The main and most effective method of treatment of cholelithiasis today is cholecystectomy - an operation to remove the gallbladder. But this procedure does not always eliminate the symptoms of abdominal discomfort, which manifests itself in the form of pain and dyspeptic distemper. This is the postcholecystectomy syndrome (PHC).
Causes of postcholecystectomy syndrome
The most common causes of PCHP are:
- lesion of extrahepatic biliary tract;
- cyst of the bile duct;
- stones in the bile ducts;
- liver disease;
- stagnation of bile;
- the propensity of the body to stone formation.
After removal of the gallbladder, bile enters the intestine chaotically, as a result of which digestion of food is disrupted and as a result an imbalance of the intestinal microflora occurs. Hence there are painful sensations.
Diagnosis of postcholecystectomy syndrome
The most informative is carrying out of endoscopic retrograde cholangiopancreatography and manometry of the Oldy sphincter. But the equipment for conducting such diagnostics is only in a few research centers.
The most common laboratory tests that determine the level:
- bilirubin;
- gamma glutamyl transferase;
- alkaline phosphatase;
- alanine and aspartic transaminases;
- amylase ;
- elastase;
- lipase.
These laboratory tests are advisable to be carried out either during, or within 6 hours after the next attack.
Symptoms of postcholecystectomy syndrome
Signs of PCHP:
- pain in the right side and epigastric region, which can also give to the region of the right scapula and back;
- various digestive disorders that manifest themselves in the form of nausea, flatulence, constipation, diarrhea, a feeling of bitter taste in the mouth;
- also the appearance of jaundice.
Classification of postcholecystectomy syndrome
There is no single classification of PCHP for today. Most often use such a systematization:
- Stenosing duodenal papillitis.
- Biliary pancreatitis (cholepancreatitis).
- Active adhesion process (limited chronic peritonitis) in the subhepatic space.
- Relapses in the formation of stones in the bile duct.
- Secondary gastroduodenal ulcers (biliary or hepatogenic).
Treatment of postcholecystectomy syndrome
Measures for the treatment of PHC should be aimed at eliminating those functional or structural disorders from the gastrointestinal tract, liver, bile duct and pancreas that cause pain.
One of the therapeutic measures is a fractional food (up to 6-7 times a day). At the same time with post-choledocystectomy syndrome, a diet is shown - acid, sharp, fried and smoked products are completely excluded.
When there is paroxysmal pain, it is possible to prescribe pain medications, such as:
- Mebeverin;
- Drotaverine.
If the cause of pain is enzyme deficiency, then enzyme preparations are prescribed to improve digestion, such as:
- Panzinorm forte;
- Festal;
- Creon .
If it is established that after the operation to remove the gallbladder, intestinal biocenosis is disrupted, then drugs are prescribed to restore the normal intestinal microflora. At the same time,
- Furazolidone;
- Intetriks;
- Doxycycline.
These funds are taken 5-7 days, and then drugs that colonize the intestines with useful bacteria:
- Linex;
- Bifidumbacterin and others.
Six months after the operation, patients must be under the supervision of a doctor.