Postcholecystectomy syndrome from the position of surgeon and gastroenterologist

The actuality of the problem is associated with an increase in the number of patients with cholelithiasis of working age and a significant increase in cholecystectomies not only in Russia, but throughout the world. It is known that more than 2,5 million are performed annually. Moreover, 5-40% of operated patients develop postcholecystectomy syndrome, which is manifested by recurrent abdominal pain and cholegenic diarrhea. The aim of the study is to assess morphofunctional changes in the mucous membrane of various parts of the intestine in patients with postcholecystectomy syndrome. Histological, histochemical, morphometric and bacterioscopic, parasitological methods were used to study 42 biopsy specimens of the mucous membrane of various parts of the intestines of patients who underwent cholecystectomy. The control group consisted of 18 biopsies of practically healthy individuals. To objectify the study, a morphometric study of the mucous membrane of the duodenum according to 34 parameters, of the cecum and sigmoid colon according to 22 parameters was carried out. In the mucous membrane of the duodenum, chronic duodenitis of varying degrees of activity of the pathological process and atrophy of the intestinal villi were revealed, the intestinal glands were shortened, the intestinal villi are less wide. The epithelial layer of intestinal villi and intestinal glands was abundantly infiltrated with neutrophilic granulocytes. The density of the inflammatory cellular infiltrate in the stroma of the intestinal villi and intestinal glands increased. On the surface of the epithelial layer of the intestinal villi and between the intestinal glands, campylobacters were often found, less often - cryptosporidia. In the mucous membrane of the cecum and sigmoid colon, chronic colitis of varying degrees of activity of the pathological process and atrophy of the intestinal glands were revealed. The thickness of the mucous membrane and the depth of the intestinal glands were lower than normal. Thus, in patients with postcholecystectomy syndrome, pronounced morphometric and histological changes were revealed in the mucous membrane of various parts of the intestine, while the depth and degree of its damage were more significant in its proximal parts.

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Postcholecystectomy syndrome after laparoscopic cholecystectomy: A single center experience from Eastern India

Eastern Journal of Medical Sciences ◽

10.32677/ejms.2017.v02.i02.002 ◽

2017 ◽

Vol 2 (2) ◽

pp. 25-28

Author(s):

Deepak Kumar ◽

Rajeev Kumar ◽

Annu Babu ◽

R N Jha

Keyword(s):

Laparoscopic Cholecystectomy ◽

Single Center ◽

Eastern India ◽

Postcholecystectomy Syndrome ◽

Single Center Experience

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Postcholecystectomy syndrome

Disease-a-Month ◽

10.1016/s0011-5029(59)80012-2 ◽

1959 ◽

Vol 5 (9) ◽

pp. 1-40

Author(s):

Gordon McHardy

Keyword(s):

Postcholecystectomy Syndrome

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WAYS TO IMPROVE DIAGNOSIS OF PATIENTS WITH POSTCHOLECYSTECTOMY SYNDROME

International Medical Journal ◽

10.37436/2308-5274-2021-1-6 ◽

2021 ◽

pp. 31-35

Author(s):

O. V. Gorbulitch ◽

S. H. Yefimenko ◽

S. A. Pavlychenko ◽

O. A. Lazutkina ◽

K. A. Aleksanian

Keyword(s):

Morphological Changes ◽

Gallstone Disease ◽

Diagnostic Algorithm ◽

Sphincter Of Oddi ◽

Duodenal Papilla ◽

Biliary Surgery ◽

Postcholecystectomy Syndrome ◽

Functional Changes ◽

Post Surgery ◽

Major Duodenal Papilla

Postcholecystectomy syndrome is a symptom complex that occurs or worsens after cholecystectomy and is a functional and / or organic disorder. It often complicates the post−surgery course of gallstone disease. The presence of symptoms of the disease indicates a deterioration in the quality of life of patients, but the diagnostic examination is not always possible to detect morphological or functional changes. Thus, at present the syndrome is an urgent problem of gastroenterology and biliary surgery. Diagnostic issues with a differentiated approach to the functional or organic nature of postcholecystectomy syndrome are important for the choice of further treatment tactics. In order to improve the diagnostic algorithm taking into account the changes in the area of the major duodenal papilla, a study was conducted in 137 patients. To determine the functional disorders of the sphincter of Oddi there was used the method of ultrasound investigation of hepatobiliary area and Vater's papilla with choleretic loading on Boyden as well as the Grigoriev's methods in the absence of organic obstruction of the terminal choledochus at previous stages of examination. Morphological changes in the major duodenal papilla area were evaluated using the technique of parietal ph−impedancemetry, which was performed on the background of benign mechanical jaundice in the patients after cholecystectomy during endoscopic retrograde cholangiopancreatography prior to endoscopic papillosphincterotomy. The obtained results help to perform a differentiated approach to the patients who underwent cholecystectomy, taking into account morphofunctional changes in the area of the major duodenal papilla and allow the implementation of the selected methods to the research algorithm of patients with postcholecystectomy syndrome. Key words: postcholecystectomy syndrome, functional and organic changes of major duodenal papilla, patency of the terminal choledochus, treatment tactics.

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Acupuncture for the Postcholecystectomy Syndrome: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/7509481 ◽

2020 ◽

Vol 2020 ◽

pp. 1-19

Author(s):

Zihan Yin ◽

Qiwei Xiao ◽

Guixing Xu ◽

Ying Cheng ◽

Han Yang ◽

...

Keyword(s):

Grey Literature ◽

Risk Of Bias ◽

Biomedical Literature ◽

Cochrane Library ◽

Gastrointestinal Function ◽

Clinical Effects ◽

Postcholecystectomy Syndrome ◽

Comprehensive Therapy ◽

Function Recovery ◽

Literature Database

Background. Postcholecystectomy syndrome (PCS) has become a common postoperative syndrome that requires systematic and comprehensive therapy to achieve adequate clinical control. Acupuncture and related therapies have shown clinical effects for PCS in many studies. However, systematic reviews/meta-analyses (SRs/MAs) for them are lacking. Objective. To evaluate the efficacy and safety of acupuncture in the treatment of PCS using randomized controlled trials (RCTs). Methods. Potentially eligible studies were searched in the following electronic databases up to 1 February 2020: PubMed, Embase, Cochrane Library, Web of Science (WoS), Chinese databases (Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), WanFang Database (WF), and China Science and Technology Journal Database (VIP)), and other sources (WHO ICTRP, ChiCTR, Clinical Trials, and Grey Literature Database). The RevMan 5.3 was employed for analyses. The Cochrane Collaboration’ risk of bias tool was used to assess the risk of bias (ROB). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of the evidence. Results. A total of 14 RCTs with 1593 participants were included in this SR. MA showed that acupuncture in combination with conventional medicine (CM) did not show statistical differences in reduction in pain. However, acupuncture in combination with CM significantly reduced the incidence of postoperative nausea and vomiting (PONV) (RR, 0.71; 95% CI, 0.55–0.92) and improved gastrointestinal function recovery compared to the CM group. Acupuncture combined with traditional Chinese medicine and CM, and acupuncture as monotherapy may improve gastrointestinal function recovery with acceptable adverse events. Conclusion. Acupuncture may be an effective and safe treatment for PCS. However, this study lacks conclusive evidence due to poor quality evidence, limited data, and clinical heterogeneity of acupuncture methods in the included studies.

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