Sphincteroplasty in the treatment of biliary tract disease

Abstract

Forty-six patients in whom sphincteroplasty was performed by an original technique are presented. In 43 cases the indication was oddian stenosis (associated or not with cholelithiasis or hepatic hydatid disease). Only in three patients a "security" operation was performed. Sphincteroplasty was achieved with the aid of an original probe, and average length of the incision of the ampullary area was 27 mm. The postoperative control, made by tube cholangiography and barium investigation, has evidenced the presence of a wide, open choledochoduodenal aperture. Amylase activity was also followed up in 25 patients. One case of acute pancreatitis, two upper digestive haemorrhages and one case of duodenal fistula were recorded as postoperative complications. Healing was obtained in all patients.

Manometry based randomised trial of endoscopic sphincterotomy for sphincter of Oddi dysfunction

“…This hypothesis is supported by the observation that some patients have dilatation of the bile duct on retrograde cholangiography, transient increases in liver enzymes with pain, or both abnormalities. In uncontrolled surgical studies, operative sphincteroplasty appeared to be helpful for pain,2 3 and sphincter histology often disclosed abnormalities, including inflammation, muscle hypertrophy, and fibrosis 4…”

The Sphincter of Oddi

“…However, response to these agents has generally been disappointing. Surgical management of SOD includes procedures to sever the sphincter muscle such as sphincteroplasty, sphincterotomy and septectomy [52][53][54]. These have been successful in the majority of cases in providing long-term relief from symptoms of SOD, but are limited by the invasiveness of the procedure and related morbidity and mortality.…”