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Hymecromone (4-MU) is a recognized agent currently used in clinical practice. Since 1960, hymecromone has been used in many countries as a choleretic and cholespasmolytic, a drug approved for use in humans with biliary tract disorders. The review presents both traditional European and Russian studies of the selective antispasmodic and choleretic properties of hymecromone, due to which hymecromone is the drug of choice for the treatment of biliary tract diseases, as well as new fundamental and clinical studies of numerous pleiotropic effects of 4-MU associated with inhibition of hyaluronic acid and many other properties of this exciting molecule. These include antibacterial, antiviral, and nonspecific anti-inflammatory effects. Positive results have been demonstrated in carbohydrate and lipid metabolism disorders, autoimmune diseases, as well as liver, heart, and kidney diseases. Numerous in vitro and in vivo studies have been presented in pancreatic, prostate, skin, esophagus, breast, liver, ovary, bone cancers, metastatic lesions, leukemia, autoimmune and inflammatory diseases. Hymecromone is indicated not only as a choleretic and cholespasmolytic but also as a choleseptic in cholangitis and chronic cholecystitis, including opisthorchiasis, which does not disagree with its label. Odecromone® (hymecromone, tablets 200 mg) is available on the Russian market; it replaced the originator drug and is its fully equivalent generic.

Abstract Postcholecystectomy syndrome (PCS) is persistent distressing symptoms which develops following a laparoscopic cholecystectomy (LC); in cases when the condition is severe, readmission may be necessary. However, research on the prevalence of PCS and potential factors associated with PCS in Nepalese patients is still limited. An observational point-prevalence, correlational predictive cross-sectional study was conducted to determine the prevalence of PCS and examine what predicting factors including preoperative anxiety, preoperative dyspepsia, smoking, alcohol consumption, and duration of preoperative symptoms are associated with PCS. A total of 127 eligible Nepalese patients who came for follow-up after 1 week of LC at outpatient department of surgery in one single university hospital, Kathmandu, Nepal, were recruited. A set of questionnaires consisting participants' information record form, Hospital Anxiety and Depression Scale (HADS), Leeds Dyspepsia Questionnaires (LDQ), Fagerstrom Test for Nicotine Dependence (FTND), and Alcohol Use Disorder Identification Test (AUDIT) was administered for data collection. The associations between influential factors and PCS were analyzed using Binary logistic regression. 43.3% of participants reported PCS after 1 week of surgery. The findings from logistic regression analysis affirmed that the patients with preoperative anxiety (OR = 6.38, 95%CI = 2.07–19.67, p

Postcholecystectomy syndrome (PCS) is persistent distressing symptoms which develops following a laparoscopic cholecystectomy (LC); in cases when the condition is severe, readmission may be necessary. However, research on the prevalence of PCS and potential factors associated with PCS in Nepalese patients is still limited. An observational point-prevalence, correlational predictive cross-sectional study was conducted to determine the prevalence of PCS and examine what predicting factors including preoperative anxiety, preoperative dyspepsia, smoking, alcohol consumption, and duration of preoperative symptoms are associated with PCS. A total of 127 eligible Nepalese patients who came for follow-up after 1 week of LC at outpatient department of surgery in one single university hospital, Kathmandu, Nepal, were recruited. A set of questionnaires consisting participants' information record form, Hospital Anxiety and Depression Scale (HADS), Leeds Dyspepsia Questionnaires (LDQ), Fagerstrom Test for Nicotine Dependence (FTND), and Alcohol Use Disorder Identification Test (AUDIT) was administered for data collection. The associations between influential factors and PCS were analyzed using Binary logistic regression. 43.3% of participants reported PCS after 1 week of surgery. The findings from logistic regression analysis affirmed that the patients with preoperative anxiety (OR = 6.38, 95%CI = 2.07–19.67, p < 0.01) and moderate to severe dyspepsia (OR = 4.01, 95%CI = 1.34–12.02, p < 0.05) held the likelihood to report PCS 6.38 and 4.01 times, respectively, greater than others. The implications from study results are that screening of anxiety and patients' tailored interventions to reduce anxiety should be implemented preoperatively. An appropriate health education about persistence of PCS and self-management should be provided to those postoperative patients. [ABSTRACT FROM AUTHOR]

Cholecystectomy is the best method for treating gallstone diseases. However, 10%–30% of patients who undergo a cholecystectomy continue to complain of upper abdominal pain, dyspepsia, or jaundice—this is referred to as postcholecystectomy syndrome. Cystic duct stump stones are a troublesome cause of postcholecystectomy syndrome. Conventionally, surgery is mainly performed to remove cystic duct stump stones. However, repeated surgery can cause complications, such as postoperative bleeding, biliary injury, and wound infection. As an alternative method of surgery, endoscopic retrograde cholangiopancreatography is sometimes used to remove cystic duct stump stones, although the success rate is not high due to technical difficulties. Recently, peroral cholangioscopy, which can directly observe the bile duct, has been suggested as an alternative method. We report two cases in which a cystic duct stump stone was successfully removed via a single-operator cholangioscopy, after failure with an endoscopic retrograde cholangiopancreatography.

Morten Rune Blichfeldt-Eckhardt,1– 3 Dorte Aalund Olsen,4 Rikke Fredslund Andersen,4 Palle Toft,3,5 Laila Bendix2 1Department of Anesthesiology, Vejle Hospital, Vejle, Denmark; 2Multidiciplinary Pain Center of Southern Denmark, Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark; 3Department of Clinical Research, University of Southern Denmark, Odense, Denmark; 4Department of Biochemistry and Immunology, Vejle Hospital, Vejle, Denmark; 5Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, DenmarkCorrespondence: Morten Rune Blichfeldt-Eckhardt, Multidisciplinary Pain Center of Southern Denmark, Department of Anesthesiology and Intensive Care, Odense University Hospital, Heden 9, Indgang 200, Odense, DK-5000, Denmark, Tel +4565414721, Fax +45 6541 3026, Email mr.be@rsyd.dkPurpose: Chronic, abdominal pain remains a problem in a subset of patients after cholecystectomy. The cause is often obscure but central sensitization may be an important component and could theoretically be mediated by spinal PGE2, which is regulated by several cytokines. The aim of the study was to examine cerebrospinal fluid (CSF) of participants with post cholecystectomy syndrome and healthy volunteers for signs of PGE2 and cytokine mediated central sensitization.Patients and Methods: In phase 1 of the study, 83 subjects were included for DNA analysis, eight of these subjects with post cholecystectomy syndrome. We examined the SNPs rs5275, rs16944 and rs1800795 from the Cox-2, IL-1β and IL-6 genes respectively. In phase 2 of the study, we examined concentrations of PGE2-metabolite (PGEM), IL-1β and IL-6 in CSF and plasma from 6 patients with post cholecystectomy syndrome and visceral hyperalgesia and 11 pain free volunteers.Results: We found a significant difference in distribution of the rs5275 SNP of the Cox-2 enzyme (CT-genotype=88% in pain group, 45% in pain free group, TT-genotype=0 in pain group, 41% in pain free group, p=0.05) but not in the other SNPs. PGEM, but not IL-6, was significantly elevated in CSF of the pain group (3.6 pg/mL, sd=1.9 vs 2.1 pg/mL, p=0.03), IL-1β was undetectable.Conclusion: We found elevated PGEM levels in CSF of patients with post cholecystectomy syndrome and visceral hyperalgesia, suggesting a central, possibly inflammatory component to the pain, and overrepresentation of the CT-genotype in the rs5275 SNP in the Cox2 gene, suggesting overexpression of Cox2 as a possible cause for elevated PGEM levels.Keywords: T8473, visceral pain, post cholecystectomy syndrome, hyperalgesia, central sensitization

Cholecystectomy is the definite treatment for symptomatic gallstones, and rates are rapidly rising. Symptomatic complicated gallstones are generally treated with cholecystectomy, but there is no consensus on the clinical selection of patients with symptomatic uncomplicated gallstones for cholecystectomy. The aim of this review is to describe symptomatic outcomes before versus after cholecystectomy in patients with symptomatic gallstones as reported in prospective clinical studies and to discuss patient selection for cholecystectomy. Following cholecystectomy, resolution of biliary pain is high and reported for 66–100%. Dyspepsia has an intermediate resolution of 41–91% and may co-exist with biliary pain but may also develop following cholecystectomy with an increase of 150%. Diarrhea has a high increase and debuts in 14–17%. Persisting symptoms are mainly determined by preoperative dyspepsia, functional disorders, atypical pain locations, longer duration of symptoms, and poor psychological or physical health. Patient satisfaction following cholecystectomy is high and may reflect symptom alleviation or a change in symptoms. Comparison of symptomatic outcomes in available prospective clinical studies is limited by variations in preoperative symptoms, clinical presentations, and clinical management of post-cholecystectomy symptoms. When selecting patients with biliary pain only in a randomized controlled trial, 30–40% still have persisting pain. Strategies for the selection of patients with symptomatic uncomplicated gallstones based on symptoms alone are exhausted. For the development of a selection strategy, future studies should explore the impact of objective determinants for symptomatic gallstones on pain relief following cholecystectomy. [ABSTRACT FROM AUTHOR]

The term post-cholecystectomy syndrome (PCES) includes a heterogeneous group of symptoms and changes in patients who have previously undergone cholecystectomy. Patients with PCEC may have abdominal pain, jaundice, or dyspeptic symptoms. Many of these complaints can be related to complications, including bile duct damage, bile fistulas, and left stones in the bile ducts. Late complications include recurrent stones in the bile ducts and bile duct strictures. With the increasing number of cholecystectomies performed during the laparoscopy era, the number of patients with PCES is also increasing. The article details the clinical case of the formation of scar changes in choledochus, right and left hepatic ducts, which led to cholestasis and cholangitis, as well as the formation of liver cirrhosis two years after cholecystectomy.

Doina Georgescu,1,* Alexandru Caraba,1,* Ioana Ionita,1 Ana Lascu,2 Emil Florin Hut,3 Simona Dragan,4 Oana Elena Ancusa,1 Ioana Suceava,1 Daniel Lighezan1 1Department of Internal Medicine I, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Department of Functional Sciences, Discipline of Pathophysiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 3Department IX of Surgery I/Compartment of Hepato-Bilio-Pancreatic Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 4Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania*These authors contributed equally to this workCorrespondence: Alexandru CarabaDepartment of Internal Medicine I, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Piata Eftimie Murgu 2, 300041, RomaniaTel +40 744 769 850, Fax +40 256 490 626, Email caraba.alexandru@umft.roBackground: Gallstone disease (GSD) represents one of the most frequent digestive disorders, highly reported in female gender. The purpose of the study was to explore the clinical and gut microbiota particularities of female patients with postcholecystectomy syndrome (PCS) and the possible relationship between gut dysbiosis (DB) and abdominal complaints.Patients and Methods: In total, 129 female participants: 104 outpatients divided into two equal groups, 52 PCS (+), 52 PCS (−) and 25 healthy controls were consecutively enrolled in this observational study. Patients underwent clinical examination with assessment of pain, bloating, transit disturbances, abdominal ultrasound/computer tomography/magnetic resonance imaging/endoscopic retrograde cholangiopancreatography, upper and lower digestive endoscopies. Laboratory work-ups and stool microbiology assessments were performed for all study participants (patients and controls). Stool microorganisms were identified by matrix-assisted laser desorption ionization – time-of-flight– mass spectrometry and in patients with DB also by next-generation sequencing.Results: Older age, complicated gallstones disease, associated conditions like diabetes mellitus/impaired glucose tolerance and irritable bowel syndrome were significantly present in PCS (+) group, as well as sedentary lifestyle and diets characterized by a low fiber intake (p< 0.0001). PCS (+) patients displayed significant differences related to the incidence and severity of overall gut microbiota DB, decreased H index of biodiversity and the unbalanced Firmicutes/Bacteroidetes (F/B) ratios by comparison to the PCS (−) group (p< 0.0001). Strong positive correlations of the severity of overall DB with bloating and the intestinal habit disorders, as well as of F/B ratios to all abdominal symptoms were noted.Conclusion: PCS in female patients was associated with older age, sedentary lifestyle, specific dietary habits, history of complicated gallstone disease, diabetes mellitus/impaired glucose tolerance and irritable bowel syndrome, as well as gut microbiota particularities. Overall DB and unbalanced F/B ratios were strongly correlated to abdominal complaints.Keywords: postcholecystectomy syndrome, female patients, gut microbiota imbalance

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.

This article provides an overview of the data on postcholecystectomy syndrome (PCES). The entire period of study of this frequent complication (up to 40%) can be divided into 2 periods: surgical and therapeutic. Surgical complications of cholecystectomy accounted for 10% and were studied by surgeons. This study led to the correction of surgical treatment, formulated the examination program and reduced and minimized surgical complications. The second part of the complications is made up of functional disorders of the sphincter of Oddi, which today are the leading ones and, apparently, remain so. The article gives an idea of PCES as a dynamic disorder of the sphincter of Oddi, gives the last definition of PCES given by the IV Roman Concensus, suggests an algorithm for diagnosis and treatment. As a clinical illustration, the authors present their own data on the diagnosis and treatment of 60 patients with PCES, which confirmed the point of view proposed by the international gastroenterological community. The authors separated two types of postcholecystectomy syndrome: one with a predominance of sphincter of Oddi (SO) spasm and another with a predominance of sphincter of Oddi hypotension. The drug of choice in the spastic type is the selective antispasmodic gimecromone, in which case a dose is of the essence. In case of a hypotonic type of postcholecystectomy syndrome, motor regulators to increase the SO tone should be used. The therapy should be stepwise with an assessment of the effect and correction of the next step of treatment. This treatment option for patients with postcholecystectomy syndrome we see today as the leading one. The features of treatment associated with the developing syndrome of bacterial overgrowth (SIBO) and chronic biliary insufficiency (CBI), which require constant monitoring (diagnosis) and permanent treatment, are considered.

Aim. Evaluation of the practice of using trimebutine (tablets, 300 mg, extended release), for the treatment of patients with functional gastrointestinal disorders (FGID) in primary health care. Materials and methods. A prospective observational multicenter non-interventional study was carried out, which included patients of both sexes aged 18 to 60 years with a verified diagnosis of functional gastrointestinal disorders (functional dyspepsia, irritable bowel syndrome, biliary tract dysfunction, sphincter of Oddi dysfunction, postcholecystectomy syndrome). Trimebutine was prescribed in accordance with the instructions for medical use: orally, 300 mg twice per day for 28 days. The severity of simptoms was evaluated by five-point rating scale. Results. The study included 4433 patients, the per protocol sample consisted of 3831 people. The proportion of patients with a significant decrease in the severity of abdominal pain after treatment was 74.73% (95% confidence interval CI 73.3276.11). At the and of the study a statistically significant decrease in the severity of FGID` simptoms was observed: epigastric pain/burning (mean score at the 1st visit was 1.21 [95% CI 1.181.25], at the 2nd visit 0.22 [95% CI 0.20.23]; p0.001), abdominal pain (1st visit 2.01 [95% CI 1.982.04), 2nd visit 0.33 [95% CI 0.310.35]; p0.001), biliary pain (1st visit 1.22 [95% CI 1.181.26], 2nd visit 0.2 [95% CI 0.190.22]; p0.001), postprandial fullness and early satiation (1st visit 1.29 [95% CI 1.251.32], 2nd visit 0.21 [95% CI 0.190.22]; p0.001), severity of heartburn (1st visit 0.92 [95% CI 0.880.95], 2nd visit 0.18 [95% CI 0.170.20]; p0.001), belching (1st visit 1.13 [95% CI 1.091.16], 2nd visit 0.22 [95% CI 0.210.24]; p0.001), as well as abdominal distention (1st visit 1.99 (95% CI 1, 96, 2.03), 2nd visit 0.43 [95% CI 0.410.45]; p0.001). Conclusion. The present prospective observational multicenter non-interventional study has demonstrated that trimebutine is an effective approach to treating FGID.

Although it has been demonstrated that cholecystectomy is successful in relieving symptoms in 90% of cases, some patients continue to experience gastrointestinal symptoms despite surgical intervention; this is known as postcholecystectomy syndrome. For this reason, we decided to investigate this syndrome and, relying on the article by Desai et al entitled "Foreign bodies in common bile duct in postcholecystectomy state-series of 8 cases: an experience of a single center in western India," delve into the different symptoms that appear in the syndrome. Based on an extensive review of articles published about the syndrome, the most common symptoms are dyspepsia, pain in the upper right quadrant of the abdomen, abdominal distension, and gastrointestinal issues. Consequently, it is critical to take these symptoms into consideration because, even though it may not seem like postcholecystectomy syndrome occurs frequently, one needs to be familiar with its clinical picture.

The occurrence of chronic diarrhea after cholecystectomy (CCY) has been described by many researchers. However, the main mechanisms of the development of this diarrhea are not fully understood. Supposed that dysregulation of the bile acids (ВA) absorption in the ileum is played a significant role in the development of diarrhea syndrome. Aim. To determine the role of the fibroblast growth factor 19 (FGF19) level in the serum and BA concentration in feces in pathogenesis of bile acid diarrhea (ВАD) in patients after CCY. Materials and methods. Sixty-one patients were examined at various times after CCY: 30 patients with chronic diarrhea that appeared after CCY (group 1) and 31 patients with normal stools (group 2). In all patients, the level of FGF19 in the blood serum, and the daily excretion of BA in the feces were studied. The control group consisted of 28 healthy individuals. Results. In the 1st group we found lower concentrations of FGF19 in the blood serum 86.2 ng/ml (67.8; 117.8) compared with concentrations in the 2nd group 259 ng/ml (170.6; 318.8), p0.001. The daily excretion of bile acids with feces in the 1st group was 657.4 mg/day (524.6; 830.1), which was twice more than in the 2nd group and the control group. It was established an inverse correlation between serum concentration of the FGF19 and the BA excretion in the feces in all examined patients. It indicates a possible relationship between the low concentration of FGF19 in blood serum and malabsorption of the BA. Conclusion. Low level of FGF19 in the blood serum and a high excretion of BA in the feces may be one of the causes of BAD in patients undergoing cholecystectomy. Our results indicate the important role of FGF19 in the development of chronic diarrhea, which can be considered as one of the variants of postcholecystectomy syndrome.

Cholecystectomy is the definite treatment for symptomatic gallstones, and rates are rapidly rising. Symptomatic complicated gallstones are generally treated with cholecystectomy, but there is no consensus on the clinical selection of patients with symptomatic uncomplicated gallstones for cholecystectomy. The aim of this review is to describe symptomatic outcomes before versus after cholecystectomy in patients with symptomatic gallstones as reported in prospective clinical studies and to discuss patient selection for cholecystectomy. Following cholecystectomy, resolution of biliary pain is high and reported for 66–100%. Dyspepsia has an intermediate resolution of 41–91% and may co-exist with biliary pain but may also develop following cholecystectomy with an increase of 150%. Diarrhea has a high increase and debuts in 14–17%. Persisting symptoms are mainly determined by preoperative dyspepsia, functional disorders, atypical pain locations, longer duration of symptoms, and poor psychological or physical health. Patient satisfaction following cholecystectomy is high and may reflect symptom alleviation or a change in symptoms. Comparison of symptomatic outcomes in available prospective clinical studies is limited by variations in preoperative symptoms, clinical presentations, and clinical management of post-cholecystectomy symptoms. When selecting patients with biliary pain only in a randomized controlled trial, 30–40% still have persisting pain. Strategies for the selection of patients with symptomatic uncomplicated gallstones based on symptoms alone are exhausted. For the development of a selection strategy, future studies should explore the impact of objective determinants for symptomatic gallstones on pain relief following cholecystectomy.

The aim. Improving the algorithm for diagnosing patients with post cholecystectomy 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. [ABSTRACT FROM AUTHOR]

Aim:To determine the effectiveness of the influence of the use of mineral medicinal water on the functional state of the liver of patients after laparoscopic cholecystectomy in a long period of rehabilitation in the conditions of the Morshynkurort health resort complex. Materials and Methods: An analysis of 100 medical records of patients after laparoscopic cholecystectomy who were undergoing rehabilitation at the Morshynkurort health resort complex in 2017 and 2018 was carried out. Medical records were selected by a randomized method using the Random Allocation Rule program. Blinded evaluators while processing medical records. The method of comparison of indicators of the functional state of the liver of patients before the beginning of rehabilitation and after its completion was carried out by the method of mathematical statistics – Student’s t-test. The studied parameters: total protein (g/l), thymol test (unit), total bilirubin (mkmol/l), activity of alanine transpeptidase (ALT, (units/hour • l)), aspartate transaminase (AST, (units/hour • l)), total cholesterol (mmol/l), triglycerides (mmol/l), blood glucose (mmol/l). All patients were examined before and after treatment. There was no dropout from the study among the surveyed. Results: Mathematical statistics revealed a significant (p <0,05) improvement in such indicators as: thymol test, alanine transpeptidase activity, total cholesterol. Conclusions: Hydrotherapy for 14 days MPO well No. 3-k and groundwater source No. 4 in Morshyn diluted to mineralization 3,0-3,4 g/dm³ at a long stage of rehabilitation leads to an improvement in liver function in patients after laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

Aim. This study was designed to prove the connection between postcholecystectomy syndrome, chronic disorder of duodenal patency, adhesive disease of the abdominal cavity, and chronic colostasis and to develop the methods of its treatment.Materials and methods. During the period from 2004 to 2016 we monitored 140 patients with a clear picture of postcholecystectomy syndrome which was manifested after the surgeries on the extrahepatic biliary tract by clinic of passage disorders in the digestive tract.Results. The results of our study indicate that there are created a number of conditions that cause various pathologies in patients with colostasis who have unfavorable outcomes after cholecystectomy. Colostasis can cause functional changes in the biliary tract due to the overstretch of the colon areas by the accumulated contents. Functional disturbances can be a consequence of the tension of the mesocolon lowered by the transverse colon or duodenojejunal ligament narrowing the lumen of the duodenum. The hepatic angle of the large intestine in high position, deforming the bile duct and duodenum, can also cause postcholecystectomy syndrome.Conclusion. Long-term results of the surgical treatment of the pathological conditions after cholecystectomy depend not only on the condition of the organ which surgery was performed on but also on other physiologically related organs and body systems. The biliary and enteroenteric connections are very important in this case. Psychosomatic disorders of the patient are also crucial while assessing the long-term results of the surgical treatment of this type of patients. The results of the surgical treatment of the duodenal patency chronic disorders depend on the selected type of surgery. Thus, the exclusion of the duodenum from the food passage gives better results than the surgeries aimed at improving the passage of food through the duodenum. The choledochojejunostomy and duodenoenterostomy are not effective. In the most severe cases of duodenal patency chronic disorders two sided exclusion of the duodenum with duodenenterostomy can be the only effective method of its correction but the development of post-resection syndrome cannot be ruled out.

Aim. To estimate the incidence of abdominal pain syndrome (APS) and to assess quality of life (QOL) in patients within 10 years after cholecystectomy (CE). Subjects and methods. This investigation is part of a long-term prospective follow-up study of patients after CE for cholelithiasis (CL). It enrolled 145 people: 30 (21.5%) patients with baseline asymptomatic CL and 115 (80.7%) with its clinical manifestations. The time course of changes in APS and QOL were analyzed. Results. Over 10 years, all the patients showed a decrease in the incidence of APS from 84.1% (n=95) to 66.4% (n=75; p=0.004). In Group 1 (n=89), APS was at baseline detected in all the patients; 10 years later, its incidence declined to 67.4% (n=60; p < 0.001). Biliary pains were predominant; these had been identified significantly less frequently over the 10-year period in 47 (52.8%) patients; p

The article analyzes the causes of recurrent abdominal pain and dyspeptic phenomena in 657 patients after cholecystectomy. The authors found out that after gall bladder resection 48% of patients complain of pain and dyspepsia. Postcholecystectomy syndrome (dysfunction of Oddi’s sphincter) is diagnosed in 15.2% of the patients. The proportion of diseases of the esophagus and organs of the gastroduodenal zone is 36.4%, of the hepato-pancreato-biliary one is 38.3 per cent. Diagnostic errors at the preoperative stage and/or tactical ones during cholecystectomy amounted to 7.8%.

After cholecystectomy, elderly patients require special attention, due to the influence of involution processes in the body on the formation of complications. To identify prognostic criteria for the formation of fatty liver degeneration in the long-term period of minimally invasive cholecystectomy, 159 men were examined. Dysregulation of the biliary tract was determined using magnetic resonance cholangiopancreatography, elastography and magnetic resonance imaging of the liver. Microbial markers of the wall microbiome of the intestine were determined using chromatography-mass spectrometry. The relationship between an increase in body mass index and a decrease in the amount of obligate microbiome (r=-0,43, p<0,050), as well as with the formation of fatty liver degeneration in elderly patients, was revealed. The features of vegetative regulation in elderly people with fatty liver degeneration have been determined. It has been proven that in old age, a decrease in the number of obligate anaerobic association of microorganisms of the small intestine (on average from 15 659 to 7 630 in persons of the 2nd age subgroup and from 1 457 to 17 837 in the 3rd) is a predictor of fatty liver degeneration. The prognostic algorithm developed on the basis of the analysis of highly informative signs makes it possible to identify with an accuracy of at least 75% a high risk of fatty liver degeneration in the long-term period of cholecystectomy.

Postcholecystectomy syndrome (PCS) is a common syndrome with complex etiologies after laparoscopic cholecystectomy, rather than a specific disease. In addition to bile duct stones, bile duct injury, and sphincter of Oddi dysfunction, PCS is also associated with the abnormalities in bile acid pool, farnesoid X receptor, and GPBAR1/TGR5 pathways after surgery, reductions in fibroblast growth factor 19 and surfactant protein D, changes in gastrointestinal hormones such as motilin and cholecystokinin, and disappearance of various physiological reflexes and nerve reflexes involving the gallbladder. All these changes in physiological function can induce PCS. As the number of patients undergoing laparoscopic cholecystectomy is increasing year by year, the incidence rate of PCS is also increasing. This article briefly summarizes the etiology, pathophysiology, diagnosis, treatment, and prevention of PCS. [ABSTRACT FROM AUTHOR]

The article tells about the current concept of the postcholecystectomy syndrome according to the Rome Consensus II - III guidelines, and therapeutic approaches in the management of such patients.

A prospective clinical and instrumental study of 119 patients with cholelithiasis (CLT) and 71 patient with postcholecystectomy syndrome (PCES), who underwent cholecystectomy (CE) 2-45 years ago, was conducted. We established polymorphism of PCES clinical picture, which was presented by permanent pain syndrome (56.3%) and intermittent pain (43.7%) together with dyspepsia and motor vacuation disorders. Clinical symptoms occurred 1.2-3.7 times more often in a remote period (> 14 years after CE) regardless of the operation type. Various organic and functional GIT pathologies were found in 77.5 % of cases. Their prevalence one year after surgery is 15.1%, 2-14 years – 73.9%, 15-45 years – 84.0%ю. According to manometric data, PCES patients with prolonged pain syndrome are mostly susceptible to the functional disorders of sphincter of Oddi that are manifested through increased pressure and amplitude of contractions of sphinсter, choledochus and duodenum. It was established that the sphincter of Oddi dysfunction increases after the disappearance of reservoir and cumulative functions of the gall bladder, correlating with the development of GIT pathology in a distant period.

The incidence of postcholecystectomy syndrome (PCS) at Cipto Mangunkusumo Hospital, Indonesia, was previously found to be 54.29% (2012), which was higher than those reported in other countries. This research was undertaken to identify the risk factors for PCS in developing countries with limited resources and facilities. This was a cross-sectional study of all patients who underwent cholecystectomy in our hospital during 2015. The variables included sex, body mass index, preoperative symptom duration, preoperative flatulence, level of education, preoperative symptoms, preoperative awareness, and preoperative ultrasound. All the data were analyzed through bivariate and multivariate analyses. In total, 112 patients who underwent laparoscopic cholecystectomy were followed. We found the incidence of PCS to be 45.5%. Multivariate logistic regression analysis showed that preoperative flatulence (P ≤ 0.001, OR = 17.152), nonspecific preoperative symptoms (P = 0.012, OR = 3.984), and patients' poor preoperative awareness of PCS (P = 0.003, OR = 5.907) were independent predictive factors for PCS. Statistically significant correlation between patients' awareness and preoperative education (P ≤ 0.001, OR = 69.00) was found. We concluded that preoperative flatulence, nonspecific preoperative symptoms, and poor preoperative awareness increased the incidence of PCS. Besides abdominal ultrasound, other examinations, such as upper GI endoscopy, for nonspecific preoperative symptoms that do not meet the Rome III criteria are recommended to rule out the diagnosis and avoid unnecessary surgeries. Adequate preoperative information and education may reduce the incidence of PCS. [ABSTRACT FROM AUTHOR]

Postcholecystectomy syndrome(PCS)is a common clinical syndrome in the digestive system．The pathogeny of PCS includes biliary and non biliary reasons．Biliary causes include common bile duct residual or recurrent stones，bile duct injury，excess residual cystic duct，residual gallbladder，duodenal diverticulumnipples， duodenal papilla benign stricture，Oddi sphincter dysfunction，etc.. The biliary causes include functional and organic disease，commoning peptic ulcer，pancreatitis，gastritis，gastrointestinal functional or dynamic disease，liver disease，cardiovascular system diseases，such as gastrointestinal malignant tumor．Recent studies have shown that the etiology of some patients with cholecystectomy may be related to changes in intestinal microbiological metabolism． This article aims to reviewthe progress of etiology of post cholecystectomy syndrom(PCS). [ABSTRACT FROM AUTHOR]

There are a lot of different views on the definition of postcholecystectomy syndrome. 4 major causes of complications after cholecystectomy are distinguished. Pathogenesis of digestive disorders associated with postcholecystectomy syndrome is proved to be a complex and multicomponent process, consisting of a number of interlinked and closely related pathogenic "rings". In case of absence of indications for surgical correction of the syndrome, prescription of combination of pancreatine in enterosoluble mini-microspheres and selective myotropic anti-spasmatic mebeverine is recommended as the optimal way of breaking the "vicious circle" described above.

Cholecystectomy is one of the most common surgical procedures done in Russia and worldwide. Complaints of pain and dyspepsia occur at least in half of patients who underwent the surgery. Postcholecystectomy syndrome (PCS) is a polyetiological syndrome with functional or organic causes. About half of pain and dyspepsia after cholecystectomy are associated with organic disease (distal common bile duct stricture, pancreatic and gastric cancer, acute pancreatitis, etc). Other cases are explained by functional causes, including sphincter of Oddi dysfunction and functional disorders of intestinal motility.

Biliary and nonbiliary disorders are responsible for postcholecystectomy syndrome (PCS). The most common cause of late PCS of biliopancreatic origin is calculi in the common bile duct or the cystic duct remnant. Intra-hepatic calculi causing PCS is very uncommon. We present a case of late PCS caused by intrahepatic calculi in the left intra-hepatic biliary radicles and left hepatic duct causing obstruction of the left ductal system. Endoscopic retrograde cholangiopancreaticography did not show any stricture in the ductal system. Sphincterotomy followed by stenting of the left hepatic duct was performed to relieve the obstruction.

Introduction: Laparoscopic cholecystectomy (LC) is one of the most common surgical procedures in our country. Postcholecystectomy diarrhea is an unrecognized entity, with a reported prevalence between 0.9 and 35.6%, nonetheless in Chile this has not been clearly defined. Objective: To determine the prevalence and characteristics of diarrhea following elective laparoscopic cholecystectomy in our institution. Material and methods: A structured questionnaire about consistency and defecation frequency was applied to adult patients summited to an elective LC between December 2014 and February 2015, by a telephone survey within 4 and 6 months after the surgical procedure. Postcholecystectomy diarrhea was defined as the presence of liquid or unusually disrupted faecal material beginning after LC. Persistent diarrhea was established when diarrhea continued for a period longer than four weeks. Results: One hundred patients were included (73% women). The overall prevalence of postcholecystectomy diarrhea was 35% (n = 35). The prevalence of patients with persistent diarrhea was 15% (n = 15). In the group of patients with persistent diarrhea, complete resolution was observed on 57% of the cases (n = 8) within an average period of 99 ± 29 days. Conclusion: Post cholecystectomy diarrhea is a frequent condition in our population, with a high prevalence within the first 28 days after LC. In most patients it resolved within 6 months. [ABSTRACT FROM AUTHOR]

Sump syndrome is a rare complication of side-to-side choledochoduodenostomy (CDD) and occasionally occurs after spontaneous gallbladder-bile duct-digestive tract fistula or end-to-side choledochojejunostomy. Before the development of minimally invasive surgery, conventional surgical operation used to be the most important treatment method. This article reviews the research advances in sump syndrome in recent years and points out that endoscopic retrograde cholangiopancreatography is the major diagnostic method for this disease, and endoscopic sphincterotomy combined with bile duct debridement is the most simple and effective measure for the treatment of sump syndrome. Meanwhile, this article briefly reviews sump syndrome with reference to related literature and clinical practice, in order to raise the awareness for sump syndrome. [ABSTRACT FROM AUTHOR]

Anatomical variations in the calots triangle encountered during laparoscopic cholecystectomy are not uncommon. Misidentification and misperception of these structures are the major cause of vasculobiliary injuries. This study was conducted to estimate the prevalence of anatomical variations of the cystic artery, cystic duct (CD), and gall bladder. This is the first study in India to access the rate of intraoperative and postoperative complications in anatomical variants compared to normal individuals., Patients and Methods: It was a prospective observational study on patients undergoing laparoscopic cholecystectomy in the department of General Surgery at the tertiary center of India. The calculated sample size was 298. Variations of the cystic artery, CD, and gall bladder along with intraoperative and postoperative complications were noted. The comparative analysis of intraoperative and postoperative complications and a subgroup analysis between anatomical variants and normal patients were performed., Results: The most common variations were found in cystic arteries (16.8%). CD anomalies were present in 11.4% of patients, and gall bladder anomalies were the least common of all (5.4%). Intraoperative and postoperative complications were compared between patients with anatomical variations and normal anatomy. Intraoperative complications in patients with anatomical variations were significantly higher. Bile leak (15.7% vs. 6.4%) ( P =0.01), haemorrhage (16.8% vs. 1.9%) ( P -value <0.001), conversion to open (3 vs. 0 patients) ( P -value =0.03). Subgroup analysis revealed a strong association between intraoperative haemorrhage and bile leak with cystic artery and CD anomalies, respectively., Conclusion: Cystic artery anomalies are the most common variations. Patients with anatomical variations had significant intraoperative and postoperative complications compared to patients with normal anatomy., Competing Interests: The authors declare that they have no financial conflict of interest with regard to the content of this study., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)