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Enriched view of postcholecystectomy syndrome: Nowadays and in former times

Μετά χολοκυστεκτομή σύνδρομο. Χθές — σήμερα

  • Review / Ανασκοπηση
  • Published:
Hellenic Journal of Surgery

Abstract

Aim-Background

The aim of the present review is to evidence the differences in the nature of PCS between open and laparoscopic cholecystectomy and also to examine how this condition has evolved over the years. In 5 to 40% of patients with cholelithiasis, regardless of the type of surgery, the symptoms persist postoperatively, leading to the development of the so-called postcholecystectomy syndrome (PCS). The time of the onset of symptoms ranges from 2 days to 25 years after cholecystectomy.

Methods

A total number of 926 articles were found as a literature reference pool. We searched English language articles published in Medline, Scopus and google scholar. Only review articles were retrieved because no comparative studies or prospective clinical trials were found to provide statistically significant conclusions. The final group of articles was reviewed, and a total of 57 papers were used for the present review.

Results

The literature is conflicting as concerns the pathophysiology and the aetiology of PCS. Regardless of the type of surgery, it seems that PCS is correlated to age and sex. The prevailing view is that retained or recurrent gallstones, gallbladder remnants and Sphincter of Oddi dysfunction are the primary causes. Moreover, systemic diseases of the gastrointestinal (GI) tract, cardiac disorders, autoimmune diseases, nervous system and psychological distress can mimic PCS symptoms. Nonetheless, there are many available techniques regarding diagnosis and treatment. Nowadays, the majority of researchers endorse ERCP as the gold standard for diagnosis and treatment.

Conclusion

The preoperative meticulous investigation of patients with cholelithiasis is mandatory in order to identify coexisting disorders related to PCS, achieve a better therapeutic approach, and principally reduce PCS incidence.

Περίληψη

Σκοπός

Σκοπός της παρούσας ανασκόπησης είναι να καταγράψει και να αναδείξει τις διαφορές στη φύση του μετά χολοκυστεκτομή σύνδρομο PCS μεταξύ της ανοικτής και λαπαροσκοπικής χολοκυστεκτομής καθώς επίσης να εξετάσει πώς αυτή η κατάσταση έχει εξελιχθεί με την πάροδο των ετών.

Εισαγωγή

Η χολοκυστεκτομή αποτελεί μια από τις συχνότερες επεμβάσεις στις ανεπτυγμένες χώρες. Η κυριότερη αιτία για την οποία πραγματοποιούνται είναι η χολολιθίαση. Τα τελευταία 20 χρόνια η πλειονότητα των επεμβάσεων πραγματοποιείται λαπαροσκοπικά. Σε ποσοστό 5 έως 40% των ασθενών με χολολιθίαση, ανεξάρτητα από τον τύπο του χειρουργείου, τα συμπτώματα επιμένουν μετεγχειρητικά ή αναπτύσσεται το «μετά χολοκυστεκτομή σύνδρομο» (PCS), ενώ ο χρόνος από την έναρξη των συμπτωμάτων κυμαίνεται από 2 ημέρες έως 25 χρόνια.

Υλικό-Μέθοδος

Από την αναζήτηση της διεθνούς βιβλιογραφίας ανακτήθηκαν 926 άρθρα ως βάση αναφοράς. Στη συνέχεια χρησιμοποιήθηκαν άρθρα ανασκόπησης της αγγλικής βιβλιογραφίας. Για την παρούσα μελέτη χρησιμοποιήθηκαν 57 δημοσιεύσεις ανασκόπησης στις οποίες προστέθηκαν κατά περίπτωση αναφορές σε χαρακτηριστικά του PCS.

Αποτελέσματα

Από την ανασκόπηση της βιβλιογραφίας καταγράφονται αντικρουόμενα αποτελέσματα σχετικά με την παθοφυσιολογία και την αιτιολογία του PCS. Ανεξάρτητα από το είδος της χειρουργικής επέμβασης φαίνεται ότι το PCS συσχετίζεται με την ηλικία και το φύλο. Η κυρίαρχη άποψη είναι ότι τυχόν παραμείναντες λίθοι εντός του κυστικού πόρου ή του χοληδόχου πόρου ή υποτροπιάζουσα λιθίαση καθώς και η δυσλειτουργία του σφιγκτήρα του Oddi είναι οι κύριες αιτίες του συνδρόμου. Επίσης, συστηματικά νοσήματα του γαστρεντερικού σωλήνα, καρδιακές παθήσεις, αυτοάνοσα νοσήματα, παθήσεις του νευρικού συστήματος καθώς και ψυχολογικά αίτια μπορεί να μιμούνται τα συμπτώματα PCS. Στις μέρες μας υπάρχουν πολλά διαθέσιμα μέσα όσον αφορά στη διάγνωση και στη θεραπεία. Σήμερα η πλειοψηφία των ερευνητών υποστηρίζει ότι ο χρυσός κανόνας στη διάγνωση και θεραπεία είναι η ERCP. Η προεγχειρητική σχολαστική έρευνα των ασθενών με χολολιθίαση είναι υποχρεωτική προκειμένου να προσδιοριστούν συνυπάρχουσες διαταραχές που σχετίζονται με το μεταχολοκυστεκτομή σύνδρομο έτσι ώστε να επιτευχθεί μια καλύτερη θεραπευτική προσέγγιση αλλά κυρίως ελάττωση της συχνότητας εμφάνισης του μεταχολοκυστεκτομή συνδρόμου.

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Authors and Affiliations

  1. 2nd Surgical Department and Unit of Surgical Oncology of Korgialenion-Benakion, Red Cross Hospital, Athanasaki 1, 11526, Ampelokipoi, Athens, Greece

    A. Kouloura, G. Sgourakis, S. Lanitis, Gionous Sourtse, A. Pintireki, S. Peristeraki, K. Karkoulias & C. Karaliotas

  2. Department of Rheumatology and Rehabilitation - Physical Medicine, VFN University Hospital Prague, Prague, Czech republic

    Ch. Karaliotas

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  1. A. Kouloura
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Kouloura, A., Sgourakis, G., Lanitis, S. et al. Enriched view of postcholecystectomy syndrome: Nowadays and in former times. Hellenic J Surg 87, 156–164 (2015). https://doi.org/10.1007/s13126-015-0201-x

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