Sphincterplasty in the treatment of biliary and pancreatic disease

Abstract

FEW operations are more distressing to the patient bile-duct in almost 75 per cent. These figures and the surgeon alike than re-exploration of the suggest that the standard methods of exploring the biliary passages. Preston (1959, reporting on 74 biliary passages are frequently inadequate. consecutive and unselected postoperative cholangioThis article puts forward the case for duodenograms, found that 43 per cent showed persistent tomy and transduodenal choledochoduodenostomy abnormalities at the distal end of the common bile-(sphincterplasty) as a useful and reliable surgical duct and residual stones were demonstrated in procedure to ensure patency of the biliary passages 24 per cent. Other reports on the incidence of recurrent or residual stones in the biliary passages give a figure of between 2 and 28 per cent. Moreover, the incidence of recurrent or residual stones is higher after a previous positive exploration of the common bile-duct than after a negative exploration, and a history of multiple operations on the hiliary passages is not infrequent in these patients (Jones, Smith, Keller, and Joergenson, 1963). In 69 patients requiring secondary exploration of the biliary passages, Mongk (1966) found stones in the common

Sphincterplasty of ampulla of vater. A safe technique

“…NOT infrequently the surgeon is presented with the need to provide unimpeded biliary drainage into the duodenum by releasing an obstructive and stenotic sphincter. In a review of indications for operations on the distal biliary system, Rothwell-Jackson (1968) found sphincterplasty a suitable procedure for recurrent obstructive jaundice and/or chronic pancreatitis. Details of the technique for this procedure were presented.…”

“…Using a supraduodenal choledochotomy as a route to dilate the sphincter with graduated sounds might be surgically incomplete and diagnostically insufficient. Indications for duodenotomy have been discussed by Rutherford and Owens (1966). The merits of sphincterotomy over dilatation have been emphasized by Braash and McCann (1967) and Bartlett and Quimby (1957).…”

“…A transduodenal catheter may be placed in the duct as a splint, but this is usually not necessary. It is useful, however, for a cholangiogram during the postoperative course (Rothwell-Jackson, 1968).…”

Morbidity of Simple Cholecystectomy and Cholecystectomy with Transduodenal Sphincteroplasty

“…The procedure enables a thorough exploration of the duct and makes it likely that any retained stones will pass naturally. The formation of a 2-3 cm sphincteroplasty, as described by Rothwell-Jackson (1968), destroys the function of both the sphincter ampulla and sphincter choledochus (Boyden 1957). The present study was undertaken to see if the long-term results in patients undergoing transduodenal sphincteroplasty are affected by the destruction of these sphincters, compared with patients merely having a cholecystectomy.…”