Postcholecystectomy syndrome: the modern approach: resolution of Advisory council

Aim of publication. To present proceedings of Advisory council on postcholecystectomy syndrome (August 25, 2017; Prague, Czech Republic) with support of the Adamed Group company. Summary. The Advisory council proposed algorithm for investigation and management of patients with postcholecystectomy syndrome (PCS). Gallstone disease (GSD) is diagnosed in 10-25% of the population of various age, with obvious trend to involvement of the younger patient categories in the last decades. The total number of GSD patients increases every decade no less than twice. Cholecystectomy remains the basic method of surgical treatment of symptomatic GSD. Nowadays laparoscopic cholecystectomy became universally popular and earned the status of the «gold standard» of surgical treatment. At the same time at asymptomatic GSD the watchful waiting approach avoiding active treatment is considered to be the most expedient. Biliary sludge and microlithiasis including cases undiagnosed at routine investigation can be one of important factors for development of the PCS. Pharmacological treatment of sphincter of Oddi dysfunction that develop at GSD/PCS include following of dietary recommendations, intake of selective spasmolytics, digestive enzymes and ursodeoxycholic acid. Conclusions. Follow-up program for the patient of the cholecystectomy should include regular assessment of clinical symptoms for duly diagnostics of acute and/or severe complications and associated diseases, that may require surgical treatment. Treatment has to include regular courses of selective antispasmodics, the presence of indications - prescription of bile acid supplements, when required - methods of endoscopic surgery

Резолюция Экспертного совета «Диагностика и лечение больных со сладжем в желчном пузыре»

Aim of publication. To present the data of Advisory council which took place on August 19, 2016 in Poland (Krakow) with the participation of Adamed Russia company. Summary. Advisory council activity provided the algorithm of diagnosis and treatment of biliary sludge. At detection of gallbladder sludge in a patient with right hypochondrial pain it is necessary to carry out general examination to rule out the other diseases that may be dangerous (neoplastic, acute cholecystitis, pancreatitis). In the absence of other changes, besides biliary sludge, prescription of initial course of hymecromone combined to ursodeoxycholic acid (UDCA) is indicated. In the case of clinical improvement at primary therapy course it is necessary to continue UDCA treatment for 3 months. Primary treatment course that should include combination of hymecromone and UDCA is indicated for those patients with asymptomatic sludge, who have putty-like bile in the gallbladder or bile ducts. In the case over the other forms of asymptomatic sludge usually only diet limitations and follow up (abdominal US every six months) are indicated. At detection of the ultrasound signs, typical for chronic pancreatitis, according to the Cambridge diagnostic criteria, verification of the diagnosis by multidetector computer tomography according to the pancreatic protocol is mandatory. Selective antispasmodic medications (e.g. hymecromone) will be one of the basic pharmaceutical agents in this case, indications to endoscopic treatment should be evaluated, typically - by means of endoscopic ultrasound investigation). Conclusions. At of patient with the biliary sludge selective antispasmodic medications and UDCA should be widely applied, in some cases methods of endoscopic surgery as well