Сравнительный анализ результатов различных способов резекции головки поджелудочной железы при хроническом панкреатите

Background In more than half of cases of chronic pancreatitis (CP), enlargement of the pancreatic head is diagnosed with the presence of complications that serve as an indication for organ resection. The development of an optimal method for the surgical treatment of CP with damage to the pancreatic head (PH) is one of the tasks of surgical pancreatology.Aim of study To perform comparative evaluation of immediate and late results of different types of PH resection in CP.Material and methods A prospective controlled study was conducted with a comparative analysis of the results of surgical treatment of 131 patients with CP with pancreatic head enlargement. In 29% (n=38) cases inflammatory complications were revealed, in 86.3% (n=113), they have been associated with compression of adjacent organs, jaundice also developed (n=60), as well as duodenal obstruction at the level of duodenum (n=43), regional portal hypertension (n=10). A total of 47 pancreatoduodenal, 58 subtotal, and 26 partial resections of the pancreas were performed.Results Duodenum preserving pancreatic head resections had significantly better short-term results compared to pancreatoduodenal resections. Subtotal PH resection in the Bern’s version was superior to all other resections in terms of average duration of surgery, postoperative inpatient treatment, and intraoperative blood loss. The frequency of relaparotomy for intraperitoneal complications of hemorrhagic etiology was 8.2% (n=4). The frequency of the adverse effect according to pain preservation 5 years after duodenum preserving resection tract was 0.125; after pancreatoduodenal resection - 0.357 with a statistically significant relative risk (RR) of 0.350 (CI95% = 0.13–0.98). According to other indicators of clinical long-term surgical treatment depending on the various methods of PH resection, there were no statistically significant differences (p>0.05). The quality of life of patients 5 years after the operation according to the EORTC QLQ-C30 questionnaire was statistically significant (p=0.0228) by only two indicators: dyspnea (DY:8.3) and insomnia (SL:16.67; 27.4) with higher values after operations of Beger and the Bern’s version of the subtotal PH resection, respectively.Актуальность Более чем в половине наблюдений хронического панкреатита (ХП) диагностируется увеличение головки поджелудочной железы (ПЖ) с наличием осложнений, которые служат показанием к резекции органа. Разработка оптимального способа хирургического лечения ХП с поражением головки поджелудочной железы (ГПЖ) является одной из задач хирургической панкреатологии.Цель Провести сравнительную оценку непосредственных и отдаленных результатов различных способов резекции ГПЖ при ХП.Материал и методы Выполнено проспективное контролируемое исследование со сравнительным анализом результатов хирургического лечения 131 пациента с ХП с увеличением размеров ГПЖ. В 29% (n=38) наблюдений у больных присутствовали осложнения воспалительного характера, в 86,3% (n=113) они были связаны с компрессией соседних органов, в том числе диагностированы механическая желтуха (n=60), непроходимость на уровне двенадцатиперстной кишки (ДПК) (n=43), и региональная портальная гипертензия (n=10). Проведено 47 панкреатодуоденальных, 58 субтотальных и 26 частичных резекций ГПЖ.Результаты При дуоденосохраняющих резекциях ГПЖ получены статистически значимо лучшие непосредственные результаты по сравнению с панкреатодуоденальными резекциями. Субтотальная резекция ГПЖ в бернском варианте превосходила все остальные дуоденосохраняющие резекции по показателям средней продолжительности операции, послеоперационного стационарного лечения, интраоперационной кровопотери. Частота релапаротомий по поводу внутрибрюшных осложнений геморрагического характера при этом составила 8,2% (n=4). Частота неблагоприятного эффекта по параметру сохранения боли через 5 лет после дуоденосохраняющих резекций ГПЖ составила 0,125, а после панкреатодуоденальной резекции — 0,357 при статистически значимой величине относительного риска (RR), равной 0,350 (ДИ 95%=0,13–0,98). По остальным показателям клинических отдаленных результатов хирургического лечения в зависимости от различных способов резекции ГПЖ статистически значимых различий получено не было (p>0,05). Качество жизни больных через 5 лет после операции, согласно анкете EORTC QLQ-C30, статистически значимым  (р=0,0228) получено только по двум показателям: одышка (DY:8,3) и бессонница (SL:16,67;27,4) с более высокими значениями после операций Beger и бернского варианта субтотальной резекции ГПЖ соответственно

Непосредственные и отдаленные результаты оригинальных способов продольной панкреатоеюностомии с расширением площади анастомозирования панкреатоеюнального соустья

RELEVANCE. The dependency results of draining operations on the efficcacy of drainig of ductal system of the pancreas and adequate outflow of the pancreatic juce through anastomosis are undoubtful, therefore the development of new techniques of longitudinal pancreatojejunostomy (LPJ) extending area of anastomosis is an actual challenge.AIM OF STUDY. To compare the immediate and long-term results of longitudinal pancreatojejunostomy with the expansion of the area of anastomosis in patients with chronic pancreatitis.MATERIAL AND METHODS. We analysed immediate and long-term results of LPJ in 58 patients with chronic pancreatitis with impaired patency of the major pancreatic duct (MPD) without the head enlargement.RESULTS. All patients were divided into two groups: comparison group ( n=26, operated up to 2008 ) and main group (n=32, operated stumps during the MPD diastasis and posterior pancreatic surface (n=3) into anastomosis, with resection of the anterior pancreatic surface in the form of triangular fragments (n=11), with circulation of the small intestine loop during the recovery phase (n=19). The original LPJ in the study group of patients did not lengthened the surgery (160 [135, 185]) and intraoperative blood loss (265 [175, 340]). In the main group of patients there was no postoperative complications and fatal outcomes, but the average duration postoperative hospital treatment (18 [16; 20.5]) exceeded some data of foreign and domestic authors. Pain within 5 years after surgery in patients of the main group exceeded 26.6% and the appearance of diarrheal syndrome with dependance from reception of enzyme preparations was twice lower than in patients og the comparison group. According to questionnaire EORTC QLQ-C30, 5 years after surgery statistically significant differences between groups in terms of scales CF, NV, DY (p=0.03, 0.02, 0.006 respectively), indicating the advantage of intervention performed in the mail group.CONCLUSIONS. 1. An indication for longitudinal pancreatojejunostomy in chronic pancreatitis is impaired patency of the main pancreatic duct in the absence of an increase and inflammatory mass in the pancreatic head.2. The width of the main pancreatic duct is less than 5 mm and the presence of diastasis between its proximal and distal stumps with the posterior surface of the pancreas preserved, is not a reason for refusing longitudinal pancreatic jujunostomy in favor of the resection method.3. The expansion of pancreatojejunal anastomosis when performing longitudinal pancreatojejunostomy can improve the immediate and longterm results of surgical treatment for chronic pancreatitis.АКТУАЛЬНОСТЬ. Зависимость результатов дренирующих операций от эффективности дренирования протоковой системы поджелудочной железы (ПЖ) и адекватности оттока панкреатического сока через анастомоз не вызывает сомнений, в связи с чем разработка новых способов продольной панкреатоеюностомии (ППЕС), расширяющих площадь панкреатоеюнального соустья, является актуальной задачей.ЦЕЛЬ ИССЛЕДОВАНИЯ. Сравнить непосредственные и отдаленные результаты ППЕС с расширением площади панкреатоеюнального соустья у больных хроническим панкреатитом (ХП).МАТЕРИАЛ И МЕТОДЫ. Проведен анализ непосредственных и отдаленных результатов лечения 58 больных ХП с нарушением проходимости главного панкреатического протока (ГПП) на всем протяжении без увеличения головки поджелудочной железы (ГПЖ), оперированных в объеме ППЕС. Все больные были распределены на две группы: сравнения (n=26, оперированные до 2008 г.) и основную (n=32, оперированные после 2008 г. с использованием новых способов ППЕС: с включением в единое панкреатоеюнальное соустье дистальной и проксимальной культей при диастазе ГПП и задней поверхности ПЖ (n=3), с иссечением передней поверхности ПЖ в виде фрагментов треугольной формы (n=11), с циркуляцией петли тонкой кишки на восстановитель- ном этапе операции (n=19).РЕЗУЛЬТАТЫ. Применение оригинальных способов ППЕС в основной группе больных не удлинило среднюю продолжительность операции (160 [135; 185]) и интраоперационную кровопотерю (265 [175; 340]). В основной группе больных не было послеоперационных осложнений и летальности, но средняя продолжительность послеоперационного стационарного лечения (18 суток [16; 20,5]) превысила данные некоторых зарубежных и отечественных авторов. Купирование боли через 5 лет после операции у больных основной группы превысило на 26,6%, а развитие диарейного синдрома с зависимостью от приема ферментных препаратов оказалось вдвое ниже, чем у больных группы сравнения. По данным анкетирования EORTC QLQ-C30, через 5 лет после операции установлены статистически значимые межгрупповые различия по показателям шкал CF, NV, DY (р=0,03; р=0,02; р=0,006 соответственно), что указывает на преимущество вмешательства, примененного в основной группе.ВЫВОДЫ. 1. Показанием к продольной панкреатоеюностомии при хроническом панкреатите является нарушение проходимости главного панкреатического протока при отсутствии увеличения и воспалительной массы в головке поджелудочной железы.2. Ширина главного панкреатического протока менее 5 мм и наличие диастаза между его прок- симальной и дистальной культями при сохраненной задней поверхности поджелудочной железы не являются поводом для отказа от продольной панкреатоеюностомии в пользу резекционного метода.3. Расширение площади панкреатоеюнального соустья при выполнении продольной панкреатоеюностомии позволяет улучшить непосредственные и отдаленные результаты хирургического лечения хронического панкреатита

Stabilization of the floating sternocostal segment of the chest with multiple bilateral fractures of the ribs and the manubrium of the sternum

Among patients with floating rib fractures without pneumo- and hemopneumothorax or after their elimination, the most severe disorders of ventilation and circulation occur in patients with multiple bilateral rib fractures and a fracture of the sternum manubrium with the formation of a floating sternocostal segment of the chest. At the same time, the suction aero- and hemodynamic function of the chest is disturbed, there is pressure on the heart and large vessels. As a result, the efficiency of external respiration progressively decreases, the respiratory muscles are exhausted, which requires an urgent transfer to artificial ventilation of the lungs. The article presents a clinical case of successful treatment of such a chest injury using the author’s technique (Patent No. 2621871 of the Russian Federation). The extrathoracic silicone reinforced splint has two horizontal branches that go around the mammary glands. The splint is attached to the floating sternocostal segment with ligatures passed behind the sternum and laterally – to stable sections of the ribs along the posterior axillary line on both sides. The tire reliably holds the sternocostal segment from paradoxical movements. The tire is removed after 3  weeks. By this time, fibrous calluses are formed in places of fractures of bones and cartilage, and the swelling of the chest wall subsides. Superficial bedsores in the places of fixation of the splint are epithelialized under the scab within 7–8 days. The patient was examined a year later, her condition was satisfactory, she had no complaints, there was no chest deformity. The technique is less traumatic, it is indicated for patients with polytrauma and in other cases

Postoperative ileus in obstetric and gynecological practice: a prospective solution to the problem: A review

In obstetric and gynecological practice, after operations on the abdominal cavity, the development of dynamic intestinal obstruction, which is referred to as postoperative ileus, is possible. The frequency of POI after gynecological surgery averages 1015% (range 525%). Chewing gum has been used in abdominal surgery and obstetric and gynecological practice to reduce postoperative intestinal obstruction since the beginning of the 21st century. The present review considers the main randomized clinical trials, reviews and meta-analyses devoted to the study of the effect of chewing gum after surgical interventions in obstetric and gynecological practice for the prevention of postoperative ileus. The data presented in the review indicate the effectiveness and safety of the use of chewing gum in the postoperative period for the prevention of postoperative ileus in obstetric and gynecological practice

Results of sleeve gastrectomy in obese patients with type 2 diabetes mellitus and impaired glucose tolerance: Retrospective cohort registry-based study

Background. In the available literature, the data on the positive effects of sleeve gastrectomy in treatment of type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT) become more common, however, they are heterogeneous and not always unambiguous.The aim. To analyze our own results of treatment of patients with type 2 diabetes mellitus and impaired glucose tolerance, who underwent sleeve gastrectomy.Materials and methods. Retrospective cohort registry-based study was carried out. From 2016 to April 2021, 29 (19 %) and 7 (4.6 %) patients with diagnosed T2DM and IGT respectively underwent surgery. Of these, sleeve gastrectomy was performed in 13  (44.8  %)  patients with type  2 diabetes mellitus and in 5  (71.4  %)  patients with IGT. The mean duration of follow-up for T2DM and IGT patients was 14.2 ± 12.3 and 11.2 ± 9.0 months respectively.Results. The mean %EWL (% excess weight loss) in patients with T2DM and IGT was 44.1 ± 17.3 and 51.5 ± 16.9 respectively, and the mean %TWL (% total weight loss) was 25.0 ± 8.0 and 27.8 ± 6.0 respectively. At the moment of observation, all patients had normal level of fasting blood glucose. The level of HbA1c in patients with type 2 diabetes before the surgery was 8.2 ± 1.6, after surgery, at the time of observation – 5.8 ± 0.5 (U = 4; p ≤ 0.01). Targeted HbA1c values was recorded in all 13 patients with type 2 diabetes.Conclusion. Our study shows the efficiency of sleeve gastrectomy both in terms of weight loss and of the remission for patients with T2DM and IGT

Первые результаты рандомизированного контролируемого исследования применения гемоблока у пациентов с большими вентральными послеоперационными грыжами

ABSTRACT. When penetrating into the cell, local anesthetics affect some structures and processes, in addition to blocking sodium channels, leading to the development of cell damage. The aim of the article was to study the damaging effect of bupivacaine on the sciatic nerve and biceps femoris in rats.AIM OF STUDY. Analysis of the first results of a randomized clinical trial (RCT) for the use of Hemoblock in patients with large incisional hernias and postoperative ultrasound (US) monitoring.OBJECTIVES. Improving the results of surgical treatment of patients with large incisional hernias.MATERIAL AND METHODS. Design of a simple blind randomized controlled trial with a 90 percent study power, α-error equal to 0.05 and β-error equal to 0.10. For this purpose, the total number of subjects is planned to be 66. Currently, there are 18 patients in the study, 10 in the comparison group (B), and 8 in the main group (A). Surgery is plastic prosthetic mesh implant in the sublay retromuscular position. We applied Hemoblock 15 ml retromuscularly and 15 ml subcutaneousely in group B. Wounds were drained by vacuum suction drains. Postoperatively — monitoring of a wounds by ultrasound examination on day 3, 7, 10, 12, 15, 18, and 21 after the removal of drains. The average age was 58.5±6.3 in group B and 55.6±11.7 years in group A (U=36.5, p>0.05), BMI 33.6±3.44 and 32.2±5.19 kg/m2 respectively (U=35, p>0.05), the width of the hernia defect was 11±1.7 cm and 11.1±1.0 (U=33, р>0.05), length 13.6±2.7 cm and 12.5±3.3 cm (U=29.5, p>0.05), the area was 118±22.7 cm2  and 108.1±24.1 cm2  respectively (U=28.5, p>0.05). The average ASA was 2.2 in group B and 2.0 in group A.RESULTS AND DISCUSSION. Median of follow-up for all patients was 30 days. Significant differences obtained in the duration of postoperative wound drainage — 4.2±0.9 days in group B versus 2.5±0.5 days in group A (U=4, p<0.01). In patients of group A, the amount of discharge by drainage and the level of CRP and albumin were lower. On ultrasound examination of the postoperative wound, starting from the 10th day, a significantly smaller volume of fluid accumulations was revealed in patients of this group, and from the 15th day fluid accumulations were not detected. In group B, one patient had seroma IIIc (according to MoralesCondo, 2012), 8 patients had IVa seroma, and one patient had IVb seroma spontaneously opened through the postoperative wound, which required debridement of the cavity on an outpatient for 21 days. In group A, only 3 patients had IVa seroma. The number of punctures was 23 in group B, and 3 in group A (χ2 =8.654, p=0.04, Fisher’s exact two-sided test (F) =0.00654, p<0.05). Hospital stay was 8.9±0.6 days in group B and 8.0±0.5 days in group A (U=11.5, p<0.05).CONCLUSION. According to preliminary data using local haemostatic agent Hemoblock allows: 1) to reduce the duration of postoperative wound drainage, 2) to reveal the period of inflammatory exudative processes in the postoperative wound, 3) to reduce the number of puncture interventions after incisional hernia repair, 4) to reduce the severity of pain and the need for analgesics, 5) to reduce the hospital stay time.Authors declare lack of the conflicts of interests.ЦЕЛЬ. Анализ первых результатов рандомизированного клинического исследования применения местного гемостатика «Гемоблок» у пациентов с большими послеоперационными вентральными грыжами и ультразвукового мониторинга послеоперационной раны.ЗАДАЧА. Улучшение результатов хирургического лечения пациентов с большими послеоперационными вентральными грыжами.МАТЕРИАЛ И МЕТОДЫ. Дизайн простого слепого рандомизированного контролируемого исследования. Планируется общее число испытуемых — 66. В настоящий момент в исследовании 18 пациентов, в основной группе (А) — 8, в группе сравнения (В) — 10. Операция — пластика сетчатым проленовым протезом в позиции sublay retromuscular. В группе B применяли введение препарата «Гемоблок» 15 мл в ретромускулярное и 15 мл в надапоневротическое пространства. Раны дренировали вакуум-аспирационными дренажами. Послеоперационно — мониторинг ран путем ультразвукового исследования (УЗИ) на 3-и, 7-е, 10-е, 12-е, 15-е, 18-е, 21-е сутки после удаления дренажей. Средний возраст — 58,5±6,3 в группе А и 55,6±11,7 года — в группе В (U=36,5, p>0,05), индекс массы тела — 33,6±3,44 и 32,2±5,19 кг/м2  соответственно (U=35, p>0,05), ширина грыжевого дефекта — 11±1,7 см и 11,1±1,0 (U=33, p>0,05), длина — 13,6±2,7 см и 12,5±3,3 см (U=29,5, p>0,05), площадь — 118±22,7 см2  и 108,1±24,1 см2  соответственно (U=28,5, p>0,05). Среднее ASA — 2,2 в группе В и 2,0 — в группе А.РЕЗУЛЬТАТЫ И ОБСУЖДЕНИЕ. Медиана наблюдения составила 30 суток. Достоверные различия получили в длительности дренирования послеоперационной раны — 4,2±0,9 суток в группе А против 2,5±0,5 суток в группе В (U=4, p<0,01). В группе А количество отделяемого по дренажам и уровень С-реактивного белка и альбумина были меньше. При УЗИ послеоперационной раны, начиная с 10-х суток, достоверно меньший объем жидкостных скоплений определялся у пациентов группы А, с 15-х суток жидкостные скопления не определялись вообще. В группе В — у одного пациента наблюдалась серома IIIc (по S. Morales-Condo, 2012), 8 пациентов — IVa, один пациент — IVb, спонтанно вскрывшаяся серома, которая потребовала санации ее полости амбулаторно на протяжении 21 суток. В группе А всего 3 пациента имели серому IVa. В группе В число пункций составило 23, в группе А — 3 (χ2 =8,654, p=0,04, (F)=0,00654, p<0,05). Койко-день составил 8,9±0,6 суток в группе В и 8,0±0,5 суток в группе А (U=11,5, p<0,05).ЗАКЛЮЧЕНИЕ. По предварительным данным, использование местного гемостатика «Гемоблок» позволяет: 1) уменьшить длительность дренирования послеоперационной раны, 2) сократить период воспалительно-экссудативных процессов в послеоперационной ране, 3) уменьшить количество пункционных вмешательств в области послеоперационной раны, 4) уменьшить выраженность болевого синдрома и потребность в анальгетиках за счет сокращения длительности стояния дренажей и числа пункционных вмешательств, 5) уменьшить длительность стационарного лечения ввиду более быстрой реабилитации пациентов.Авторы заявляют об отсутствии конфликта интересов

Comparative Analysis of the Results of Various Methods for Pancreatic Head Resection in Chronic Pancreatitis

Background In more than half of cases of chronic pancreatitis (CP), enlargement of the pancreatic head is diagnosed with the presence of complications that serve as an indication for organ resection. The development of an optimal method for the surgical treatment of CP with damage to the pancreatic head (PH) is one of the tasks of surgical pancreatology.Aim of study To perform comparative evaluation of immediate and late results of different types of PH resection in CP.Material and methods A prospective controlled study was conducted with a comparative analysis of the results of surgical treatment of 131 patients with CP with pancreatic head enlargement. In 29% (n=38) cases inflammatory complications were revealed, in 86.3% (n=113), they have been associated with compression of adjacent organs, jaundice also developed (n=60), as well as duodenal obstruction at the level of duodenum (n=43), regional portal hypertension (n=10). A total of 47 pancreatoduodenal, 58 subtotal, and 26 partial resections of the pancreas were performed.Results Duodenum preserving pancreatic head resections had significantly better short-term results compared to pancreatoduodenal resections. Subtotal PH resection in the Bern’s version was superior to all other resections in terms of average duration of surgery, postoperative inpatient treatment, and intraoperative blood loss. The frequency of relaparotomy for intraperitoneal complications of hemorrhagic etiology was 8.2% (n=4). The frequency of the adverse effect according to pain preservation 5 years after duodenum preserving resection tract was 0.125; after pancreatoduodenal resection - 0.357 with a statistically significant relative risk (RR) of 0.350 (CI95% = 0.13–0.98). According to other indicators of clinical long-term surgical treatment depending on the various methods of PH resection, there were no statistically significant differences (p>0.05). The quality of life of patients 5 years after the operation according to the EORTC QLQ-C30 questionnaire was statistically significant (p=0.0228) by only two indicators: dyspnea (DY:8.3) and insomnia (SL:16.67; 27.4) with higher values after operations of Beger and the Bern’s version of the subtotal PH resection, respectively

Patient with constipation syndrome at the ambulatory-polyclinic reception: actual aspects of differential diagnosis and treatment

Constipation is a serious medical and social problem due to the widespread prevalence of this condition, a decrease in the quality of life and social activity of patients. For the successful treatment of constipation, it is necessary to establish the causes leading to the violation of the stool in the patient. And this task is a priority for the doctor at the outpatient stage.The clinical features of constipation largely depend on their cause, duration, severity and characteristics of intestinal damage. Constipation is often accompanied by general somatic and other gastroenterological symptoms.Within the framework of the review article, the main conditions and diseases are considered, in the clinical picture of which there is constipation syndrome, which must be considered by the doctor at the outpatient stage when conducting differential diagnosis and prescribing appropriate treatment, which also presupposes impact on causal factors. Currently, drugs based on high molecular weight polyethylene glycol 4000 are widely used to treat chronic constipation in adults and children in most countries of the world. Preparations based on polyethylene glycol 4000 are affordable and easy to use, they can be used both on an outpatient basis and in a hospital. Polyethylene glycol 4000 preparations act quickly, are highly effective and well tolerated, have a  high safety profile  (practically does not affect homeostasis) both for  adult patients and in  pediatric practice. International clinical trials have shown the possibility of long-term use of polyethylene glycol 4000 preparations.Current international clinical guidelines and domestic clinical guidelines for the treatment of constipation recommend the use of  polyethylene glycol 4000  preparations instead of  lactulose and volume-forming laxatives in  the  symptomatic treatment of constipation in children and adults. In the second part of the review, the possibilities of polyethylene glycol 4000 and the first domestic drug polyethylene glycol 4000 in the treatment of chronic constipation are considered

Cholecystocardial syndrome in real clinical practice

Cholecystocardial syndrome is a complex symptom complex, manifested by various disorders in the heart, the development of which is facilitated by the presence of gallstone disease and other diseases of the biliary tract in the patient. For many years, clinicians around the world have been studying the relationship between acute and chronic diseases of the biliary tract and the cardiovascular system. Often these disorders are detected during an attack of biliary colic, in which painful sensations in the region of the heart often occur, and in some cases they are equivalent to an attack of biliary colic. In real clinical practice, cholecystocardial syndrome is an actual syndrome of interest to therapists, cardiologists, gastroenterologists and surgeons. The review presents data on its prevalence, causes and mechanism of development, clinical manifestations. Data on the incidence of cholecystocardial syndrome in real clinical practice vary significantly, which depends on the interpretation of the concept of cholecystocardial syndrome. With the introduction of ultrasound into the widespread practice, the diagnosis of cholelithiasis was significantly simplified, therefore, cholecystocardial syndrome in the classical version described by S.P. Botkin, has been found less and less recently. With a broader consideration of the concept of cholecystocardial syndrome as a complex of clinical symptoms indicating the possibility of changes on the part of the cardiovascular system, in patients with a diagnosed pathology of the biliary tract, its occurrence is quite high. The analysis of domestic data on the problem of cholecystocardial syndrome in real clinical practice, combined with data obtained as a result of a search of foreign literature on electronic biomedical databases (PubMed, MEDLINE, Scopus, Google Scholar) suggests the allocation of another mechanism of its development, associated with cholestasis, high levels of circulating bile acids and activation of bile acid receptors, and allows us to consider its cholecystocardial syndrome not only as a diagnostic syndrome during differential diagnosis, but also as a syndrome reflecting the comorbidity of the pathology of CVS and the biliary tract