The transduodenal approach to the common bile-duct

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).…”

“…Nevertheless, this complication after exploration of the common bile duct purely via the transduodenal route has been well documented (Shieber, 1962;Kourias and Tierris, 1966;Hardy and Davenport, 1969;Thomas et al, 1971;Stuart and Hoerr, 1972). Under such circumstances, cholangitis is probably a consequence of stasis in the extrahepatic biliary apparatus rather than a consequence of reflux of duodenal contents into the common bile duct (Bernard, 1950).…”

“…However, transduodenal exploration of the common bile duct is a well-established procedure and was first described by McBurney in 1898. More recent reports have confirmed the value of this technique and its relative safety, and indeed some authors have advocated the transduodenal route as the primary method of exploration (Wright, 1960;Hardy and Davenport, 1969; Hunter, 1972;Carter, 1973;Peel et al, 1974). However, others have stressed the potential hazards of this technique, namely haemorrhagic pancreatitis, duodenal obstruction and duodenal fistulation (Shieber, 1962;Rains, 1969).…”

Recurrent bile duct stones after transduodenal sphincteroplasty

“…First recorded by McBurney in 1898 [4] transduodenal sphincteroplasty is one of several ways of achieving free drainage of CBD. The choice of permanent drainage procedure for the CBD should be tailored to the specific problem, but each operation has its own indications and contraindications [1,5].…”

“…Division of the sphincter of Oddi allows duodenal contents to reflux as easily as the free flow of bile. Indeed one proof of an effective sphincteroplasty is the free reflux of barium into the common bile duct (CBD) on a contrast X‐ray [4], followed by rapid and complete efflux. The free efflux provided by the complete sphincteroplasty should act as permanent prophylaxis against further stones.…”