Microscopic transduodenal sphincteroplasty and transampullary septoplasty for papillary stenosis

doi:10.1016/0002-9610(86)90438-1

The American Journal of Surgery

Volume 152, Issue 6, December 1986, Pages 621-627

https://doi.org/10.1016/0002-9610(86)90438-1 Get rights and content

Abstract

Recurrent, severe, and intractable symptoms of right upper quadrant abdominal pain without a clear cause are extremely frustrating to patients and their physicians. This study examines the use of strict preoperative criteria utilizing endoscopic retrograde cholangiopancreatography, strictly defined clinical symptoms, and laboratory values to identify patients with hepatobiliary or pancreatic pain resulting from abnormalities of the papilla of Vater and the duct of Wirsung. Microscopic sphincteroplasty techniques stressing complete transection of the muscular transampullary septum have been incorporated with strict preoperative screening criteria to produce significantly improved long-term results (p > 0.005). Sixty-eight percent of 81 highly selected patients with at least a 6 month follow-up reported good results. Ninety-four percent claimed the procedure was definitely of benefit.

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Cited by (24)

Contemporary Outcomes of Transduodenal Sphincteroplasty: the Importance of Surgical Quality
2023, Journal of Gastrointestinal Surgery
Sphincter of Oddi dysfunction (SOD) is managed primarily by endoscopic sphincterotomy (ES); however, surgical transduodenal sphincteroplasty (TDS) is a treatment option for select patients. In our high-volume pancreatico-biliary practice, we have observed variable outcomes among TDS patients; therefore, we sought to determine preoperative predictors of durable improvement in quality of life.
SOD patients treated by TDS between January 2006 and December 2015 were studied. The primary outcome measure was long-term changes in quality of life after sphincteroplasty. The secondary outcome measure examined postoperative outcomes, including postoperative complications, need for repeat procedures, and readmission rates.
Perioperative data were abstracted, and the SF-36 quality-of-life (QoL) survey was administered. Standard statistical analysis included non-parametric methods to examine bivariate associations.
Eighty-eight patients had an average follow-up duration of 6.7 (± 2.9) years. Thirty (34%) patients were naïve to endoscopic therapy. Patients with prior endoscopy averaged 2.1 procedures (range 1 to 13) prior to surgery. Perioperative morbidity was 27%; one postoperative death was caused by severe acute pancreatitis. Twenty-nine (33%) patients required subsequent biliary-pancreatic procedures. QoL analysis from available patients showed that 66% were improved or much improved. With multivariable analysis including SOD type and prior endoscopic instrumentation, freedom from surgical complication was the only variable that correlated significantly with a good outcome (p < 0.02).
Surgical transduodenal sphincteroplasty provides durable symptom management for select patients with sphincter of Oddi dysfunction. Minimizing surgical complications optimizes long-term outcomes.
Sphincter of Oddi Dysfunction
2015, Gastrointestinal Endoscopy Clinics of North America
Citation Excerpt :
Transduodenal sphincteroplasty with transpapillary septoplasty is the traditional open operative approach. Clinical success rates are similar to endoscopic sphincterotomy, ranging from 43% to 75%, and depend highly on SOD type.4,6,77–79 SOD remains one of the most enigmatic entities in the spectrum of pancreaticobiliary diseases.
Postcholecystectomy problems
2012, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas
Acute Relapsing Pancreatitis
2011, Clinical Gastrointestinal Endoscopy, Second Edition
Postcholecystectomy Problems
2006, Surgery of the Liver, Biliary Tract and Pancreas: Volumes 1-2, Fourth Edition
Key issues in sphincter of Oddi dysfunction
2003, Gastrointestinal Endoscopy Clinics of North America

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^☆: Presented at the 38th Annual Meeting of the Southwestern Surgical Congress, San Francisco, California, April 21–24, 1986.

¹: From the Department of Surgery and Section of Gastroenterology, St. Luke's Hospital and Medical Center, Phoenix, Arizona.

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Scientific paperMicroscopic transduodenal sphincteroplasty and transampullary septoplasty for papillary stenosis☆

Abstract

Am J Surg

Am J Surg

Am J Surg

Treatment of recurrent pancreatitis by transduodenal sphincterotomy and exploration of the pancreatic duct

N Engl J Med

Fibrosis of the sphincter of Oddi

Ann Surg

Persistence of symptoms following cholecystectomy with special reference to anomalies of the ampulla of Vater

Ann Surg

Choledochoduodenostomy, choledochojejunostomy, or sphincteroplasty for biliary and pancreatic disease

Ann Surg

Pathological considerations in the choice of operation for chronic relapsing pancreatitis

N Engl J Med

Transduodenal sphincteroplasty and transampullary septectomy for postcholecystectomy syndrome

Ann Surg

Transampullary septectomy for postcholecystectomy pain

Ann Surg

Ein Fall von choledochoduodenostomia interna wegen gallensteines

Korrespond Aertze

Section of the intestine for the removal of a gallstone

NY State J Med

Scientific paper
Microscopic transduodenal sphincteroplasty and transampullary septoplasty for papillary stenosis☆