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KMID : 0371319720140040029
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Journal of the Korean Surgical Society
1972 Volume.14 No. 4 p.29 ~ p.42
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Transduodenal Sphincteroplasty, Clinical Observation and follow up
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Abstract
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A study of transduodenal sphincteroplasty was carried out in 19 patients for benign obstruction of the
common bile duct and with follows up study from Sept., 1969 to Nov., 1971.
This operation was highly effective in the prevention of recurrent choledocholithiasis after operation
for irremovable intrahepatic duct stone or muddy and sandy stones in common bile ducy. Ampullary
stenosis with fibrotic change, with or without stones, was treated by sphincteroplasty to avoid residaul
stone and to eliminate subsequent bile juice stasis and stone formation.
The sphincteroplasty with permanent wide distal common duct stoma is a procedure to prevent
residual or recurrent common duct stones and to eliminate completely the sphincter action of constricting
muscular mechanism.
Sphincterotomy and incomplete sphincteroplasties which was within 1㎝, in diameter of distal duct
stoma, are not recommended because of residual sphinster acter of Oddi´s sphincter muscular mechan
ism and subsequent fobrotic stricture.
In 19 patients who underwent sphincteroplasty, we have had clinical observation and follow up study
from 2 years to 1 month´s duration.
The following results were obtained.
1) An indication for sphincteroplasty was made during operative procedure of biliary system as follows.
1. multiple common bile duct stones with sandy or muddy stone and intrahepatic stones,
2. impacted single stone at the Ampullar of Vater,
3. fibrotic stricture of distal end of common bile duct,
4. obliteration of distal end of common bile duct due to impacted ascaria worm at Wirsung´s duct,
5. multiple ascariasis and multiple stones in the common bile duct with intrahepatic stones,
6. unable exploration of common bile duct due to marked fibrotic change of hepatoduodenal ligament
2) In comparative study of preoperative and postoperative liver function tests, a definite improvement
was confirmed.
3) Through wide permanent distal common duct stoma after sphincteroplasty, the residual stones and
the ascaria worm in the common bile duct were spontaneously passed out into the small intestinal loop.
4) No stricture of distal end of common bile duct after sphincteroplasty was observed by means of
X-ray studies.
5) In postoperative upper G.I. series studies, the barium meal refluxes into the common bile duct
were consistently shown.
6) No postoperative cholangitis was observed.
7) One patient with clonorchis sinensis of long duration was died after sphincteroplasty because of
liver cancer.
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