Changes in gepatopancreatobiliary system organs and quality of life in patients after cholecystectomy

Abstract

Aim. To assess the condition of hepatopancreatobiliary system and quality of life in patients in the remote period after cholecystectomy.Methods. 88 patients with cholelithiasis who undergone cholecystectomy in 2008-2010 were examined 5 years after the surgery. Common blood count, blood biochemistry test were performed, fasting blood glucose level was measured, esophagogastroduodenoscopy, ultrasonic examination of abdominal organs, fractional duodenal intubation, fecal elastase test (ELISA, «BioServ Diagnostics», Germany) were performed. Patients filled out questionnaires to assess the quality of life: MOS SF-36 (Medical Outcomes Study Short Form), GIQLI (Gastrointestinal Quality of Life Index) before, 1 and 5 years after cholecystectomy.Results. According to the esophagogastroduodenoscopy, 56 (63.6%) patients had duodenal reflux, 21 (23.8%) - duodenal diverticula, 9 (10.2%) - reflux esophagitis. Reduced fecal pancreatic elastase-1 was detected in 37 (42%) of patients. According to the fractional duodenal intubation, hypersecretory type was the most prevalent, 40 (45.5%) patients had hypotonic sphincter of Oddi, 48 (54.5%) - hypertonic sphincter of Oddi. All patients had crystals of calcium bilirubinate, leukocytes and bacteria in bile, microliths were identified in 76 (86%) of patients. After emergency surgery, quality of life increased by all indicators, after planned cholecystectomy for asymptomatic cholelithiasis the quality of life decreased 1 and 5 years after cholecystectomy. After planned cholecystectomy for symptomatic cholelithiasis, the surgery improved quality of life, but after 5 years indicators for quality of life returned to preoperative levels.Conclusion. Various changes in hepatopancreatobiliary system organs are detected in patients after cholecystectomy, like disorders of bile formation and biliary excretion, sphincter of Oddi dysfunction, decreased function of the pancreas, which reduce the quality of life.

State of Hepatopancreatobiliary system and post-cholecystectomy quality of life

“…Диагностика и лечение ПХЭС представляет собой непростую задачу как для хирургов, так и терапевтов. В настоящее время нет единых стандартов, рекомендаций и алгоритмов ведения больных с постхолецистэктомическими расстройствами [1,2,3,[8][9][10]. Выработка тактики ведения больных после ХЭ являются важнейшими задачами современной медицины.…”