Postcholecystectomy syndrome

Postcholecystectomy syndrome is a collective concept that unites a complex of pathological conditions observed after removal of the gallbladder. Comes immediately or after a while after surgery. Dissatisfaction with the operation is noted in 12% of patients with cholecystectomy.

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Causes

Causes of development are diverse, but they can be divided into 2 groups:

1. Associated with surgical interventions: unvaccinated or newly emerged cicatricial stenosis of the fater nipple, unresolved choledocholithiasis, cicatricial stricture of the choledochus, left part of the gallbladder, inducible pancreatitis after compression of the general duct, obliteration of biliodestic anastomosis, terminal cholangitis, adhesions, etc.
2. Unrelated to the operation due to atypically occurring diseases of the abdominal cavity organs, unrecognized gastritis and duodenitis, perigastritis and periduodenitis, peptic ulcer, hernia of the esophagus (often combined with cholelithiasis), nephroptosis, spondyloarthritis, etc.

[2], [3], [4], [5], [6]

Symptoms

Postcholecystectomy syndrome is observed in 5-40% of patients; however, most of the symptoms are associated with dyspepsia, the remaining symptoms are also more nonspecific than refer to true biliary colic. In some cases, there is another reason (for example, a forgotten bile duct stone, pancreatitis, gastroesophageal reflux). Approximately 10% of cases of biliary colic is a consequence of functional or structural changes in the sphincter of Oddi. Papillary stenosis, which is rare enough, is a fibrous narrowing around the sphincter, possibly caused by trauma and inflammation in pancreatitis, instrumental examination (eg ERCP), or migrating stone.

Diagnostics

Patients with postcholecystectomy pain should be examined for exclusion of both extrabiliary and biliary etiology. If the nature of the pain involves biliary colic, alkaline phosphatase, bilirubin, ALT, amylase and lipase, as well as ERCP with biliary manometry or NMR scanning are examined. An increase in biochemical parameters suggests a dysfunction of the sphincter of Oddi, whereas an increase in amylase and lipase indicates dysfunction of the pancreatic part of the sphincter. The best dysfunction is found with biliary manometry, which diagnoses a rise in pressure in the biliary tract, which is the cause of pain, although ERCPH is associated with a risk of developing pancreatitis. The slowing down of the passage from the liver to the duodenum, revealed during scanning, also suggests the dysfunction of the sphincter of Oddi. Diagnosis of papillary stenosis is based on ERCPH data. Endoscopic sphincterotomy can stop the pain syndrome caused by dysfunction of the sphincter of Oddi and especially the papillary stenosis, but this is problematic in patients who have postcholecystectomy pain syndrome without objective disorders.

[7], [8], [9]