Cholecystectomy for cholelithiasis – current understanding of its consequences (literature review)

The purpose of this review. To summarize the accumulated literature data at the present stage on the consequences of cholecystectomy (CE) for cholelithiasis (CD).

Key points. CD is one of the most common diseases of the biliary tract, the incidence of which in the world averages up to 20 %. The most important etiologic factors associated with the high incidence of cholesterol gallstones are: an increase in the average age of the world's population, an increase in metabolic disorders; the spreading trend of Western-style nutrition; starvation; physical inactivity; rapid weight loss; heredity; taking certain medications, etc. CE, as one of the most frequently used methods of treating cholelithiasis, leads to various consequences. The frequency of various symptoms after CE (various types of pain and gastrointestinal symptoms) among those operated on for cholelithiasis, at different times, varies from 5 to 40 %. Symptoms that bother patients after CE are usually referred to as postcholecystectomy syndrome (PCS). The manifestations of PСS may hide surgical complications, usually detected in the early postoperative periods; organic and functional pathology, previously not diagnosed, or occurring for the first time – provoked by CE; concern the pathology of the biliary tract, as well as other organs of the digestive system. A significant role in the development of symptoms after CE is played by changes in the regulation of enterohepatic circulation of bile acids, affecting changes in the intestinal microbiota, epithelial permeability of the intestine. Today it is known that through various mechanisms the gallbladder also plays a metabolic role, regulating energy, fat, carbohydrate metabolism, and CE, as an independent factor, aggravates the risks of metabolic disorders, leading to weight gain, insulin resistance, lipid metabolism disorders and the development of non-alcoholic fatty liver disease, mortality from all causes, including cardiovascular pathology.

Conclusions. CE cannot be considered a harmless method of treatment, and the tactics of managing patients with cholelithiasis should be selective, the choice in favor of surgical treatment should strictly correspond to the indications.

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