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At least 19 recordsLinked to original sources

PubMed1990

[The remnant cystic duct in the syndromal complex of the postcholecystectomy syndrome].

Some modern aspects of the postcholecystectomy syndrome and the importance of d. cysticus remnant for its arising are discussed. Analysis is made of 13 patients with postcholecystectomy syndrome surgically treated at the Department of Propedeutics of Surgical Diseases, Research Institute of Surgery, over the period 1983-1989. Results are reported of a study of 180 operated patients (cholecystectomized), in in 7.8 of whom low-grade postcholecystectomy syndrome developed. Accent is laid on the importance of the intraoperative diagnosis and on some characteristics of technical nature, requiring precision in processing d. cysticus. Conclusion is drawn, aimed at reducing to a minimum the percentage of postcholecystectomy syndrome.

Adult↗

PubMed1987

Postcholecystectomy syndromes.

The postcholecystectomy syndrome in its chronic form is characterized by severe episodes of upper abdominal pain that may or may not be accompanied by hepatic or pancreatic dysfunction or ductal dilation. Endoscopic retrograde cholangiopancreatography is the most definitive way to identify anatomic defects. Transendoscopic papillary manometry is a promising new diagnostic technique. A surgical approach should be used only after persistence of symptoms without apparent cause and a prolonged trial of medical therapy. The operation should include exploration of the contents of the peritoneal cavity and transduodenal examination of the papilla of Vater. An extended papilloplasty should be performed to include a 1- to 2-cm anterior sphincteroplasty and an excision of the transampullary septum. Approximately 75 percent of patients with chronic pain after cholecystectomy will gain long-term relief of their symptoms.

Cholecystectomy↗

PubMed1996

[Endoscopic treatment methods in patients with the postcholecystectomy syndrome].

458 patients with postcholecystectomy syndrome have been examined. In 289 (63.1%) of them the reason of complication and location of the lesion in biliopancreatic-duodenal zone have been specified. In 212 (73.4%) patients the endoscopic treatment was used, including papillosphincterotomy with removal of concrements; suprapapillary choledochoduodenostomy; nasobiliary draining, endoprosthesis. In 181 (85.4%) of cases these methods appeared to be efficient and final; in 31 (14.6%) they promoted stabilization of clinical status of patients and performing surgery in more favorable conditions. Complications have been registered in 4 (1.9%) patients, 1 patient (0,47%) died. The authors advocate endoscopic methods as methods of choice in postcholecystectomy syndrome.

Drainage↗

PubMed1977

[The postcholecystectomy syndrome. Prophylaxis and therapy (author's transl)].

The postcholecystectomy syndrome is no inevitable sequel to operation on the biliary tract. The conditions for the postcholecystectomy syndrome are only created if the patients do not come for operation early, i.e. in good time, because the gall bladder disease has by then become a disease of the biliary tract and consequently the technique of the operation and prognosis have assumed considerably more serious characteristics. The postcholecystectomy syndrome is an internal medical, surgical and general medical problem which is preprogramed by procrastinators.

Cholecystectomy↗

PubMed1981

Endoscopic retrograde cholangiopancreatography. Its use in the evaluation of nonjaundiced patients with the postcholecystectomy syndrome.

Forty-two patients with the postcholecystectomy syndrome were studied by endoscopic retrograde cholangiopancreatography (ERCP). Both the biliary ductal system and pancreatic duct were well visualized in all patients. The ERCP was abnormal in 22 patients (52%). Abnormal findings included choledocholithiasis, papillary stenosis, pancreas divisum, pancreatic carcinoma, sclerosing cholangitis, incomplete cholecystectomy, and chronic pancreatitis. The results of one or more standard liver function tests and/or other noninvasive tests were abnormal in 36 patients; however, none reliably predicted the presence or specific anatomical type of pancreaticobiliary tract disease. Our data indicate that ERCP is essential in the diagnosis and management of the postcholecystectomy syndrome. The high yield of abnormal findings amenable to surgical correction in patients with recurrent biliary tract symptoms following cholecystectomy justifies the use of this procedure in all such patients.

Adult↗

PubMed1991

[The so-called postcholecystectomy syndrome in light of the results of endoscopic retrograde cholangiopancreatography].

The term "postcholecystectomy syndrome" indicates etiologically and pathogenetically various lesions of the organism related to variably expressed symptoms of pain and dyspepsia. The author has performed endoscopic retrograde cholangiopancreatography (ERCP) to 60 patients with "postcholecystectomy syndrome" to find out what underlies this syndrome. In 34 (56%) of the patients the biliary ducts were dilated. The most frequent cause of this was Vater's papilla stenosis, which was found in 26 patients (43%). The author is of the opinion that this stenosis preceded the cholecystectomy and was the result of inflammatory processes related to cholelithiasis. In 20 patients stones were found in the biliary ducts, single or multiple. In most cases the stones in the biliary duct had been missed during the cholecystectomy. In some patients the stones in the biliary duct were formed after the operation. In 26.6% of the patients ERCP helped in discovering other diseases such as chronic pancreatitis, duodenal ulcer and peripapillary diverticulum which are in the basis of the "postcholecystectomy syndrome". The author recommends to every patients with persistent complaints after cholecystectomy ERCP to be performed in order to find out the cause of the complaints and determine the correct treatment--medicamentous or surgical.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMedDate not supplied

[The postcholecystectomy syndrome].

Based on an analysis of treatment of 216 patients with postcholecystectomy syndrome the authors have found its occurrence to be 15.5%. It may be true and false. Patients with the true postcholecystectomy syndrome should be reoperated. The methods of the reoperations must be individual.

Adult↗

PubMed1977

[Ultrasonic methods in the differential diagnosis of the "postcholecystectomy syndrome" (author's transl)].

The "postcholecystectomy syndrome" as a collective term for all upper abdominal complaints following cholecystectomy is a common clinical picture. For the purpose of clarification the easily practicable sonography offers itself in addition to conventional cholangiography and to endoscopic retrograde cholangiopancreaticography (ERCP). By means of echography, pathological changes in the upper abdominal organs can be detected or excluded. Chronologically, echography should be carried out at the beginning of diagnosis as an informative, harmless and rapid method. The most invasive investigations can then be omitted or performed specifically as required.

Adult↗

PubMed1991

[Dysfunction of the sphincter of Oddi as a cause of so-called postcholecystectomy syndrome].

In up to 30% of cases of the so-called postcholecystectomy syndrome functional disturbances of the sphincter of Oddi are responsible for the clinical picture. These pathological changes in pressure and motility at the sphincter can be identified by means of endoscopic manometry. We found dysfunction of the sphincter of Oddi in 4 out of 10 patients with so-called postcholecystectomy syndrome. In 2 patients in whom the basal pressure was higher than 40 mmHg endoscopic papillotomy was performed, after which the patients remained symptom-free. In one case tachyoddi was diagnosed and in another case the proportion of retrograde sphincter contractions exceeded 50%. Endoscopic manometry at the sphincter of Oddi enables many of the as yet unclarified postcholecystectomy symptoms to be identified.

Biliary Dyskinesia↗

PubMed1980

Pathogenetic significance of bile acid metabolism in the postcholecystectomy syndrome.

There is a long-pending question if the clinical concept of the "postcholecystectomy-syndrome" should be eliminated from the medical literature and medical praxis. To answer this question, the pathophysiological aspect of bile acid metabolism was investigated. Total bile acid level and basic bile acid concentration in blood serum and bile were estimated in the clinical course of 45 patients with cholelithiasis before and after cholecystectomy. In these patients, the endogenous bile acid tolerance test following intramuscular administration of 20 micrograms of caerulein was also performed. These patients were divided into two groups, i.e. patients with the postcholecystectomy syndrome and those without the syndrome. The postoperative clinical course was observed for at least one year. In both groups, the results of clinical examinations were compared. Based on the results of these investigations, it should be stressed that the derangement of bile acid metabolism contributes to the pathogenesis of the postcholecystomy syndrome, and that this clinical concept must be admitted in practice, although the pathophysiology of this disorder has not been clarified in detail.

Adult↗

PubMed1990

[Postcholecystectomy syndrome--still a current argument today?].

The "postcholecystectomy syndrome" was originally defined by Pribram as a pure functional disturbance after cholecystectomy. Today it has become a melting pot of various postoperative syndromes of mostly obscure origin. It's incidence is said to be 26-40%, but surgically treatable lesions of the biliary system amount only 1.5%. Functional consequences for biliary excretion are rare because the loss of the gallbladder reservoir is substituted in part by the biliary tree.

Bile↗

PubMed1996

The postcholecystectomy syndrome. A role for duodenogastric reflux.

We have assessed the relationship between dyspepsia and gallstones and evaluated the effects of cholecystectomy on symptoms, endoscopic findings, and degree of duodenogastric reflux. Thirty patients with gallstones were enrolled in our study. Their symptoms, gastroscopic findings, and bile salt concentrations in fasting gastric juice were evaluated before and after surgery. Before cholecystectomy, biliary colic was present in 26 patients and dyspepsia in 20 patients; 16 patients also had biliary colic. After surgery, biliary colic disappeared in all patients. Dyspeptic symptoms improved in 12 patients (40%), 13 (43%) remained the same, and five patients (17%) developed dyspepsia or showed increase in their symptoms, the postcholecystectomy syndrome (PCS). Endoscopic gastritis developed in 50% after surgery compared with 30% before. Benign gastric ulcers developed in three patients, whereas none had been present before. Concentration of bile salts in fasting gastric juice increased from 0.56 +/- 0.4 mM to 1.47 +/- 0.75 mM after cholecystectomy (p < 0.0001). There was a positive correlation between the severity of symptoms in the postcholecystectomy syndrome and the change in the concentration of bile salts in fasting gastric juice (p = 0.0012). These observations suggest that duodenogastric reflux may play a significant role in the pathogenesis of symptoms in the postcholecystectomy syndrome.

Adult↗

PubMed1991

Effect of cisapride on symptoms and biliary drainage in patients with postcholecystectomy syndrome.

The study evaluates the effect of 20 mg cisapride twice daily on symptoms and biliary drainage in patients with the postcholecystectomy syndrome. Nineteen patients, all female, went through a randomized, double-blind, placebo-controlled, crossover trial with two 4-week treatment periods separated by a 2-week washout period. Symptoms were registered on diary cards. Biliary drainage was studied with dynamic cholescintigraphy. The down slope of the time-activity curve (T1/2 and elimination index) was used as a measure of the biliary drainage. More symptoms were registered during cisapride therapy than with placebo. This unfavourable effect of cisapride was statistically significant in a subgroup of patients with postcholecystectomy complaints identical to the biliary pain they experienced during injection of contrast at the endoscopic retrograde cholangiopancreatographic examination. Cisapride statistically significantly hastened biliary drainage. The median T1/2 values were 24 and 28 min after cisapride and placebo, respectively (p less than 0.01). In conclusion, cisapride promoted biliary drainage in patients with the postcholecystectomy syndrome but had an unfavourable symptomatic effect in those with bile duct-triggered postcholecystectomy complaints.

Adult↗

PubMed1996

[The postcholecystectomy syndrome and its prevention].

61 patients had a surgery because of postcholecystectomy syndrome (PCS). In 29 patients PCS was caused by bile tract diseases, in 15 patients--liver and pancreas diseases, in 12 cases disease of other organs. There was no mortality in restorative operations. The mortality rate in reconstructive operations was 5%. The full clinical and instrumental examination of extrahepatic bile ducts is the best way to prevent PCS. PCS was most frequently observed in patients, operated on urgently. The results of 79 cases of reconstructive and restorative operations in patients operated on urgently are analysed.

Diagnosis, Differential↗

PubMedDate not supplied

[The effectiveness of endoscopic retrograde cholangiopancreatography in the etiological diagnosis of postcholecystectomy syndrome].

A retrospective study of 249 with symptoms and signs of postcholecystectomy syndrome was made to evaluate the usefulness of endoscopic retrograde cholangiopancreatography (ER CP) in its etiological diagnosis. From 1693 ERCP evaluated, 1108 were checked and from these 249 patients showed symptoms and signs after the cholecystectomy. So they were selected to practice a diagnostic ERCP. 204 patients were females and its principal symptom was jaundice. Lesions found in most of the cases were: stones in the bile ducts (45.78%), benign biliary stenosis (8.3%), stenosis of vater's papilla (7.22%) and biliary fistula (7.22%). It can be conclude that biliary stones is the most frequent pathology in those patients with clinical suspicion of biliary-pancreatic organicity and that ERCP is the principal method of diagnosis in these patients.

Adolescent↗

PubMed1990

Postcholecystectomy syndrome in northern India--study on the diagnostic and therapeutic role of ERCP.

One hundred and twenty two patients with postcholecystectomy syndrome were studied by endoscopic retrograde cholangiopancreatography (ERCP). The procedure was successful in 105 patients (85.3%) and it accurately detected abnormality of the pancreatico-biliary system in 71 patients (67.6%). ERCP results were abnormal in 82.6% of patients with biliary symptoms, with or without jaundice, compared with 34.7% of patients with non-biliary symptoms (P less than 0.001). Though ERCP showed abnormality in all patients with biliary symptoms and jaundice, as many as 70.4% of patients without jaundice had abnormal ERCP. The commonest abnormality was retained/recurrent stones (37/105 patients). Patients with biliary strictures presented significantly more often with jaundice compared with patients with biliary stones (74.3% vs 22.3%). In 19 of the 37 patients with retained biliary stones endoscopic sphincterotomy was performed and it was successful in 16 patients (84.2%). Our data indicates that ERCP detects the anatomical level as well as the nature of lesion accurately, and is essential and safe in the diagnosis and management of patients with postcholecystectomy syndrome.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed1991

[A study on motility of sphincter of Oddi in postcholecystectomy syndrome].

Endoscopic manometry of sphincter of Oddi (SO) and serum levels of gastrin, glucagon, and somatostatin were measured in patients with postcholecystectomy syndrome (n = 12), asymptomatic cholecystectomy patients (n = 6), and controlled subjects (n = 14). Pentagastrin-stimulated gastric acid secretion test was also performed in part of patients who had symptoms or no symptoms after the removal of gallbladder. The results showed that the patients of symptomatic group had hypertonic dyskinesia of SO as shown by deep and wide waves superimposed on high basal pressure plateau of SO. The symptomatic group also had a higher serum level of gastrin and a greater BAO than those of other two groups. No difference of serum levels of glucagon and somatostatin was found among these three groups. The hypertonic dyskinesia of SO and hypergastrinemia are possibly important factors in the pathogenesis of postcholecystectomy syndrome.

Adult↗

PubMed1999

Postcholecystectomy syndrome: evaluation by biliary cholescintigraphy and MR cholangiopancreatography

PURPOSE: The aim of this study was to compare the anatomic data obtained by magnetic resonance cholangiopancreatography (MRCP) with the functional data obtained by Tc-99m iminodiacetic acid (IDA) hepatobiliary imaging in patients with postcholecystectomy syndrome. MRCP provides good quality imaging of the biliary tract, highlighting walls and dilatation or stenosis of the biliary tract, stones in the cystic duct remnant, the pancreas, and the pancreatic ducts. Hepatobiliary imaging permits evaluation of hepatocellular function and the dysfunctional components of biliary obstruction. METHODS: MRCP showed biliary tract dilatation in four of five patients; this was associated with pathologic dilatation of the cystic duct and stenosis of the distal end of the common bile duct in three patients. Tc-99m IDA imaging showed hepatocellular functional changes (prolonged maximum concentration time and lower hepatic extraction fraction) in five of five patients, and delayed visualization of the hepatic duct and common bile duct in four patients. Intestinal passage of the radiopharmaceutical occurred in all patients only after a high-fat meal. Two patients had slow biliary emptying of Tc-99m IDA with normal results of MRCP. RESULTS: These data, together with the absence of structural changes in the biliary tract walls, suggest that sphincter of Oddi spasm during fasting causes slower passage, whereas the physiologic stimulation of a high-fat meal aids intestinal bile flow. CONCLUSION: The combined study of the biliary tract by MRCP and Tc-99m IDA imaging yields an efficient and complete evaluation of the postcholecystectomy syndrome.

Journal Article↗