Two inhibitory mechanisms in the human colon which may contribute to postoperative ileus have been studied. Dopamine, a possible peripheral neurotransmitter, inhibited isolated colonic smooth muscle strips by a direct effect in longitudinal muscle any by a nerve-mediated mechanism as circular muscle. Plasma motilin levels were suppressed pre- and per- operatively and elevation of levels postoperatively correlated with the return of normal motility and the severity of the operation.

SUMMARYThe indications for choledochoduodenostomy in 64 patients are discussed and compared with those in other series from the literature. The essential indications are the presence of a dilated common bileduct with calculous disease or associated pathology at the lower end of the common bile-duct, particularly in the elderly and poor-risk patients. It is a safe procedure with few complications provided that a stoma of 2.5 cm. or more is made.

No abstract

No abstract

No abstract