Authors
Kalibatov R.M., Aslanov A.D., Logvinа O.E., Gadaborsheva Z.R., Kardanova L.Y.
Kabardino-Balkarian State University named after H.M. Berbekov, Nalchik
Abstract
Backgraund: Currently, among the adult population of most countries of the world, the growth of cholelithiasis (GI) and its complications continues, which reach 20% of the total number of cases. Regardless of age and concomitant diseases, minimally invasive laparoscopic cholecystectomy has become the gold standard of treatment for such patients, but after it is performed, various costs of surgical intervention arise; for example, in the long-term postoperative period, changes occur from the gastrointestinal tract, having a characteristic clinical and endoscopic picture.
Aims: The aim of the study was the pathomorphologic substantiation of clinical and functional changes of the upper gastrointestinal tract in the remote postoperative period after minimally invasive cholecystectomy.
Materials and methods: The data of 119 patients with chronic calculous cholecystitis were analyzed. The patients were divided into 3 groups: the first — treated in hospital without surgery, medically, the second — observed after cholecystectomy for a period from 8 months to 1 year and the third — for more than 3 years. A group of 50 volunteers who did not present any complaints was formed for comparison. The diagnosis of chronic calculous cholecystitis was made on the basis of clinical signs, laboratory and ultrasound examination. Endoscopic and then morphologic assessment of the mucosa of the upper digestive system by targeted mucosal biopsy with histologic examination was performed by means of fibrogastroscopy. In the obtained biopsy specimens the cells belonging to the diffuse endocrine system were recognized by immunohistochemistry.
Results: It was established that in patients after minimally invasive cholecystectomy in the postoperative period clinical, endoscopically confirmed inflammatory and atrophic processes of the digestive tract develop and they do not disappear.
Conclusions: Inflammation of the mucosa of the esophagus, stomach and duodenum leads to a decrease in the density of diffuse endocrine glands and impaired production of digestive peptides by them. Due to the lack of digestive peptides, a vicious circle is created that supports digestive disorders.
Keywords: cholelithiasis, laparoscopic cholecystectomy, postoperative period, diffuse endocrine system.
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