How is gallstone disease treated?

Non-drug treatment of gallstone disease

In case of exacerbation of cholelithiasis, the child must be hospitalized. Physiotherapy aimed at improving the outflow of bile is prescribed: paraffin and ozokerite applications, inductothermy on the liver area. It is advisable to use magnesium electrophoresis, 1% papaverine solution, 0.2% platifillin solution. Fresh or pine baths with a temperature of 37-37.5 C for 7-12 minutes every other day are useful. The course is 10-12 baths. Sanatorium and spa treatment is indicated at the resorts of Zheleznovodsk, Essentuki, Goryachiy Klyuch, in local recovery and rehabilitation centers.

Meal intake should be regulated; table No. 5 is prescribed. Watching TV and playing computer games is limited to 2 hours per day. Physical activity, including sports competitions, is limited so as not to provoke abdominal pain, however, complete exclusion of physical exercise and walks in the fresh air is unacceptable due to the risk of developing hypokinetic syndrome.

Drug treatment of gallstone disease

Bile acid preparations are used - derivatives of deoxycholic acid. In childhood, only ursodeoxycholic acid is used, for children under 3 years old, the drug is prescribed in the form of syrup, for children over 4 years old - in capsules, orally 10 mgDkgxday). The entire dose should be taken in the evening before bedtime, washed down with liquid (water, tea, juices, milk, etc.). Ursodeoxycholic acid is well tolerated, has no side effects. The duration of treatment is from 6 to 24 months in a continuous course.

In case of long-term drug litholysis of gallstones, hepatoprotectors of combined action are prescribed - gepabene, chophytol. When choosing a drug, they focus on the functional state of the biliary tract. In case of hypertensive dysfunction, gepabene is used (1 capsule during meals 3 times a day, 1 capsule before bedtime for 1-3 months), which has an antispasmodic effect. In case of hypotension of the gallbladder, chophytol is prescribed orally 1 tablet at the age of 5-10 years or 2 tablets at 15 years 3 times a day before meals for 2 weeks.

Contraindications to conservative treatment:

• complicated course of cholelithiasis (acute and chronic cholecystitis, biliary colic and other diseases);
• disabled gallbladder;
• obesity stage III;
• chronic hepatitis and liver cirrhosis;
• chronic diarrhea:
• single stones with a diameter of more than 15 mm, multiple, occupying more than 50% of the lumen of the gallbladder;
• pregnancy;
• gallbladder carcinoma;
• choledocholithiasis.

In severe cases of cholelithiasis, litholytic treatment is indicated in cases where the probability of an unfavorable outcome of surgical intervention is higher than the risk of a fatal outcome of cholelithiasis, for example, in children with congenital heart defects, hemolytic anemia and other severe somatic diseases.

Before starting treatment, parents and the child should be informed about the duration of treatment, which ranges from 6 months to 2 years, and about the frequency of recurrence of stone formation after completion of treatment.

The therapeutic effect and side effects of the drugs used are monitored every 4 weeks during the first 3 months, by examining the activity of blood enzymes, and then by performing an ultrasound of the bile ducts every 6 months.

During treatment with ursodeoxycholic acid, diarrhea develops extremely rarely, disappearing on its own on the 4th-5th day from the start of treatment or after a reduction in the dose of drugs. Subsequent increase in the dose does not lead to resumption of diarrhea.

Even careful selection of patients with indications for litholytic treatment and correct selection of drugs allows achieving success only in 22-25% of cases in children with cholelithiasis at the stage of gallstone formation. In 68% of children at the stage of biliary sludge, treatment does not prevent relapses of stone formation, sediment formation, attacks of biliary colic and complications.

Surgical treatment of gallstone disease

An alternative method to the conservative method is laparoscopic cholecystectomy. Indications for surgical intervention are determined taking into account the following factors:

• age of the child;
• size and location of gallstones;
• duration of the disease;
• clinical form of gallstone disease (asymptomatic stone carriage, painful form, biliary colic).

Children under 3 years of age are recommended to be observed by a pediatrician and surgeon, litholytic therapy is prescribed according to indications, and surgical treatment is prescribed in case of recurrent abdominal pain. At this age, spontaneous dissolution of gallstones is possible.

At the age of 3 to 12 years, planned surgical intervention is indicated for children with dyspeptic form of cholelithiasis and biliary colic. Performing cholecystectomy at this age is pathogenetically justified, since removal of the shock organ does not lead to disruption of the functional capacity of the liver and bile ducts. Postcholecystectomy syndrome does not develop.

Children aged 12-15 years should undergo surgical interventions only for emergency indications. Surgery and anesthesia during the period of imbalance of neuroendocrine functions can trigger hereditary chronic diseases; rapid (within 1-2 months) formation of alimentary-constitutional obesity, arterial hypertension, interstitial nephritis is possible.

Forecast

In cases of early diagnosis and adequate treatment, the prognosis is favorable.

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