the development of gallstones.
Due to the long stagnation of bile, cholesterol precipitates out of which the so-called “sand” is formed, the particles of which join each other and form stones (concrements). Stones of small size (1-2 mm) are able to go out through the bile ducts, and larger ones are already cholelithiasis, requiring therapeutic intervention.
Symptoms of JCB
Heartburn can be a symptom of JCB.
Often, a person does not know about the presence of gallstones before abrupt manifestations of symptoms that require immediate action. List of common symptoms of this disease:
- acute pain in the right hypochondrium,
- a sharp attack of biliary colic,
- nausea and vomiting,
- high temperature
- yellowness of the skin.
The neglect of the disease can provoke the following complications:
- gallbladder infection,
- narrowing of the bile ducts
- the formation of chronic inflammatory processes leading to such diseases as hepatitis, cholecystitis, duodenitis, pancreatitis.
GIB treatment methods
Laser stone crushing is a method for treating gallstones.
Modern medicine practices the following methods of treatment for gallstone disease:
Methods that do not require surgery:
- dissolution of stones with medication,
- treatment with ultrasound remote lithotripsy.
Methods with minimal intrusion:
- crushing stones with a laser
- contact chemical litholysis.
Methods requiring surgery:
- open abdominal surgery,
- endoscopic cholecystectomy.
Before choosing the necessary treatment you need to determine the composition of the stones. By nature of origin, they are: calcareous, cholesterol, pigment and mixed. Cholesterol calculi can be dissolved by the action of bile acids (ursodeoxycholic, chenodeoxycholic).
If this is not enough, then it is necessary to crush stones with ultrasound or laser, and only then apply acids. Despite the abundance of gentle methods of removing stones, the cholecystectomy method is still actively used. By this definition is meant the removal of the gallbladder, along with the stones. But gradually such operations are replaced by an endoscopic method of removal.
Dissolving the stones with drugs
Allohol - a drug that stimulates the production of bile fluid.
This method of treatment is effective only for cholesterol stones, with lime and pigment stones, alas, this method does not work. The following medications can be used:
- Analogs of bile acids: Henofalk, Khenokhol, Ursosan, etc.
- Drugs that stimulate the reduction of the gallbladder and the production of bile fluid: Kholasas, Allohol, Liobil, Zixorin, etc.
Cons medication therapy:
- when discontinuation of medication is often (10-70% of cases) there is a recurring return of the disease, since the level of cholesterol rises again,
- there are side effects in the form of diarrhea and changes in liver samples (AST, ALT),
- the course of treatment is long, medication is administered for at least half a year, sometimes up to three years,
- high cost of medicines.
Contraindications to drug treatment:
- diseases of the gastrointestinal tract: ulcers, gastritis,
- kidney disease
- gestation period.
Laser stone crushing
Crushing stones can be done with a laser.
This procedure is non-durable, takes about 20 minutes. The anterior abdominal wall is punctured, then the laser beam is directed to the necessary zone of the gallbladder and the stones are split.
Disadvantages of laser crushing:
- this way you can damage the walls of the gallbladder, injuring them with sharp stones,
- abstraction of the bile ducts is possible,
- most likely to receive a burn of the mucous, which can later lead to the formation of an ulcer,
- Professional equipment required.
- body weight of the patient is higher than 120 kg,
- the patient is in serious condition
- the procedure cannot be performed by persons over 60 years old.
Crushing Concretions with Ultrasound
Crushing stones with ultrasound is used if the patient has no more than four stones.
This method is used when the patient has no more than four stones, up to 3 cm in size, that do not contain lime impurities.
The principle of action consists in influencing the high-pressure stones and the vibrations of the regenerated shock wave in order to grind the stones to a size not exceeding 3 mm.
Next, small stones are displayed on the bile duct into the duodenum. Disadvantages of ultrasonic crushing:
- there is a possibility of bile duct obstruction due to vibration waves,
- sharp stones can damage the gallbladder wall.
- poor blood clotting,
- gestation period
- inflammatory processes and chronic diseases of the gastrointestinal tract: pancreatitis, ulcers, cholecystitis.
To the general indications is added the requirement for the composition of stones. Only cholesterol stones undergo dissolution. How to determine the composition of gallstones? This can be done using an organ radiography using contrast. A competent diagnostician will determine the chemical structure of the stones, and the gastroenterologist will prescribe the following preparations for crushing gallstones:
- Ursodeoxycholic acid, which is sold in a pharmacy called Ursosan.
- Chenodesoxycholic acid is contained in the tool Henofalk.
Before treatment, the functional stability of the gallbladder, the patency of the ducts, and the weight of the patient are evaluated.
The drug is prescribed from six months to several years, since the dissolution of the stone is a very long process. The acid first enters the gallbladder, where it activates the synthesis of bile acids and inhibits the synthesis of cholesterol. That is, in bile, there is a preponderance of a substance that dissolves stones compared to their building material. Acids gradually dissolve the stone, utilizing cholesterol in layers.
Etiology and symptomatology of pathology
The main reasons for the formation of gallstone deposits:
- violation of metabolic processes,
- long-term use of hormonal drugs and various drugs,
- age changes
- prolonged feeding through intravenous catheters - the production of bile, which is necessary for the digestion of food, is impaired,
- cirrhosis of the liver,
- transplantation of internal organs,
- intestinal pathologies with impaired absorption of nutrients,
- the use of a large number of products with iron content (meat, seafood).
The exacerbation of gallstone disease makes itself felt the following symptoms:
- paroxysmal cutting pains in the stomach, extending to the right hypochondrium,
- signs of dyspepsia: nausea, heartburn, vomiting, gas accumulation in the intestines,
- intense heat
- skin begins to turn yellow due to stagnation of bile.
If untreated, gallstones provoke narrowing of the bile ducts, the gallbladder becomes inflamed, and chronic cholecystitis develops. In the future, the lesions may also affect other organs of the urinary system: the bladder, kidneys, and liver. In acute attacks of the disease, emergency surgical intervention and removal of stones from the organ is required.
In terms of composition, stones are divided into the following types:
- Cholesterol stones arising from the abuse of fatty carbohydrate foods, when due to a sedentary lifestyle, overweight, diabetes mellitus or hereditary predisposition, the level of cholesterol in the blood rises.
- Pigment (bilirubin) occur as a result of anemia, with liver cirrhosis, when blood formation processes are disturbed. Make up 10–20% of all gallstones. More often black.
- Calcareous are formed by infection of bile by pathogenic bacteria in inflammatory lesions of the mucous tissue of the walls of the gallbladder. There are brown.
- Mixed stones is a mixture of cholesterol and calcium formations.
To select the method of treatment, diagnostics is carried out and the composition of the stones is determined. The basis of stone formations can be cholesterol, lime deposits, enzymes and mixed composition. Cholesterol deposits can be dissolved using bile based drugs. Grinding of more strong and large stones is made by ultrasound or the laser.
Gallstone disease of the gallbladder can be treated in the following ways:
- diet therapy and wellness procedures,
- medical dissolution of gallstones without surgery,
- grinding of stones (lithotripsy),
- surgical removal of the affected bile organ with all existing stone formations (cholecystectomy).
As noted above, only cholesterol stones up to 2 cm in size can be dissolved with bile-based drugs (Ursosan, Ursofalk, Khenohol). At the same time, the cause of stone formation in the bile-excreting organs, aimed at restoring gallbladder activity and stimulating bile production, must be affected . For this purpose, prescribe drugs Allohol, Kholosas and Lyobil.
Contraindications to medical treatment:
- pathologies of the digestive system (gastritis, tumors of various etiologies, motility disorders, intestinal obstruction, etc.),
- inflammation in the kidneys (pyelonephritis),
- use of hormonal oral contraceptives,
- excessive body weight
- pregnancy and lactation.
Disadvantages of this method:
- the probability of a repeat of the disease after the completion of medication,
- long course of treatment (from 6 months to several years),
- violation of intestinal microflora,
- high cost of drugs.
Removal of gallstone deposits by crushing them
The main indications for the use of lithotripsy:
- presence of calcium in the calculus,
- disease duration: the greater the age of the stones, the more difficult it is to dissolve them,
- contraindications to the use of drugs
- large sizes of stones.
The essence of the method allows crushing stone formations with a shock wave into smaller fractions, which are removed from the bladder with bile fluid into the duodenum and leave the body along with feces.
The disadvantages of this method of therapy:
- the likelihood of the failure of larger fragmented fragments in the gallbladder,
- the possibility of particles getting stuck in the bile ducts,
- possible injury to the ducts by the sharp edges of the calcium particles upon exiting.
Such complications may be due to the fact that there has been a separation of gallstone formation into relatively large parts, exceeding the size of the ducts. For this purpose, a drug dissolution of particles or several shock wave lithotripsy procedures are used in the complex. There are 2 main methods: ultrasonic and laser crushing of gallstones.
The separation of gallstone deposits with an ultrasound machine is based on the impact of a wave on them. Ultrasonic crushing them into fragments of 4–8 mm in size is ideal, then they can freely leave the gallbladder. To get the desired result, as a rule, 5-7 sessions are required.
Indications for the use of grinding stones with ultrasound:
- the number of formations in the bubble is not more than 4 pieces,
- the formations consist of cholesterol deposits, without liming substances,
- the size of each stone is no more than 3 cm in diameter,
- the functionality of the gallbladder is intact, bile escapes from it unhindered.
Disadvantages of ultrasound extraction of stones:
- there is no guarantee of the formation of new stones due to the persistent gallbladder pathologies,
- the above conditions correspond to only 15% of patients with cholelithiasis,
- the sharp edges of the fragments can injure the mucous membranes of the gallbladder, duodenal intestine at the exit, and also get stuck in the bile ducts, which will require surgery,
- vibration can damage the gallbladder wall, cause inflammation and the formation of scar tissue in the peritoneum.
Contraindications for ultrasonic crushing:
- dysfunction in the gallbladder,
- gastrointestinal diseases (gastritis, pancreatitis, ulcers, duodenitis, etc.),
- electronic pacemaker for cardiac activity,
- poor blood clotting,
- carrying a child.
Crushing stones with a laser
You can crush gallstones with the help of laser beams. To do this, produce a perforation of the anterior part of the peritoneum, and the apparatus is introduced into the bile organ. The laser beam acts directly on the cluster of stones, crushing them into small fractions. The procedure lasts no more than 20 minutes. Indications for the use of laser surgery are the same as for ultrasonic crushing.
Crushing gallstones with a laser has the following possible side effects:
- burns of the mucous membrane of the gallbladder when exposed to a laser beam, which can provoke the formation of ulcerative foci of the mucous epithelium,
- painful sensation when particles leave the bubble,
- damage to the walls of the bladder and intestines when moving crushed particles with pointed edges,
- Jamming of larger particles in narrow bile ducts
- the probability of re-formation of stones.
Contraindications for laser lithotripsy:
- patient weight more than 120 kg
- old age of the patient (over 60 years),
- concomitant pathology of the digestive tract, cardiovascular system.
In order to avoid cases of destruction of the biliary tract and injury to the mucous membranes, simultaneous use of ursodeoxycholic acid preparations for dissolving small fragments is recommended.
With this method, several abdominal punctures are performed under general anesthesia. First, carbon dioxide is injected into the peritoneum. Then, in one puncture, an endoscope is inserted to obtain an image, with the help of which the location of the deposits is found. A metal tube is inserted into another hole through which stones are pulled out of the organ.
Contraindications for surgery:
- large sizes of stones
- the body's susceptibility to the formation of adhesions,
- purulent inflammation of the gallbladder,
- cardiovascular pathology.
Removal of the gallbladder (cholecystectomy)
In cases where the presence of especially large stone formations has been diagnosed, with appropriate contraindications for other treatment methods and in especially emergency situations, a surgical operation is performed to remove the affected gallbladder.
When cholecystectomy solved all the problems associated with the formation of stones in the body. However, in case of removal of this organ, the patient will be forced to take substitute drugs and follow a special diet for the rest of his life.
Prevention of gallstone pathology
To prevent the re-formation of stone deposits in the gallbladder, the following recommendations should be observed:
- eliminate from the diet foods high in carbohydrates,
- limit the consumption of fatty, salty and spicy foods,
- refuse alcoholic and carbonated drinks,
- add protein foods, cereals, fruits, vegetables to the menu,
- make nutrition divided and fractional (in small portions 5–6 times a day),
- in order to avoid stomach irritation, do not eat too hot or cold food,
- practice long walks in the fresh air (not less than an hour),
- exercise with moderate exercise (swimming, yoga, Pilates, aqua aerobics, dancing),
- for prevention, you can take drugs to liquefy bile,
- timely treatment of concomitant diseases of the gastrointestinal tract and biliary organs,
- undergo a routine checkup and measure cholesterol levels in the blood.
Compliance with these simple rules will allow patients to avoid recurrent relapses of the disease and surgery to remove the gallbladder.
Laser stone crushing technology
Stone grinding with laser is called percutaneous cholecystolithomy and belongs to the category of highly effective procedures. It is prescribed in cases where for a number of reasons it is impossible to conduct a surgical intervention.
The advantage of this method is that it is not possible to introduce viruses and bacteria into the patient's body. The recovery period after crushing stones is minimal. With consistent diet and preventive measures, the result has a lasting effect.
The laser allows you to crush stones to sand grains. After which they are removed from the body of the patient along with the bile. The absence of sharp edges and large stones after crushing excludes trauma to the walls of the organ and blockage of the bile ducts.
Laser crushing of stones is used in the presence of large stones and the absence of positive dynamics after conservative treatment. Cholecystolithomy is also used in the period of exacerbation of gallstone disease.
The procedure has several contraindications:
- localization of fragments outside the wave area,
- diseases of the circulatory system
- viral diseases
- body weight in excess of 120 kilograms
- malignant tumors.
Laser stone removal is a quick procedure. It takes about 20 minutes and is performed in several stages:
- A small incision is made on the surface of the abdomen. It is located in the gallbladder.
- Under observation, a laser is directed through the ultrasound equipment to the calculus.
- The stone is crushed after direct exposure to the laser beam. Cleavage occurs to the smallest fragments.
- Within a week after the procedure, drainage is established in the hole.
Of the main disadvantages of removing gallstones with a laser should be a possible recurrence of the disease. According to statistics, about 30% of the procedures lead to the re-formation of stones.
Shock wave method
Shock-wave lithotripsy is an ultrasonic destruction of calculus without surgical intervention. The method is to create pulses that penetrate through the tissue and transmit their energy to the local zone. Under the action of a pulse, the stone is destroyed at the level of the crystal lattice. Stones in the gallbladder disintegrate into small pieces. The resulting elements go out independently with bile. With increased stone hardness, several procedures may be required.
The method of destruction by ultrasound showed the maximum effect when the size of the stones no more than 25 millimeters. It is important that no duct blockage occurs at the time of crushing. The oxalate and uric acid stones are most easily affected by the shock wave.
At the time of the procedure, the specialist takes into account the nature of the formations, the performance of the gallbladder, the general condition of the patient. In the event that the formations occupy more than a third of the volume of the gallbladder, and it does not empty completely, the procedure is contraindicated.
Like most methods, ultrasonic removal of stones has a number of contraindications:
- body weight up to 120 kg
- patient height exceeds 2 meters,
- diseases of the cardiovascular system, circulatory system, arrhythmia,
- viral diseases in the acute phase.
It should be noted that the ultrasonic crushing is not carried out in the case of increased density of stones. Before the procedure, the patient undergoes a full examination. It is important to determine the exact location of the stones, their dimensions, the type of education. The patient takes a blood test, his blood type is determined, Rh factor.
A few days before the start of the manipulation prescribed drugs aimed at thinning the blood. If inflammatory processes or infections have been identified, antibiotics are prescribed.
Laser crushing is carried out under anesthesia or with the use of local anesthetics. To control the procedure using the ultrasound machine. The patient is located under the apparatus lithotriptor, an ultrasonic shock wave is directed to the area of localization of stones. It acts with a given frequency and power. The procedure takes no more than 1 hour. During the crushing may experience pain in the lumbar region, bouts of colic. The pain is associated with the discharge of stones. The full effect is observed only 2-3 weeks after the procedure. During this time there is a crushed stone.
Shock wave lithotripsy can cause complications. They are associated with the subsequent discharge of stones through the ducts and the impact of the shock wave on the tissue of the organ. This method splits concretions into fragments of arbitrary size. They may have sharp edges. In some cases, during the release of stones through the ducts, tissue injury occurs, accompanied by severe pain.Large fragments are capable of blocking ducts, which adversely affects the patient's general well-being.
It should be noted that complications after shock-wave lithotripsy are quite rare. With proper execution of the procedure, the patient is completely cured.
Method of contact chemical cholelitholysis
Crushing of gallstones using the method of contact chemical cholelitolysis was used not so long ago. He belongs to the category of experimental. For the use of contact chemical dissolution of stones must be satisfied several conditions:
- stones have cholesterol origin,
- gallbladder function is fully preserved,
- bile ducts are passable,
- inflammatory processes in the gall bladder are absent.
The procedure consists in inserting a catheter into the gallbladder at the location of the stone. Through it comes a potent solvent. The catheter is installed by puncture, through a puncture in the skin. Means is served in small portions. After dissolving part of the calculus, it is sucked through a syringe and a new batch is supplied. The procedure is lengthy. It takes 4 to 16 hours.
At the moment, the main solvent is methyl tert-brown ether. It dissolves cholesterol in a few hours without causing damage to the gallbladder mucosa. The lack of a sufficient amount of statistical data does not allow for the active use of this method.
The main disadvantage of contact dissolution is residual garbage. Cholesterol particles are not always completely removed from the gallbladder. Subsequently, they can provoke the development of new stones. For this reason, contact crushing is used in conjunction with conservative treatment methods.
Crushing stones by non-traditional methods
Many patients are concerned about the question whether stones can be removed without surgery and medication. It turns out that the initial stages of high efficiency showed the use of herbal decoctions. They allow you to crush the formations formed from cholesterol crystals and calcium salts.
Popular methods are effective only when the size of stones to 2.5 centimeters. Larger formations can clog the ducts and worsen the overall picture of the disease. Such herbs as Goldenrod, Common Two-nettle, Motherwort, Celandine, Dandelion, and Donnik are known for crushing and splitting effects. The most effective decoctions of several herbs.
It is important to understand that herbs do not provoke a sharp outflow of bile from the body. They act gently. The stone is gradually crushed and split into sand grains. After that, they are excreted through the bile ducts. This process takes a long time.
In addition to herbal decoctions, vegetable juices have a crushing effect. Experts noted that carrot juice gives a high result. Beet, cucumber, parsley and celery. They are used alone or in a mixture. For a therapeutic effect, at least 1–2 liters of juice should be drunk per day over several approaches. The action of vegetable juices due to the presence of acids, which dissolve and remove stones from the body:
- The recipe is based on Motherwort. For preparation, you will need a mixture of Herb, Goldenrod and Common Nettle in equal parts. 200 ml of boiling water requires 1/2 spoon of each herb. The mixture is brought to a boil and defend for 15 minutes. Broth take half an hour before meals. Removal of stones from the gallbladder occurs within a month.
- Recipe from a mixture of herbs. To prepare the required 5 tsp. Celandine, Donnik and flowers of Wormwood, 3 tsp. Dandelion leaves, Chicory root, Valerian, Gentian. Herbs mix well. For broth use 1 tablespoon of the mixture per cup of boiling water. Defend the decoction is recommended for at least an hour. Take the medicine 2 times a day, 50 ml. The course of treatment for at least 2 months.
- A mixture of beet juice, carrots and cucumber. For cooking use 70 ml of carrot and 30 ml of beet and cucumber juice. 3-4 vegetable cocktails are drunk during the day. It is desirable to distribute the reception time evenly.
- Celery juice with parsley. For the cocktail, use 100 ml of carrot juice, 50 ml of celery juice and 20 ml of parsley juice.
In cases where the drug treatment did not work, and after crushing the stones appeared again and were accompanied by severe pain, removal of the gallbladder was shown. The method of surgical intervention is determined by the attending physician.
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Effects of treatment
As with any treatment, these techniques can cause complications. The most dangerous is blockage by a fragment of stone of the bile ducts. The situation can develop with any procedure. Sometimes, even with the normal diameter of the duct, after the intervention, the lumen decreases and even a small stone can get stuck there. The flow of bile stops and the gallbladder becomes full. Subhepatic jaundice is formed. The patient will gradually turn yellow, the skin will begin to itch from bilirubin, the urine will be dark, unlike light feces. The treatment is only surgical. The option of laparoscopic access is possible.
Another less serious complication is the formation of pancreatitis (inflammation of the pancreas). Lithotripsy of gallstones leads to the release of fragments of stones and sand into the duodenum, the ducts of the pancreas are also opened there. They may partially clog or inflame from pathological effects. This leads to edema of the gland parenchyma and the development of symptoms of pancreatitis. Treatment conservative in a surgical hospital.
The consequences of lithotripsy include recurrence of stone formation. In more than 50% of cases, doctors re-find stones within 5 years. This is due to the fact that crushing stones is a symptomatic treatment, that is, aimed at eliminating the manifestation of the disease. At the same time, the reasons for its formation are preserved, and the stones appear again.
Drug dissolution of stones
Only cholesterol stones up to 2 cm in diameter can be dissolved (this method does not work on calcareous and pigment stones). For this purpose, analogs of bile acids Ursosan, Henofalk, Urofalk, Henokhol, etc. are used.
In parallel, stimulation of the contractile function of the gallbladder and the production of bile with the help of Allohol, Holosas, Zixorin, Liobil can be carried out.
Various concomitant diseases of the gastrointestinal tract (ulcer, gastritis) and kidney,
Acceptance of oral contraceptives containing estrogen,
High recurrence rate (10-70%), because after stopping the medication, the cholesterol level in the bile rises again,
Long duration of treatment (from 6 months to 3 years),
Side effects such as diarrhea (10% of cases), changes in liver function tests (ALT and AST),
High cost of drugs.
Crushing stones with ultrasound
This method is based on the grinding of stones under the influence of high pressure and vibration of the regenerated shock wave. Ultrasound destroys stones and breaks them up into smaller particles with dimensions not exceeding 3 mm, which are subsequently displayed along the bile ducts into the duodenum. Ultrasonic lithotripsy is suitable for patients who have found a small amount (up to 4 pieces) of rather large cholesterol stones (up to 3 cm in diameter), without lime impurities in their composition.
Chronic inflammatory diseases of the digestive tract (cholecystitis, pancreatitis, ulcers),
Possible obstruction of the bile duct due to vibration,
Damage to the gallbladder walls by the sharp edges of stone fragments.
Contact chemical cholelitholysis
This method was developed in the framework of the current trend in the development of organ-preserving treatment methods. With it, not only cholesterol stones are dissolved, but also any other types of stones. The size and number of stones also do not matter. This method can be used at any stage of the disease, and, unlike the previous two, not only with asymptomatic 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 an ultrasound, through which a special drug dissolving stones is introduced by drip. The effectiveness of the method is 90%.
Methyl tertiary butyl ether, which is a strong organic solvent, is commonly used as a drug. It is proved that the gallbladder is resistant to the cytotoxic effect of methyl tertiary butyl ether.
The disadvantage of the method is Invasiveness.
Laparoscopy is performed under general anesthesia. Stones are removed using trocar (metal conductors), which are inserted into incisions in the abdominal cavity. 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 the stones. After the operation is completed, staples are applied to the ducts and vessels of the gallbladder. The duration of the operation is about an hour, the stay in the hospital is 1 week.
The indication for laparoscopy is calculous cholecystitis.
Too large stones
The presence of adhesions after surgery,
Diseases of the heart and respiratory system.
In laparoscopic cholecystectomy, gallstones are removed along with the bladder through a small incision up to 1.5 cm in diameter on the anterior surface of the abdomen. A total of 3-4 such incisions are performed. A laparoscope (a small tube with a video camera) is inserted through another incision to monitor the operation. The advantages of laparoscopy before abdominal surgery are a short recovery period, the absence of noticeable scars and lower cost.
Abdominal open surgery
Open cholecystectomy is performed when there are very large stones in the gallbladder, as well as with various complications of gastrointestinal diseases and inflammatory processes in the internal organs. In open surgery, the gallbladder is removed through a 15–30 cm incision that runs from the right hypochondrium to the navel.
High degree of invasiveness
Need for anesthesia,
The risk of internal bleeding or infection, The possibility of death in emergency surgery.
Why not remove the gallbladder?
Removal of the gallbladder leads to a chain of biochemical changes, during which the regulation of the flow of bile is lost. Motility of the duodenum muscles is impaired, bile acquires a more liquid consistency and weakly protects the organ from pathogenic microorganisms, which begin to multiply, destroying the normal microflora of the digestive organs. As a result, bile acids strongly irritate 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), and colitis.
Additionally, there are violations of the 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 rapidly eliminated, which adversely affects the process of digestion.
After cholecystectomy, patients often complain that pain in the right hypochondrium and in the area of the liver persists, bitterness in the mouth often appears, food has a metallic taste.
Surgery does not eliminate the symptoms of gallstone disease. Stones after removal of the gallbladder can form in the bile ducts, and a so-called choledocholithiasis occurs.
Removal of the bubble is due to the formation of stones in it, the cause 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 impact not only on the state of the gastrointestinal tract, but also on other systems of the body.
Based on the above, we can conclude 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, stones of small size and with no serious contraindications. However, in all other cases, it should be remembered that cholecystectomy is the last way out, and it should be resorted to when all other methods turned out to be ineffective.
What is desirable to exclude from the diet?
The composition of the diet is of great importance in this disease.
For gallstones, it is recommended to exclude the following products and dishes from the menu:
Fatty meat (pork, lamb, beef) and fish,
Sausages, smoked meats, pickles,
Legumes, radishes, radishes, eggplants, cucumbers, artichokes, asparagus, onions, garlic,
Fried, sour and spicy dishes,
Coffee, cocoa and alcohol.
It is recommended to use foods that stimulate the excretion of excess cholesterol:
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.
Article author: Gorshenina Elena Ivanovna | Gastroenterologist
Education: A diploma in the specialty “Medicine” was received at the Russian State Medical University. N.I. Pirogov (2005). Postgraduate Studies in Gastroenterology - educational and scientific medical center.
Gallstone disease (ICD) is a disease characterized by the formation of stones in the gallbladder and its ducts due to the disruption of certain metabolic processes. Another name for the disease is cholelithiasis. The gallbladder is an organ adjacent to the liver and acts as a reservoir for the liquid bile produced by the liver.
In humans, several types of bile acids are produced. In such preparations as Ursohol, Ursofalk and Ursosan, the active ingredient is ursodeoxycholic acid. Henodesoxycholic acid forms the basis of such drugs as Henohol, Khenosan and Henofalk. These drugs are designed to recover.
Beet syrup. It is necessary to take a few beet heads, peel them off and rinse well with running water. Beets need to cut and boil until the broth does not take the form of syrup. The resulting syrup is taken orally 0.5 cups 3 times a day before.
As a choleretic agent, anise tincture is used. To do this, take them in the amount of 40 grams and put in vodka. Its volume should be 250 grams. Insist should be for 10 days. After that, ingest during meals.
The menu should contain food of protein origin. This is due to the fact that the gallbladder regulates carbohydrate metabolism, but proteins are not able to overload it. Oils such as vegetable and cream are not recommended to completely remove from the diet. It would be more correct to add it already with cooked food.
Diagnosis of gallstone disease, its symptoms and causes
Gallstone disease develops for a long time. From the initial stages of formation of stone deposits to the first symptoms, 5-10 years pass. This can be explained by the fact that a person does not feel the presence of stones. The symptoms and treatment should be known in advance.The appearance of pain indicates the ingress of stones and bile ducts, which are beginning to be injured. Choledoch from the bile duct removes the digestive fluid to the duodenum. It may clog with calculus, which will cause bile stasis.
The first symptoms of pathology include:
- yellowing of the skin, sclera, mucous membranes,
- feeling of bitterness in the mouth - is one of the main signs of stagnation of bile,
- nausea, heaviness in the stomach - these sensations persist even after vomiting,
- pain in the right hypochondrium.
Such symptoms indicate the release of stones from the gallbladder. It is dangerous to leave them without attention. In some cases, there is a calculus injected into the neck of the gallbladder. There are also the main symptoms of the disease:
- Hepatic colic.
- Yellowing of the skin and sclera of the eyes.
Additional symptoms include fever, increased sweating, discoloration of feces, pain in the liver, cramps. Symptoms are expressed depending on the location of the blockage of the bile ducts. If the stone in the gall bladder does not bother, it does not mean that it should not be removed. This can harm the patient's health.
The reasons for the formation of stones in the gall bladder include:
- bile stasis or its high concentration
- violation of exchange processes,
- pathology of the structure of the digestive tract,
- dyskinesia of the bile ducts (disruption of the bladder and its ducts),
- lack of liver cells,
- scars, adhesions or neoplasms of the bile ducts,
- development of infection.
Big stones called stones from 2 mm. They are removed only abdominal surgery. Such an operation is performed in acute cholecystitis. Factors contributing to the development of gallstone disease:
- poor nutrition,
- the presence of excess weight
- sedentary lifestyle,
- age after 70 years
- taking certain medications, which include estrogens, contraceptives, fibrates (cholesterol-lowering),
- welcome spicy, spicy and fried foods,
- gender - the risk of cholelithiasis in women is higher,
- hereditary factor.
Diagnose cholelithiasis in several ways. The appearance of symptoms is associated with the number of stones. There are such survey methods:
- history - collecting information from the words of the patient,
- analysis of bile and blood
- oral cholecystography - the patient first drinks a contrast agent, and then an x-ray is performed.
Modern medicine allows you to remove stones from the gallbladder quickly and safely.
How to get rid of gallstones
The disease does not manifest itself until the late stage. The patient cannot suspect the problem until a certain point. Therefore, emergency surgical assistance is often required. Since the stones from the bladder begin to spread through the internal organs and scratch their walls, inflammatory processes are possible. This explains why it is worth starting treatment after the first signs appear. Removal of stones from the gallbladder is carried out in accordance with the condition of the patient.
Often, patients diagnosed with stones in the gallbladder, go to the doctor only after the appearance of strong biliary colic. High fever and nausea possible. Eyes may be yellowed in the sclera. To understand how to remove calculi, will help the doctor.
If the patient does not seek help for a long time, dangerous complications may appear. As a result of inflammation, illnesses such as pancreatitis, cholecystitis and duodenitis appear. There are several ways to remove stones from the gallbladder.
Therefore, the fight against gallstone disease should begin in a timely manner. The sooner the patient visits the doctor, the higher the chance to cure the disease without abdominal surgery to remove gallstones. You can get rid of stones in three modern ways:
- drug treatment (when small particles dissolve in the gallbladder),
- crushing (without removing the gallbladder) produces many small fragments,
- operation - through punctures or incision.
The first option includes not only the use of drugs, but also ultrasound lithotripsy. At the same time, no internal intervention is carried out. This method of removing stones from the gallbladder is only effective when there is a small diameter and a small amount of stones. Can a stone dissolve on its own? Without the use of special tools, this is unlikely.
In the process of crushing used laser. This is a minimally invasive method. In case of emergency, appoint an operation. What will be the method of removal of calculus, depends on the state of the body. Sometimes laparoscopy helps (stones from the gallbladder are removed through punctures), others require abdominal surgery. To understand how to get rid of stones, will help the doctor.
Before any operation, conduct a thorough examination. It is important to diagnose and find out what type of stones are located in the gallbladder. They may differ significantly in composition. It is important to know when a doctor prescribes medication. With the ineffectiveness of drugs (when the stones do not disappear), prescribe a laser or ultrasound. In advanced situations, stones are removed by surgical intervention. This is the only way to remove large gallstones.
Surgery to remove stones with gallbladder preservation
There are several methods for removing stones from the gallbladder. However, not all allow you to save the body that can function normally. The operation to get rid of stones in the gallbladder is designed to save the patient from violations of the digestive tract. Among the ways to leave the body, there are:
- laparoscopic - this is the name of the method in which the incision is not performed,
- laparotomic - when an incision is necessary.
Endoscopic surgery to remove gallstones (laparoscopy) is today increasingly used to treat cholelithiasis. This method of treatment requires a certain qualification, as well as the use of special equipment.
The operation is performed using a laparoscope. The surgeon performs a puncture in the abdominal cavity, then enters the endoscope there and monitors the operation on the screen.
Laparotomy is performed by making an incision in the anterior wall of the peritoneum. Perform the operation under general anesthesia. This method is considered classic. During the procedure, the surgeon is given the opportunity to examine the organs lying nearby and see if they have any pathology. Such an operation is prescribed if the gallbladder is located atypically, which requires caution in the process of manipulation. If you perform the procedure without an incision, rupture of the organ is possible, as well as liver pathology. A large fragment can get stuck in the bile duct, therefore crushing is carried out with a concrement diameter of not more than 2 cm. To eliminate the problem, the concrement surgery is performed in an abdominal manner..
Advantages and disadvantages
Removal of stones with preservation of the gallbladder has several pros and cons. The advantages of laparoscopy include safety, a small number of contraindications. The method is less traumatic, and no cosmetic defects remain on the skin. It can be done without general anesthesia. The disadvantages of laparoscopy include the complexity of the operation and the need for highly skilled surgeon.
Removal of gallstones through the mouth
The essence of this method of treatment is the introduction through the mouth and stomach, and then the duodenum of the small probe. To the obstacle that is stuck in the duct, serves a contrast fluid and take a picture. It is necessary to determine the cause of jaundice. Often, its source is a stone that is stuck in the duct. Removing stones through the mouth is a fairly common way to deal with gallstone disease. The procedure can be disassembled on video.
Less often find a polyp or a tumor. If the cause of the blockage is a stone, the surgeon can crush it with special tools directly in the duct itself. Then a second shot is taken to make sure that the bile passes through the duct normally. The disadvantage of the method - when detecting large stones will have to do abdominal surgery.
Recovery and rehabilitation after removal of stones from the gallbladder
When the stones are removed from the gallbladder, it is important to observe certain activities for 4-8 weeks. These actions will ensure the normal functioning of the liver. In normal condition, the liver produces 600 to 800 ml of bile every day. This amount enters the gallbladder for storage. When the food lump approaches the duodenum, accumulated bile begins to be released into it.
If abdominal surgery has been performed, the patient should not move after the release of anesthesia for at least 6 hours. Then allowed to rise and unfold. On the first day it is forbidden to eat. Only non-carbonated water is allowed. On the second day, you can drink jelly or skimmed kefir.
For 3-4 days it is allowed to eat vegetable puree, some boiled meat and lean fish. This diet is observed for 4 consecutive days. Then the patient goes on a fractional diet. Meals should be frequent. It is unacceptable to eat fried foods. Products are crushed and heated to a warm state.
When restoring (rehabilitation) after removing stones, the following are excluded from the diet:
- fish, meat, vegetable canned food,
- smoked products,
- pickles and marinades,
- bread - rye and white,
- green peas, raw vegetables.
This diet should be agreed with the doctor.
Where can I remove stones from the gallbladder and how much it will cost
In Moscow, the operation costs from 24 thousand rubles. For example, when contacting the Cosmet clinic, the price can go up to 60 thousand. There are quite a few average offers up to 30 thousand. Most clinics have clinics that remove stones from the gall bladder:
You can find many decent offers from private clinics. You can figure out how much the procedure costs after consultation with the selected institution. The cost of removing gallstones with a laser can vary greatly by region.
Removal of stones from the gallbladder with preservation of the organ.
Laparoscopy - a method of dealing with stones in the gallbladder.
Doctors resort to such methods if the patient confirms such a diagnosis as calculous cholecystitis. The operation lasts about an hour. Stages of operation:
- general anesthesia is administered,
- an abdominal incision is made,
- the abdominal cavity is filled with carbon dioxide,
- a tube is inserted into the incision to transmit the image to the monitor of the device,
- the surgeon looks for stones and removes them with metal guides (trocar),
- staples are laid on the ducts and vessels of the gallbladder.
After the operation to be under observation need about a week. Contraindications:
- stones are unacceptably large
- gallbladder abscess,
- heart diseases,
- respiratory system diseases
- the presence of adhesions after other operations.
About stones in the gallbladder - in thematic video:
Cholecystectomy and laparoscopic cholecystectomy
Under laparoscopy and laparotomy in this case means the removal of the gallbladder, together with the stones contained in it. A laparoscope is a tube with a video camera, which is inserted into one of several sections of the abdominal cavity (they are made 3-4 during the operation). Next, the gallbladder is removed through a small hole (up to 1.5 cm in diameter). Advantages of laparoscopy:
- short recovery period
- low cost
- lack of large scars.
Cavitary open operation
If there are too large stones, surgery is performed.
Surgeons use this method for cholelithiasis with severe complications, for too large stones, or for dangerous inflammatory processes.
The operation is carried out through a large incision with a diameter of up to 30 cm, extending from the right hypochondrium to the navel. Disadvantages:
- compulsory anesthesia
- high invasiveness
- possibility of infection
- risk of bleeding,
- death is possible (in case of emergency operation).
Reasons for not removing the gallbladder:
- impaired motility of the duodenal muscles,
- bile changes its texture and does not effectively protect the organ from pathogenic organisms,
- bile acid irritates the mucous layers and as a result, diseases are possible: gastritis, duodenitis, colitis, etc.
- the functions of secondary absorption of bile are disrupted and it is rapidly excreted from the body, which negatively affects the digestion process,
- the appearance of pain in the right hypochondrium, bitterness and metallic taste in the mouth.
Removal of the gallbladder does not guarantee the absence of JCB, since stones can also form in the bile ducts.
Before resorting to cholecystectomy, one should try to get rid of the problem by more gentle methods, and only when their inefficiency is confirmed, then to operate.
Products that remove excess cholesterol:
- buckwheat and oatmeal,
- low fat dairy products
- lean meat and fish
- non-carbonated water, compotes, fruit drinks (at least 2 liters per day),
- fruits vegetables.
Products not recommended for use:
- fatty meat and fish,
- sausages, pickles,
- fried, spicy, sour,
- alcohol, coffee, cocoa,
- beans, onions, garlic, eggplants, cucumbers, etc.
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