Postcholecystectomy syndrome from the position of surgeon and gastroenterologist

Veligotsky, N. N.; Lazutkina, E.A.; Arutyunov, S. E.; Менкус, Б В; Taran, Yu.Yu.; Алексанян, К. А.

doi:10.22141/1997-2938.2.37.2018.147842

Cited by 3 publications

(1 citation statement)

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“…Postcholecystectomy syndrome (PCS) is a symptom complex that contains functional and organic disorders of the major duodenal papilla (MDP) [1,2]. The most co mmon causes of PCS, both after cholecystectomy (CE) performed by the «open» method, and after laparoscopic CE, are: stones forgotten or moved during intervention in the choledochus from the gallbladder or cystic duct [3], recurrent choledocholithiasis (mainly after preliminary endoscopic manipulations with stone extraction attempts) [4,5], MDP restenosis after endoscopic papillosphincterotomy (EPST) [6], blind pouch syndrome, long vesical stump syndrome, biliary fistula, tubular stenosis of the distal choledochus due to chronic indurative pancreatitis, reflux cholangitis due to total EPST and wide choledochoduodenoanastomosis, electrical injury of the biliary tract [7,8].…”

Section: Introductionmentioning

confidence: 99%

Improvement of the algorithm for diagnostics of postcholecystectomy syndrome taking into account functional and organic changes in the area of the large duodenal nipple

et al. 2022

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The aim. Improving the algorithm for diagnosing patients with postcholecystectomy syndrome (PCS), taking into account functional and organic changes in the major duodenal papilla (MDP). Materials and methods. 208 patients with PCS were examined. Laparoscopic cholecystectomy (CE) was performed in 172 patients in history, open CE was performed in 36 patients. 47 patients had obstructive jaundice, 84 had signs of biliary hypertension without an increase in bilirubin, 77 had no signs of biliary hypertension and an increase in bilirubin. The following instrumental research methods were used: abdominal organs ultrasound examination (AO USE), duodenoscopy, endoscopic retrograde cholangiopancreatography (ERCP), computed tomography (CT). In the main group, to study the morphofunctional changes in MDP, duodenoscopy with parietal impedancemetry, ultrasound of the hepatobiliary zone with a choleretic load were used. Results. In the main group, 34 patients underwent ultrasound of the hepatobiliary zone and Vater's nipple area with a choleretic breakfast according to Boyden according to the method of Grigoriev P.Ya. in our modification, 21 patients had an expansion of the choledochus by 2 mm. At the same time, taking meverin led to a decrease in the diameter of the choledochus, which indicated functional changes in the MDP. In 13 patients, the expansion of the choledochus, observed when taking a choleretic breakfast, persisted with the use of antispasmodics, which indicated the presence of an organic pathology of MDP. Duodenoscopy with impedancemetry was performed in 41 patients: 20 patients had 760–820 Ohm, which indicated the presence of functional changes, 12 patients had inflammatory changes in the MDP and 703–760 Ohm were detected, 9 patients with cicatricial fibrous changes had indicators impedance measurement 640–703 Ohm. The use of ultrasound with a choleretic breakfast and duodenoscopy with parietal impedancemetry in patients of the main group made it possible to identify functional and organic (inflammatory, fibrous) changes in the MDP, which made it possible to develop a therapeutic algorithm using both conservative therapy and the use of various options for transpapillary endoscopic interventions. Conclusions. Conducting an in-depth diagnosis of morpho-functional changes in MDP using parietal impedancemetry of MDP and ultrasound of the hepatobiliary zone with choleretic load allows us to identify both functional and morphological changes in MDP, which makes it possible to develop a therapeutic algorithm using drug therapy and transpapillary endoscopic techniques.

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Section: Introductionmentioning

confidence: 99%

Improvement of the algorithm for diagnostics of postcholecystectomy syndrome taking into account functional and organic changes in the area of the large duodenal nipple

et al. 2022

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Tactics and techniques of choledochal sanation after papillotomy

Май

Короткевич

Леонтьев

et al. 2021

jour

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Сholelithiasis ranks third in terms of the prevalence of diseases among the adult population. A complication such as choledocholithiasis occurs in up to 33% of patients with gallstone disease. Despite the improvement in treatment methods and the use of “gold” standards, the number of complicated forms of cholelithiasis has no tendency to decrease. Timely resolution of choledocholithiasis by a correctly chosen technique helps to reduce complications and increases the frequency of favorable outcomes of the disease, returning patients to social activity.That is why it is important to know and, if possible, to use various methods of rehabilitation of the common bile duct when performing modern endoscopic transpapillary interventions.

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Differential diagnosis of changes in the area of the large duodenal nipple in postcholecystectomy syndrome by the method of parietal impedancemetry

Veligotsky

Алексанян

Arutyunov

et al. 2021

Modern Medical Technology

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Purpose of the study. To carry out differential diagnostics of organic and functional changes in the area of the large duodenal papilla (LDP) by the method of parietal impedancemetry in patients with PCES. Materials and methods. Duodenoscopy with parietal impedance LDP was performed in 47 patients. A history of 38 patients underwent laparoscopic cholecystectomy, and 9 patients underwent laparotomic cholecystectomy. In 31 patients, the study was performed against the background of signs of obstructive jaundice, in 16 – the study was performed against the background of dilatation of the common bile duct without visualization of calculi in it. All patients underwent endoscopic retrograde cholangiopancreatography with determination of parietal impedance prior to endoscopic papillosphincterotomy. The control group consisted of 8 patients without manifestations of PCES, who underwent duodenoscopy with parietal impedancemetry during a routine examination. Results. The parameters of the parietal impedance of patients with PCES against the background of benign obstructive jaundice in the presence of papillitis were 605–703 Ohm. In the absence of visual signs of inflammation, the resistance of the LDP wall varied within 760–820 Ohm and coincided with the values of the control group. Conclusion. Parietal impedancemetry is an informative method for detecting inflammatory changes in the LDP, which can be performed routinely during duodenoscopy and allows differential diagnosis between the organic pathology of the LDP zone and its absence.

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Postcholecystectomy syndrome from the position of surgeon and gastroenterologist

Cited by 3 publications

References 1 publication

Improvement of the algorithm for diagnostics of postcholecystectomy syndrome taking into account functional and organic changes in the area of the large duodenal nipple

Improvement of the algorithm for diagnostics of postcholecystectomy syndrome taking into account functional and organic changes in the area of the large duodenal nipple

Tactics and techniques of choledochal sanation after papillotomy

Differential diagnosis of changes in the area of the large duodenal nipple in postcholecystectomy syndrome by the method of parietal impedancemetry

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