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A modern conception of postcholecystectomy syndrome (based on the materials of the Advisory Board held on May 4, 2019 in Almaty, Kazakhstan)

https://doi.org/10.17749/2070-4909/farmakoekonomika.2020.036

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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

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

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

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

MD, Dr Sci Med, Professor, Director

Muratbaeva 211 ug. Shevchenko, Almaty, Kazakhstan



M. M. Sakhipov
City Clinical Hospital №7
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

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

MD, PhD, Associate Professor, Department of Surgery 

94 Tole-bi Str., Almaty 050000, Kazakhstan



O. T. Ibekenov
City Emergency Hospital
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

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

MD, PhD, deputy chief physician 

66 Rakhimzhan Koshkarbayev prosp., Nur-Sultan (Astana), Kazakhstan



Zh. M. Balzhanov
City Hospital No. 1
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


E. A. Toleubaev
Regional Clinical Hospital
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

MD, PhD, Head of the Department on Internal diseases №2

40 Gogol Str., Karaganda, Kazakhstan



K. N. Zhumagulov
South Kazakhstan Medical Academy
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

MD, PhD, senior researcher 

2 12th Farobi, Tashkent 100109, Uzbekistan



S. I. Umarova
Kyrgyz-Russian Slavic University
Kyrgyzstan

MD, PhD, associate professor

Kievskaya Str., 44, Bishkek 720000, Kyrgyz Republic



Yu. O. Shulpekova
Sechenov University
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

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



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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

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ISSN 2070-4909 (Print)
ISSN 2070-4933 (Online)