Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1983 May;197(5):627–636. doi: 10.1097/00000658-198305000-00017

Transduodenal sphincteroplasty and transampullary septectomy for postcholecystectomy pain.

F G Moody, J M Becker, J R Potts
PMCID: PMC1353049  PMID: 6847282

Abstract

Ninety-two patients underwent a transduodenal sphincteroplasty and transampullary septectomy (extended papilloplasty) for chronic, incapacitating upper abdominal pain over an 11-year period. Seventy-nine had a prior cholecystectomy; 42 of 56 patients with reported pathology had documented gallstone disease. Serious morbidity included two moderately severe cases of postoperative pancreatitis and a pulmonary embolus. There were no deaths. Operative findings revealed stenosing papillitis (n = 45), transampullary septitis (n = 40), and papillary dysfunction (n = 7). Histologic examination of septal biopsy specimens revealed inflammation in 34 cases and fibrosis in 19 cases. There were no microscopic abnormalities in 39 biopsy specimens. The results at 1 to 10 years in 83 patients is as follows: good in 36 patients (no pain--43%), fair in 27 patients (occasional pain--33%), and poor in 20 patients (unrelieved by the procedure--24%). Patients with prior sphincteroplasty (12 of 15 with a fair to good result) benefitted the most from the procedure. Those who underwent concomitant cholecystectomy responded poorly. Risk factors for failure include alcoholism, drug addiction, mental illness, and duodenal ulcer disease. The finding of papillary cholesterolosis at operation also was accompanied by a less than optimal result. Transduodenal sphincteroplasty with transampullary septectomy provides long-term benefit to carefully selected patients with chronic abdominal pain after cholecystectomy.

Full text

PDF
627

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Acosta J. M., Civantos F., Nardi G. L., Castleman B. Fibrosis of the papilla of Vater. Surg Gynecol Obstet. 1967 Apr;124(4):787–794. [PubMed] [Google Scholar]
  2. Acosta J. M., Nardi G. L. Papillitis. Inflammatory disease of the ampulla of Vater. Arch Surg. 1966 Mar;92(3):354–361. doi: 10.1001/archsurg.1966.01320210034006. [DOI] [PubMed] [Google Scholar]
  3. BARTLETT M. K., MCDERMOTT W. V., Jr Exploration of the pancreatic duct for pancreatitis. Surg Gynecol Obstet. 1957 Mar;104(3):377–379. [PubMed] [Google Scholar]
  4. BARTLETT M. K., NARDI G. L. Treatment of recurrent pancreatitis by transduodenal sphincterotomy and exploration of the pancreatic duct. N Engl J Med. 1960 Mar 31;262:643–648. doi: 10.1056/NEJM196003312621302. [DOI] [PubMed] [Google Scholar]
  5. CATTELL R. B., COLCOCK B. P. Fibrosis of the sphincter of Oddi. Ann Surg. 1953 Jun;137(6):797–806. doi: 10.1097/00000658-195306000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. COLE W. H., GROVE W. J. Persistence of symptoms following cholecystectomy with special reference to anomalies of the ampulla of vater. Ann Surg. 1952 Jul;136(1):73–82. [PMC free article] [PubMed] [Google Scholar]
  7. DAHL-IVERSEN E., SORENSEN A. H., WESTENGAARD E. Pressure measurement in the biliary tract in patients after cholecystolithotomy and in patients with dyskinesia. Acta Chir Scand. 1958 Mar 8;114(3):181–190. [PubMed] [Google Scholar]
  8. Geenen J. E., Hogan W. J., Dodds W. J., Stewart E. T., Arndorfer R. C. Intraluminal pressure recording from the human sphincter of Oddi. Gastroenterology. 1980 Feb;78(2):317–324. [PubMed] [Google Scholar]
  9. Gregg J. A., Clark G., Barr C., McCartney A., Milano A., Volcjak C. Postcholecystectomy syndrome and its association with ampullary stenosis. Am J Surg. 1980 Mar;139(3):374–378. doi: 10.1016/0002-9610(80)90296-2. [DOI] [PubMed] [Google Scholar]
  10. Jones S. A., Steedman R. A., Keller T. B., Smith L. L. Transduodenal sphincteroplasty (not sphincterotomy) for biliary and pancreatic disease. Indications, contraindications, and results. Am J Surg. 1969 Aug;118(2):292–306. doi: 10.1016/0002-9610(69)90132-9. [DOI] [PubMed] [Google Scholar]
  11. Madura J. A., McCammon R. L., Paris J. M., Jesseph J. E. The Nardi test and biliary manometry in the diagnosis of pancreaticobiliary sphincter dysfunction. Surgery. 1981 Oct;90(4):588–595. [PubMed] [Google Scholar]
  12. Moody F. G., Berenson M. M., McCloskey D. Transampullary septectomy for post-cholecystectomy pain. Ann Surg. 1977 Oct;186(4):415–423. doi: 10.1097/00000658-197710000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Nardi G. L., Acosta J. M. Papillitis as a cause of pancreatitis and abdominal pain: role of evocative test, operative pancreatography and histologic evaluation. Ann Surg. 1966 Oct;164(4):611–621. doi: 10.1097/00000658-196610000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Shingleton W. W., Gamburg D. Stenosis of the sphincter of Oddi. Am J Surg. 1970 Jan;119(1):35–37. doi: 10.1016/0002-9610(70)90008-5. [DOI] [PubMed] [Google Scholar]
  15. Stone H. H., Fabian T. C., Dunlop W. E. Gallstone pancreatitis: biliary tract pathology in relation to time of operation. Ann Surg. 1981 Sep;194(3):305–312. doi: 10.1097/00000658-198109000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Thomas C. G., Jr, Nicholson C. P., Owen J. Effectiveness of choledochoduodenostomy and transduodenal sphincterotomy in the treatment of benign obstruction of the common duct. Ann Surg. 1971 Jun;173(6):845–856. doi: 10.1097/00000658-197106010-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Thompson M. H., Williamson R. C., Salmon P. R. The clinical relevance of isolated ventral pancreas. Br J Surg. 1981 Feb;68(2):101–104. doi: 10.1002/bjs.1800680212. [DOI] [PubMed] [Google Scholar]
  18. Toouli J., Geenen J. E., Hogan W. J., Dodds W. J., Arndorfer R. C. Sphincter of Oddi motor activity: a comparison between patients with common bile duct stones and controls. Gastroenterology. 1982 Jan;82(1):111–117. [PubMed] [Google Scholar]
  19. Vogt D. P., Hermann R. E. Choledochoduodenostomy, choledochojejunostomy or sphincteroplasty for biliary and pancreatic disease. Ann Surg. 1981 Feb;193(2):161–168. doi: 10.1097/00000658-198102000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. WARREN K. W., VEIDENHEIMER M. Pathological considerations in the choice of operation for chronic relapsing pancreatitis. N Engl J Med. 1962 Feb 15;266:323–329. doi: 10.1056/NEJM196202152660702. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES