Results Following Transduodenal Choledochoampulotomy*

The selective use of combined supraduodenal and transduodenal exploration of the common bile duct

“…Complications relating to the duodenotomy-namely obstruction, fistulation and associated abscess formation-have been well documented (Shieber, 1962;Menguy, 1965;Kourias and Tierris, 1966;Rothwell-Jackson, 1968;Thomas et al, 1971). Moreover, the occurrence of severe and even fatal pancreatitis has seriously detracted from the popularity of sphincterotomy, despite the recognition that this complication can occur after any surgical procedure on the biliary tract, particularly if the operation is protracted and traumatic (Blatherwick and Pattison, 1954;Mahorner and Browne, 1955;Diffenbaugh and Strohl, 1956;Shieber, 1962;Rothwell-Jackson, 1968;Hardy, 1969;Keighley et al, 1969;Thomas et al, 1971 ;Hunter, 1972;Stuart and Hoerr, 1972;Carter, 1973). In the present series, serious complications were rare (Table ZZ).…”

“…In most large series the incidence of complications following transduodenal sphincterotomy has been high and perioperative mortality rates of approximately 5 per cent have been reported (Mahorner and Browne, 1955;Shieber, 1962;Rothwell-Jackson, 1968;Thomas et al, 1971;Hunter, 1972;Stuart and Hoerr, 1972;Carter, 1973). Complications relating to the duodenotomy-namely obstruction, fistulation and associated abscess formation-have been well documented (Shieber, 1962;Menguy, 1965;Kourias and Tierris, 1966;Rothwell-Jackson, 1968;Thomas et al, 1971).…”

“…Recognizing the difficulty in distinguishing between spasm and true stricture formation in this region-particularly since even a histological demonstration of fibrosis is not necessarily synonymous with stricture formation (Mahorner and Browne, 1955;Cattell et al, 1957;Partington, 1966;Niederle, 1967;Hunter, 1972)-we accepted a diagnosis of stricture of the ampullary region when the peroperative cholangiogram showed complete obstruction at the level of the papilla and when, on opening the duodenum, it was impossible to pass a 3-mm bougie through the ampulla into the duodenum (Doubilet and Colp, 1937;Goldsmith and Sterling, 1954;Mahorner and Browne, 1955;Cattell et al, 1957;Newman et al, 1958). It is also worth noting that in assessing the patency of the ampulla by passing bougies downwards through the common bile duct, it is important to be certain that the bougie has actually passed through the sphincter; in many cases, the bougie seems to have entered the duodenum but on duodenotomy it becomes apparent that the bougie is simply pushing the sphincter before it towards the duodenal lumen and that actual penetration of the sphincter has not occurred (Mahorner and Browne, 1955). Clearly, in doubtful cases, exact assessment of the periampullary region and of the patency of the sphincter can be achieved only after transduodenal exploration.…”