Iatrogenia as a cause of postcholecystectomy syndrome

Abstract

Objective. To analyze the most frequent diagnostic, tactical and technical errors of young doctors, leading to postcholecystectomy syndrome.

Materials and methods. The analysis was based on the clinical material of 87 patients from the Surgical Department of Regional Clinical Hospital №1 and City Clinical Hospital №2 of Izhevsk regarding reconstructive and restorative surgeries on the biliary tract for the last 40 years (1978–2018).

Results. The reasons, causing iatrogenic injuries of the bile ducts during cholecystectomy, are diagnostic, tactical, technical. Diagnostic errors are more often associated with inadequate diagnosis of cholelithiasis and cholecystitis (underestimation of history, complaints, clinical picture of the disease and its complications; failure or impossibility of FGDS; insufficient topical diagnosis while ultrasound investigation of the biliary tract and abdominal organs). Tactical errors in surgeries on the gallbladder include: overly expectant tactics, incorrect choice of surgical approach and method of anesthesia, lack of experience of the surgeon, inadequate revision of the biliary tract during surgery, refusal from surgical cholangiography and external drainage of the choledoch in case of doubtful patency of the bile duct. Technical reasons are specific features of the anatomy of the extrahepatic biliary tract, factors complicating the surgery, violation of surgical technique when performing an operation on the bile duct.

Conclusions. Correct and timely diagnosis of bile diseases as well as qualified technique of surgical intervention will minimize the development of post-cholecystectomy syndrome and other iatrogenic complications.

 

Keywords

Cholecystitis / postcholecystectomy syndrome / iatrogenic trauma / minimally invasive access / diagnosis

References

[1] Шкляев А.Е. Морфофункциональная характеристика синдрома раздраженного кишечника в процессе СМТ-фореза хлоридного рассола. Медицинский вестник Башкортостана 2013; 6.

[2] Шкляев А.Е. Факторы риска летального исхода при заболеваниях печени (ретроспективный и проспективный анализ). Практическая медицина 2014; 1.

[3] Стяжкина С.Н. Холецистит. Современный взгляд на патологию как на важную социально-экономическую составляющую нашего социума. Здоровье и образование в XXI веке 2016; 4.

[4] Огнетов С.Ю. Частота рецидивирующей и резидуальной холестеатомы после различных видов санирующих операций на среднем ухе. Казанский медицинский журнал 2016; 3.

[5] Шкляев А.Е. Экспрессия маркеров апоптоза и пролиферации у больных с эрозивными поражениями желудка в процессе лечения. Медицинский вестник Башкортостана 2013; 6.

RIGHTS & PERMISSIONS

Sitnikov V.A., Ibragimova D.R., Kasimova N.R., Styazhkina S.N.