Eine pragmatische Standortbestimmung der transduodenalen Sphincterotomie

Abstract

Of a total of 1791 biliary tract operations from 1977-1984 transduodenal sphincterotomy was performed in 6.3% of 1720 primary and in 63.4% of 71 secondary operations, altogether in 154 cases. In primary operations papillary and suprapapillary choledocholithiasis was the indication in 83.5% of sphincterotomies. In these cases papillary stenosis is not considered separately because sphincterotomy is the preferred approach to stone removal in retroduodenal choledocholithiasis. Without retroduodenal choledocholithiasis and irreversible, organic papillary stenosis was found in 0.7%, a reversible, functional papillary stenosis in 2.8% of primary cases. However, in secondary operations isolated papillary stenosis without choledocholithiasis was the indication in 24.4% of sphincterotomies. The mean age of these patients was 68, the mean interval to the first operation 26 years. Operative mortality was 1.9% for sphincterotomy, 0.6% for all operations. Late results were satisfactory in 96.3% of sphincterotomies. Endoscopic papillotomy is considered the treatment of choice for residual papillary stenosis after cholecystectomy. When the comparative risks and intraoperative findings are well accounted for, transduodenal sphincterotomy becomes a safe and reliable procedure for the serious and tangible condition of retroduodenal choledocholithiasis.