HOLETsISTOTOMYYa (Greek chole
bile + vesicotomy) — the operation consisting in opening of a gleam of a gall bladder. In cases when this operation is undertaken for removal of concrements with the subsequent mending of a wall of a bubble tightly, it is called a «ideal» cystifellotomy.
For the first time executed a «ideal» cystifellotomy in 1883 Mr. Meredith (And. M of Meredith), and in Russia — N. V. Sklifosovsky in 1890.
The «ideal» cystifellotomy is applied seldom, and, as a rule, in combination with other operations when the laparotomy is made in other occasion, napr, at an inoperable carcinoma of the stomach or a large intestine, and also at critical condition of the patient, at patients of senile age, etc.
Necessary conditions for performance of this operation are lack of small stones, inflammatory changes in walls of a gall bladder, infection of concrements and bile, and also absolute passability of bilious channels. In addition to the specified conditions there are also certain contraindications considerably narrowing the frequency of use of this operation. The matter is that the «ideal» cystifellotomy is not pathogenetic reasonable intervention as the causes of a lithogenesis at the same time are not removed and in the subsequent a recurrence of a disease is possible. Besides, sewing up holetsistotomichesky otver-
Fig. The diagrammatic representation of a stage of operation of a cystifellotomy at the time of removal of a gallstone: (/) which bottom is dissect between two threads handles (2) remove a stone from the opened gall bladder; the neck of a gall bladder is squeezed by the special tourniquet (3) interfering possible penetration of stones into bilious channels.
the stiya owing to cicatricial changes can lead further to considerable deformation of a gall bladder that is followed by disturbance of its function, emergence of the expressed pain syndrome and a lithogenesis.
The cystifellotomy as a stage of operation is made when it is necessary to keep a gall bladder for imposing of a bilio-digestivny anastomosis (see. Bilious channels, the Gall bladder, operations) or creations of outside cholecystis fistula (see the Cholecystostomy).
After a laparotomy (see) a gall bladder fence off from a free abdominal cavity gauze napkins. On a bottom of a bubble impose two threads handles, between to-rymi make a puncture of a wall a trocar or a thick needle and delete bile. On site a puncture do the section sufficient for removal of a stone. The last is taken by means of special nippers or a spoon (fig). At the same time it is necessary to interfere with penetration of smaller stones into a vesical and general bilious channel. For this purpose the neck of a gall bladder is squeezed fingers or by means of a special tourniquet. In the course of operation it is reasonable to inspect a cavity of a gall bladder a finger to be convinced of its full emptying. The wound of a gall bladder is sewn up with a two-row seam or impose an anastomosis with lean or a duodenum (see Hole-tsist oen t e growth iya, the X olets an ist an oduo-denostomiya), or with a stomach (see Hg about le of cysts August grew at t about mi I).
Bibliography: Ishchenko I. N. Operations
on the bilious ways and a liver, Kiev, 1966; Niderleb., etc. Surgery of bilious ways, the lane from Czeches., page 130, Prague, 1982;
About the h to and A. D N. Cholelithiasis, cholecystitis and their surgical treatment, M., 1949; Savelyev V. S., B at I -
novv.m. and Ognevyu. B. Acute pancreatitis, page 195, M., 1983. O. B. Milonov.