A modern conception of postcholecystectomy syndrome (based on the materials of the Advisory Board held on May 4, 2019 in Almaty, Kazakhstan)
A. V. Nersesov,
D. A. Kaibullaeva,
O. S. Vasnev,
L. K. Tashenova,
M. M. Sakhipov,
G. T. Berestimov,
G. A. Akhmetzhanova,
O. T. Ibekenov,
M. O. Doskhanov,
N. M. Zhumazhanov,
Zh. M. Balzhanov,
B. A. Aitmoldin,
E. A. Toleubaev,
E. M. Laryushina,
K. N. Zhumagulov,
G. N. Sobirova,
S. I. Umarova,
Yu. O. Shulpekova,
A. V. Okhlobystin 
Abstract
Gallstone disease is revealed in 10–20% of the population with a clear tendency to affect the younger population. In a clinically manifested course, cholecystectomy remains the treatment of choice. Symptoms and signs persist or even become more severe after gallbladder surgery in 10-15% of cases (“postcholecystectomy syndrome”). Postcholecystectomy syndrome includes heterogeneous disorders of liver, pancreas, duodenum, sphincter of Oddi, etc. that can be associated with errors or negative consequences of surgical intervention. Often, symptoms may persist because of previously unrecognized chronic diseases of neighboring organs. The spectrum of effective conservative measures is rather limited. The Advisory Board was held on May 4, 2019, in Almaty (Kazakhstan) to re-estimate the definitions and categories related to the issue of the postcholecystectomy syndrome and to develop the diagnostic and treatment algorithm for patients with the postcholecystectomy dysfunction of the sphincter of Oddi. The statements discussed by the interdisciplinary team of gastroenterologists and surgeons were addressed to general practitioners, therapists, gastroenterologists, and surgeons. The Advisory Board emphasized that organic and functional biliary diseases manifest mainly by biliary pain, main characteristics of which were defined in the Rome IV consensus based on the statistical analysis of a large pool of clinical data. For a more accurate bile duct system assessment and the exclusion of cholelithiasis, the examination algorithm was proposed, which included abdominal ultrasound investigation, endoscopic ultrasound investigation of the pancreatobiliary area, and magnetic resonance cholangiopancreatography. Diagnostic algorithm for differentiation of functional biliary disorders from organic gastrointestinal pathology was developed. Sphincter of Oddi dysfunction may be considered as a postcholecystectomy syndrome manifestation in 1.5-3% of cases. Apart from rational nutrition, conservative management of functional gastrointestinal diseases implies pharmacological therapy. The efficacy of non-steroidal anti-inflammatory drugs, prokinetics, nitrates, antispasmodics, calcium channel antagonists, botulinum toxin, and hymecromone was demonstrated in previous studies. Papillosphincterotomy is not effective in relieving biliary pain in cases of the sphincter of Oddi dysfunction. The proposed algorithm for the management of patients with the postcholecystectomy syndrome was presented.
About the Authors
A. V. Nersesov
Asfendiyarov Kazakh National Medical University
Kazakhstan
Kazakhstan
MD, Dr Sci Med, Professor, Head of the Department of Gastroenterology
94 Tole-bi Str., Almaty 050000, Kazakhstan
D. A. Kaibullaeva
Asfendiyarov Kazakh National Medical University
Kazakhstan
Kazakhstan
MD, PhD, Associate Professor, Department of Gastroenterology
94 Tole-bi Str., Almaty 050000, Kazakhstan
O. S. Vasnev
Moscow Clinical Scientific and Practical Center named after A. S. Loginov Moscow Department of Health
Russian Federation
Russian Federation
MD, Dr Sci Med, Head of the Department of High-Tech Surgery
86 Entuziastov shosse, Moscow 111123, Russia
L. K. Tashenova
Institute of Gastroenterology
Kazakhstan
Kazakhstan
MD, Dr Sci Med, Professor, Director
Muratbaeva 211 ug. Shevchenko, Almaty, Kazakhstan
M. M. Sakhipov
City Clinical Hospital №7
Kazakhstan
Kazakhstan
MD, Dr Sci Med, Professor, Associate Professor, Department of Surgery, Kazakh National Medical University named after S. D. Asfendiyarov; Head Surgery Department No. 2
Kalkaman microdistrict, Almaty, Kazakhstan
G. T. Berestimov
Asfendiyarov Kazakh National Medical University;
City Clinical Hospital №7
Kazakhstan
Kazakhstan
MD, PhD, physician of the highest category, Associate Professor of the Department of Surgery; Head. Department of Surgery No. 1 Department of Emergency Surgery
94 Tole-bi Str., Almaty 050000, Kazakhstan
0500001, Almaty, st. Aspandiyarova, 78
G. A. Akhmetzhanova
Asfendiyarov Kazakh National Medical University
Kazakhstan
Kazakhstan
MD, PhD, Associate Professor, Department of Surgery
94 Tole-bi Str., Almaty 050000, Kazakhstan
O. T. Ibekenov
City Emergency Hospital
Kazakhstan
Kazakhstan
MD, PhD, surgeon of the highest category, Deputy Chief Physician for Surgery
96 Kazybek Bi Str., Almaty, Kazakhstan
M. O. Doskhanov
National Scientific Center of Surgery named after A. N. Syzganova
Kazakhstan
Kazakhstan
surgeon of the highest category; Head of the department of hepatopancreatobiliary surgery and liver transplantation
62 Zheltoksan Str., Almaty, Kazakhstan
N. M. Zhumazhanov
City Hospital No. 1
Kazakhstan
Kazakhstan
MD, PhD, deputy chief physician
66 Rakhimzhan Koshkarbayev prosp., Nur-Sultan (Astana), Kazakhstan
Zh. M. Balzhanov
City Hospital No. 1
Kazakhstan
Kazakhstan
Head of the department of planned and reconstructive plastic surgery
66 Rakhimzhan Koshkarbayev prosp., Nur-Sultan (Astana), Kazakhstan
B. A. Aitmoldin
City Hospital No. 2
Kazakhstan
physician of the highest category, the member of the Association of Surgeons and Coloproctologists of the Republic of Kazakhstan and Russia, Head of the General surgical department and Coloproctology
6 Nogaili Str., Nur-Sultan (Astana), Kazakhstan
Kazakhstan
physician of the highest category, the member of the Association of Surgeons and Coloproctologists of the Republic of Kazakhstan and Russia, Head of the General surgical department and Coloproctology
6 Nogaili Str., Nur-Sultan (Astana), Kazakhstan
E. A. Toleubaev
Regional Clinical Hospital
Kazakhstan
Kazakhstan
surgeon of the highest category, Head of the General surgical department
15 Yerubaev Str., Karaganda, Kazakhstan
E. M. Laryushina
Karaganda State Medical University
Kazakhstan
Kazakhstan
MD, PhD, Head of the Department on Internal diseases №2
40 Gogol Str., Karaganda, Kazakhstan
K. N. Zhumagulov
South Kazakhstan Medical Academy
Kazakhstan
Kazakhstan
MD, PhD, surgeon, International medical center “Clinica DL-ECO”
Al-Farabi Square, 1/1, Shymkent 160019, Kazakhstan
G. N. Sobirova
Tashkent Medical Academy
Uzbekistan
Uzbekistan
MD, PhD, senior researcher
2 12th Farobi, Tashkent 100109, Uzbekistan
S. I. Umarova
Kyrgyz-Russian Slavic University
Kyrgyzstan
Kyrgyzstan
MD, PhD, associate professor
Kievskaya Str., 44, Bishkek 720000, Kyrgyz Republic
Yu. O. Shulpekova
Sechenov University
Russian Federation
Russian Federation
MD, PhD, associate professor of the Department of Internal diseases propedeutics, gastroenterology and hepatology of the Sklifosovsky Institute of clinical medicine
8-2 Trubetskaya Str., Moscow 119048, Russia
A. V. Okhlobystin
Sechenov University
Russian Federation
Russian Federation
MD, PhD, lecturer of the Department of Internal diseases propedeutics, gastroenterology and hepatology of the Sklifosovsky Institute of clinical medicine
8-2 Trubetskaya Str., Moscow 119048, Russia
References
1. Stinton L. M., Shaffer E. A. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012; 6 (2): 172–187. DOI: https://doi.org/10.5009/gnl.2012.6.2.172.
2. Acalovschi M., Lammert F. The Growing Global Burden of Gallstone Disease. World Gastroenterology News. 2012; 17 (4): 6–9.
3. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstone. Journal of Hepatology. 2016; 65 j: 146–181.
4. Ivashkin V. T., Mayev I. V., Shulpekova Y. O., Baranskaya Y. K., Okhlobystin A. V., Trukhmanov A. S., Lapina T. L., Sheptulin A. A. Diagnostics and treatment of biliary dyskinesia: clinical guidelines of the Russian gastroenterological Association. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018; 28 (3): 63–80. (In Russ.) DOI: https://doi.org/10.22416/1382-4376-2018-28-3-63-80.
5. Jensen SW. Postcholecystectomy Syndrome. [Electronic resource] URL: http://emedicine.medscape.com/article/192761-overview. Accessed: 03.04.2020.
6. Rafee A. A., El-Shobari M., Askar W., Sultan A. M., El Nakeeb A. Long-term follow-up of 120 patients after hepaticojejunostomy for treatment of post-cholecystectomy bile duct injuries: A retrospective cohort study. International Journal of Surgery. 2015 May 18; 205–210. DOI: https://doi.org/10.1016/j.ijsu.2015.05.004.
7. Mathivanan M., Meddings L., and Shaffer E. A. Biliary Dyspepsia: Functional Gallbladder and Sphincter of Oddi Disorders. 2013.
8. Cotton P., Elta G. H., Carter C. R. et al. Gallbladder and Sphincter of Oddi disorders. [Electronic resource] URL: https://www.uptodate.com/contents/functional-gallbladder-disorder-in-adults. Accessed: 03.04.2020.
9. Lavoie B., Balemba O. B., Godfrey C. et al. Hydrophobic bile salts inhibit gallbladder smooth muscle function via stimulation of GPBAR1 receptors and activation of KATP channels. Journal of Physiology. 2010; 588 (17): 3295–3305.
10. Behar J. Physiology and Pathophysiology of the Biliary Tract: The Gallbladder and Sphincter of Oddi – A Review. International Scholarly Research Notices. 2013; Article ID 837630. DOI: https://doi.org/10.1155/2013/837630.
11. Bielefeldt K. The rising tide of cholecystectomy for biliary dyskinesia. Aliment Pharmacol and Ther. 2013; 37: 98–106.
12. Girometti R., Brondani G., Cereser L. et al. Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography. The British Journal of Radiology. 2010; 83: 351–361.
13. Richmond B. K., Grodman C., Walker J. et al. Pilot Randomized Controlled Trial of Laparoscopic Cholecystectomy vs Active Nonoperative Therapy for the Treatment of Biliary Dyskinesia. J Am Coll Surg. 2016; 222 (6): 1156–63.
14. Thosani A.J. Acalculous Cholecystopathy. [Electronic resource] URL: https://emedicine.medscape.com/article/172013-overview. Accessed: 06.07.2020.
15. Afghani E., Lo S.K., Covington P.S., Cash B.D., Pandol S.J. Sphincter of Oddi Function and Risk Factors for Dysfunction. Front. Nutr. 2017; 4: 1. DOI: https://doi.org/10.3389/fnut.2017.00001.
16. Festi D., Dormi A., Capodicasa S., et al. Incidence of gallstone disease in Italy: results from a multicenter, population-based Italian study (the MICOL project). World J Gastroenterol. 2008; 14: 5282–9.
17. Rao K., Baig K. K. Clin Exp Gastroenterol. 2016; 9: 191–195.
18. Durkalski V., Stewart W. Measuring episodic abdominal pain and disability in suspected sphincter of Oddi dysfunction. World J Gastroenterol. 2010; 16 (35): 4416–4421.
19. Pilichiwicz A. N., Feltrin K. L., Horowitz M., Holtmann G., Wishart J. M., Jones K. L., Talley N. J., Feinle-Bisset C. Functional dyspepsia is associated with a greater symptomatic response to fat but not carbohydrate, increased fasting and postprandial CCK, and diminished PYY. Am J Gastroenterol. 2008; 103: 2613–23.
20. Isherwood J., Oakland K., Khanna A. A systematic review of the aetiology and management of post cholecystectomy syndrome. The Surgeon. 2019; 17 (1): 33–42. DOI: https://doi.org/10.1016/j.surge.2018.04.001.
21. GREPCO (The Rome group for epidemiology and prevention of cholelithiasis). The epidemiology of gallstone disease in Rome, Italy. I. Prevalence data in men. Hepatology. 1988; 8: 904–6.
22. Din S. A., Naimi I., Beg M. Sphincter of Oddi Dysfunction: A Perplexing Presentation. Case Rep Gastroenterol. 2016; 10: 714–719.
23. Bamber J. R., Stephens T. J., Cromwel D.A. et al. Effectiveness of a quality improvement collaborative in reducing time to surgery for patients requiring emergency cholecystectomy. BJS Open. 2019; 3: 802–811.
24. Abraham S., Rivero H., Erlikh I. V., et al. Surgical and Nonsurgical Management of Gallstones. American Family Physician. 2014; 89 (10): 795–802.
25. Ito K., Ito H., Whang E. E. Timing of cholecystectomy for biliary pancreatitis: do the data support current guidelines? Journal of gastrointestinal surgery. 2008; 12 (12): 2164–70. DOI: https://doi.org/10.1007/s11605-008-0603-y.
26. Besselink M. G., Venneman N. G., Go P. M. et al. Is complicated gallstone disease preceded by biliary colic? J Gastrointest Surg. 2009; 13 (2): 312–317. DOI: https://doi.org/10.1007/s11605-008-0729-y.
27. Guarino M. P., Cocca S., Altomare A., Emerenziani S., Cicala M. Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed. World J Gastroenterol. 2013; 19 (31): 5029–5034. DOI: https://doi.org/10.3748/wjg.v19.i31.5029.
28. Crawford M. Biliary pain work-up and management in general practice. Australian Family Physician. 2013; 42 (7): 458–61.
29. Shul’pekova Yu.O., Leshchenko V. I., Kardasheva S. S. Postcholecystectomy syndrome. Current view in light of Rome consensus IV. Meditsinskii alfavit. 2016; 34 (4): 12–18. (in Russ).
30. Bouzo H., Cisapride in the postcholecystectomy syndrome. A double blind, placebo-controlled, crossover study. Curr Ther Res. 1990; 47 (3) 566.
31. Abate A., Dimartino V., Spina P. et al. Hymecromone in the treatment of motor disorders of the bile ducts: a multicenter, doubleblind, placebo-controlled clinical study. Drugs Exp Clin Res. 2001; 27 (5–6): 223–31.
32. Kaibullaeva D. A., Nersesov A. V., Dzhumabaeva A. E. Noncalculous biliary pain as part of the sphincter of Oddi dysfunction: a modern understanding of the clinician. Chelovek i lekarstvo – Kazakhstan. 2019; 7 (118): 2–7. (in Russ).
33. Din S. A., Naimi I., Beg M. Sphincter of Oddi Dysfunction: A Perplexing Presentation. Case Rep Gastroenterol. 2016; 10: 714–719.
34. Zhang J., Lu Q., Ren Y. F., Dong J., Mu Y. P., Lv Y., Zhang X. F. Factors relevant to persistent upper abdominal pain after cholecystectomy. Hpb. 2017; 19 (7): 629–637.
35. Bouzo H., Cisapride in the postcholecystectomy syndrome. A double blind, placebo-controlled, crossover study. Curr Ther Res. 1990; 47 (3): 566.
36. Fraquelli M., Casazza G., Conte D., Colli A. Non-steroid antiinflammatory drugs for biliary colic (Review). Cochrane Database of Systematic Reviews. 2016; 9: CD006390. DOI: https://doi.org/10.1002/14651858.CD006390.pub2.
37. Steel P. Acute Cholecystitis and Biliary Colic. [Electronic resource] URL: https://emedicine.medscape.com/article/1950020-overview#a15. Accessed: 03.04.2020.
38. Venneman N. G., Besselink M. G., Keulemans Y. C., VanbergeHenegouwen G.P., Boermeester M. A., Broeders I. A., Go P. M., van Erpecum K. J. Ursodeoxycholic acid exerts no beneficial effect in patients with symptomatic gallstones awaiting cholecystectomy. Hepatology. 2006; 43: 1276–1283.
39. Post-cholecystectomy biliary-like pain. [Electronic resource] URL: https://theromefoundation.org/wp-content/uploads/Post_cholecystectomy_biliary_like_pain.pdf. Accessed: 03.04.2020.
40. Sand J., Arvola P., Nordback I. Calcium channel antagonists and inhibition of human sphincter of Oddi contractions. Journal Scandinavian Journal of Gastroenterology. 2005; 40 (12): 1394–1397.
41. Takeda S, Aburada M. The choleretic mechanism of coumarin compounds and phenolic compounds. J Pharmacobiodyn. 1980; 4: 724–34. DOI: https://doi.org/10.1248/bpb1978.4.724.
42. Stacchino C., Spanò R., Pettiti A. Spasmolytic activity of some 4-methylumbelliferone derivatives. Boll Chim Farm. 1983 Mar; 122 (3): 158–60.
43. Moazeni-Bistgani M., Imani R. Bile bacteria of patients with cholelithiasis and theirs antibiogram. Acta medica Iranica. 2013; 51 (11): 779–83.
For citation:
Nersesov A.V., Kaibullaeva D.A., Vasnev O.S., Tashenova L.K., Sakhipov M.M., Berestimov G.T., Akhmetzhanova G.A., Ibekenov O.T., Doskhanov M.O., Zhumazhanov N.M., Balzhanov Z.M., Aitmoldin B.A., Toleubaev E.A., Laryushina E.M., Zhumagulov K.N., Sobirova G.N., Umarova S.I., Shulpekova Yu.O., Okhlobystin A.V. A modern conception of postcholecystectomy syndrome (based on the materials of the Advisory Board held on May 4, 2019 in Almaty, Kazakhstan). FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology. 2020;13(2):205-219. (In Russ.) https://doi.org/10.17749/2070-4909/farmakoekonomika.2020.036
Views: 547
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 