Effect of osteopathic correction on the manifestations of postcholecystectomy syndrome

Introduction. Along with the increasing incidence of cholelithiasis, despite the success of its surgical treatment, there is a significant increase in the number of patients with the so-called postcholecystectomy syndrome (PCES). It is caused by the fact that cholecystectomy disturbs the process of bile secretion and does not compensate complex pathophysiological disorders occurring at cholelithiasis. The arsenal of effective means of medication and non-medication correction is relatively small that makes clinicians look for new methods of PCES therapy. Earlier studies have shown rather high clinical effectiveness of osteopathic correction in the complex treatment of patients with gastroenterological profile, which allows us to assume that osteopathic correction can be effective in the treatment of patients with PCES. The aim of the study : to substantiate the possibility of using osteopathic correction to eliminate the manifestations of postcholecystectomy syndrome. Materials and methods. The prospective controlled randomised study was conducted from January to July 2023 on the basis of the surgical department of the Kirishi Clinical Interdistrict Hospital of the Leningrad Region. Twenty-two patients aged 35 to 65 years were examined. All patients underwent surgical treatment of cholelithiasis and subsequently developed postcholecystectomy syndrome. According to the exclusion criteria, 2 patients dropped out of the study. Depending on the conducted treatment the patients were divided into 2 groups of 10 people each — main and control — using the method of randomisation envelopes. Patients of both main and control groups received complex conventional conservative treatment, but patients of the main group additionally received osteopathic correction. A total of 6 sessions with an interval of one month were conducted. The duration of each session was 60 minutes, the approach to each patient was individual. All patients before the beginning and after the completion of the course of treatment were assessed for osteopathic status, the severity of pain syndrome, ultrasonic diagnostics with evaluation of the biliary tract, biochemical blood analysis with evaluation of the level of total bilirubin. Results. The most frequently detected somatic dysfunctions (SD) in the observed patients were: lumbar region (both structural and visceral components — 100 %), neck region, visceral component (40 %), pelvic region, visceral component (30 %), dura mater region (30 %). In the same way, all patients were diagnosed with SD of local level. Among local dysfunctions it is worth mentioning: SD of spinal-motor segments of the thoracic spine (50 %), cervical spine (30 %), joints of the lower limbs (40 %), separate joints of the skull (10 %). On the background of the conducted treatment only in the patients of the main group a statistically significant ( p <0,05) decrease in the frequency of detecting SD was obtained: lumbar region, visceral and structural component, pelvic region, visceral component. After treatment both in the main group and in the control group a significant ( p <0,05) decrease in the level of pain syndrome was registered, but in the patients of the main group these changes were more pronounced ( p <0,05). A significant ( p <0,05) decrease in the level of total bilirubin was registered in the patients of the main group who received osteopathic correction after the completion of the course of therapy. The values of this index in the patients of the control group remained practically unchanged. Before treatment, patients with PCES had insignificant increase in the size of the choledochus according to ultrasound diagnostics and did not differ from each other by this indicator. On the background of treatment only patients of the main group had statistically significant ( p <0,05) positive dynamics in the form of choledochus size reduction. Conclusion. Application of osteopathic correction in the framework of complex treatment of patients with postcholecystectomy syndrome allows to achieve pain relief, reduce the diameter of the choledochus and reduce the level of total bilirubin. The obtained data allow us to recommend consultation of an osteopathic physician to patients with postcholecystectomy syndrome in order to decide on the inclusion of osteopathic correction in the programme of complex treatment.