In this article, we will look at the symptoms and treatment of postcholecystectomy syndrome.
The number of surgical interventions for the treatment of chronic calculous cholecystitis and the complications it causes is growing every year. In our country, the number of such operations annually reaches 150 thousand. Every third patient who has undergone cholecystectomy, that is, the removal of the gallbladder, has various disorders of an organic and functional nature from the biliary tract and related organs. All these disorders in medical practice are called postcholecystectomy syndrome, or PCES for short.
Varieties of PCES
PCES in the vast majority of cases does not develop, subject to compliancesome rules, including a complete preoperative examination of the patient, a correctly established diagnosis and indications for surgical intervention, as well as a well-performed cholecystectomy in terms of technique.
Depending on the origin of the disease, the following types of pathology are distinguished:
- True postcholecystectomy syndrome. Its other name is functional. Appears as a complication due to the lack of the gallbladder to perform its functions.
- Conditional, or organic. This is a set of symptoms that arise as a result of technical errors made during the operation or incomplete examination of the patient in preparation for cholecystectomy. Sometimes, at the stage of preparation for surgery, some complications of calculous cholecystitis are ignored.
There are many more organic forms of PCES than functional ones.
Reasons
Factors that provoke the development of postcholecystectomy syndrome directly depend on its variety. So, the main reasons for the occurrence of true PCES are:
1. Dysfunctional disorder of the sphincter of Oddi, which is responsible for regulating the flow of bile and pancreatic secretions into the duodenum.
2. Syndrome of duodenal obstruction in the chronic form of the course, which causes an increase in pressure in the duodenum in the compensated stage, its decrease and expansion indecompensated.
Reasons for conditional form
The conditional form of postcholecystectomy syndrome (ICD-10 code - K91.5) can be caused by the following disorders:
1. Narrowing of the common bile duct.
2. Elongated and inflamed stump of the gallbladder duct.
3. Granuloma or neuroma around the surgical suture.
4. Formation of a gallstone in the duct.
5. The occurrence of adhesions under the liver, which causes narrowing and deformation of the common bile duct.
6. Damage to the major duodenal papilla through trauma during surgery.
7. Partial removal of the gallbladder, when another similar organ can arise from a wider stump.
8. Disease of the biliary tract of an infectious nature.
9. Hernia formation of the esophageal opening of the diaphragm.
10. Duodenal ulcer.
11. Secondary pancreatitis in a chronic form.
12. Papillostenosis.
13. Duodenal diverticulum in the region of the major papilla.
14. A cyst in the common bile duct with a complication in the form of its dilatation.
15. Mirizzi Syndrome.
16. Chronic fistula formed after surgery.
17. Fibrosis, reactive hepatitis, hepatic steatosis.
Symptoms of postcholecystectomy syndrome
In the postoperative period, the patient may experience heaviness and pain in the righthypochondria. There are a large number of clinical manifestations of postcholecystectomy syndrome, but all of them are classified as specific. Symptoms develop both immediately after the operation and after some time, called the light period.
Depending on the factors that provoked the appearance of postcholecystectomy syndrome, the following symptoms are distinguished:
1. Sharply arising severe pain in the right hypochondrium. These are the so-called biliary colic.
2. Similar to pancreatic pain, characterized as girdle and radiating to the back.
3. Yellow tint of skin, mucous membranes and sclera, itching.
4. Feeling of heaviness in the region of the right hypochondrium and stomach.
5. Bitterness in the mouth, nausea, bilious vomiting, belching.
6. Tendency to intestinal disorders, manifested by frequent constipation or diarrhea. This is usually due to not following dietary recommendations after surgery.
7. Regular flatulence.
8. Psycho-emotional disorders, expressed by tension, discomfort, anxiety, etc.
9. Chills and fever.
10. Increased sweating.
Diagnosis
Based on the patient's complaints and the collected history, the specialist can conclude that there is a postcholecystectomy syndrome. To confirm or exclude postcholecystectomy syndrome (ICD-10 - K91.5), an examination is prescribed, including both instrumentalmethods, and laboratory.
Clinical Research Methods
Clinical research methods include a biochemical blood test, which includes such indicators as total, free and conjugated bilirubin, ALT, AsAT, LDH, alkaline phosphatase, amylase, etc.
Instrumental methods are important in the process of diagnosing postcholecystectomy syndrome (code). The main ones are:
- Oral and intravenous cholegraphy. It involves the introduction of a special substance (contrast) into the biliary tract, followed by fluoroscopy or radiography.
- A special type of ultrasound called transabdominal ultrasonography.
- Endoscopic type of ultrasonography.
- Ultrasound functional testing, with fat trial breakfast or nitroglycerin.
- Esophagogastroduodenoscopy. It involves the study of the digestive tract in the upper section through an endoscope.
- Sphincteromanometry and cholangiography with endoscope.
- Computer hepatobiliary scintigraphy.
- Retrograde cholangiopancreatography endoscopic type.
- Magnetic resonance cholangiopancreatography.
What is the treatment for postcholecystectomy syndrome?
Medicated treatment
The disease in its true form is treated with conservative methods. The main recommendation of the specialist will be a lifestyle adjustment, involvinggiving up bad habits like drinking and smoking.
Another important point is the observance of a special therapeutic diet, which involves eating according to table No. 5. This diet provides for a fractional nutrition option, which improves the outflow of bile and prevents it from stagnation in the biliary tract.
Differentiated approach
Any appointments for postcholecystectomy syndrome KSD, including medicines, require a differentiated approach, suggesting the following:
1. Increased tone or spasm of the sphincter of Oddi suggests taking myotropic antispasmodics, such as Spazmomen, No-shpa, Duspatalin. In addition, doctors prescribe peripheral M-anticholinergics, such as Gastrocepin, Buscopan, etc. After the hypertonicity is eliminated, cholekinetics are taken, as well as drugs that accelerate the process of excretion of bile, such as sorbitol, xylitol or magnesium sulfate.
2. If the tone of the sphincter of Oddi is reduced, the patient is prescribed prokinetics. This group of drugs includes Ganaton, Domperidone, Tegaserod, Metoclopramide, etc.
3. To eliminate duodenal obstruction in the chronic form of the flow, prokinetics are used, namely Motilium, etc. When the disease enters the decompensated stage, repeated washings of the duodenum with disinfectant solutions are introduced into therapy. Next, antiseptics are introduced into the intestinal cavity, such as "Dependal-M", "Intetrix", etc., as well as antibiotics from the category of fluoroquinolones.
4. With inadequate production of cholecystokinin,the body is injected with its synthetic analogue ceruletide.
5. With a deficiency of somatostatin, its analogue octreotide is prescribed.
6. With signs of intestinal dysbiosis, pre- and probiotics are used, such as Duphalac, Bifiform, etc.
7. In secondary pancreatitis of the biliary-dependent type, it is recommended to take polyenzymatic drugs like Creon, Mezim-forte, etc., as well as analgesics and myotropic antispasmodics.
8. If a somatized variety of a depressive state or autonomic dystonia of the nervous system is diagnosed, the use of tranquilizers and drugs such as Coaxil, Grandaxin and Eglonil is considered effective.
9. To prevent the formation of new stones, it is recommended to take bile acids, which are contained in drugs such as Ursosan and Ursofalk.
Organic forms of the disease are not amenable to conservative methods of therapy. Postcholecystectomy syndrome is treated surgically.
Physiotherapy Methods
Specialists highly appreciate the effectiveness of physiotherapeutic treatment of PCES. In order to accelerate tissue regeneration, the following procedures are prescribed to the patient:
1. Therapy with ultrasound. It is carried out by exposing the affected area to oscillations with a frequency of 880 kHz. The procedure is repeated once every two days. Duration of 10-12 procedures.
2. Low frequency magnetotherapy.
3. Decimeter wave therapy. Emitter in the form of a cylinder orThe rectangle is placed in contact or a few centimeters above the skin in the liver projection area. The procedure lasts 8-12 minutes and is performed every other day for up to 12 sessions.
4. Infrared laser therapy.
5. Radon or carbon dioxide baths.
Recommendations for postcholecystectomy syndrome should be strictly followed.
Techniques
To help the patient cope with pain, the following techniques are used:
1. Diadynamic therapy.
2. Amplipulse therapy.
3. Electrophoresis with analgesics.
4. Electroplating.
To reduce spasms of the muscles of the biliary tract, the following procedures are used:
1. Electrophoresis using antispasmodics.
2. Electroplating.
3. High frequency magnetotherapy.
4. Paraffin therapy.
5. Ozokerite applications.
The excretion of bile into the intestines is facilitated by such methods of physiotherapy as:
1. Electrical stimulation.
2. Tubage or blind probing.
3. Mineral waters.
Physiotherapeutic procedures are prescribed not only for patients with postcholecystectomy syndrome (ICD-10 - K91.5), but also as a preventive measure after cholecystectomy.
Prevention
Two weeks after the operation to remove the gallbladder, the patient can be referred for further recovery in a spa treatment. The conditions for such a referral is an assessment of the patient's conditionas a satisfactory and good condition of the postoperative scar.
To prevent the development of postcholecystectomy syndrome, the patient must be examined both before and during surgery, as this will help to identify complications in time that can significantly disrupt the patient's life in the future, causing postcholecystectomy syndrome (ICD code - K91. 5) organic type.
An equally important role is played by the qualifications of the surgeon performing the operation, as well as the amount of tissue injury during cholecystectomy.
Conclusion
The patient needs to be aware of the need to lead a proper lifestyle after surgery. This involves giving up bad habits, a balanced diet, regular monitoring in a dispensary and following all the prescriptions of the attending physician.
PCES is an unpleasant consequence of cholecystectomy. However, early detection and treatment will help minimize the risk of further complications.
The article discussed the symptoms and treatment of postcholecystectomy syndrome.
