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KMID : 0381219740060090442
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Journal of RIMSK
1974 Volume.6 No. 9 p.442 ~ p.454
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Sphincteroplasty for common Duct Stones
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주상용/Choo, Sang Yong
김희규/Kim, Hee Kyu
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Abstract
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Koreans have high incidence of common bile duct (CBD) stones. Concerning the formation and origin of CBD stones, it is probable that the stones are either formed by bile stasis in the CBD itself (primary stone), or migrated from the gallbladder through cystic duct or descended from the intrahepatic bile duct (secondary stone). Even after the classic cholecystectomy and choledocholithotomy, the possibility of stone recurrence still remains because of the underlying pathophysiologic alteration in CBD or intrahepatic duct.
Among the surgical preventive procedures for recurrent CBD stones, the sphincteroplasty, providing that an extensive performance leaves no untoward complications, may be preferable one, because the simple sphincterotomy is not good enough to eliminate the terminal tapering of CBD, and the choledochoduodenostomy, in the case of side to side fashion, creates blind pouch distally in CBD. Based on the study of human cadaver anatomy, a new method of extensive sphincteroplasty was. devised and applied to patient with primary or secondary common bile duct stones.
The extended sphincteroplasty was performed on 22 patients during last 2 years at the surgical department, Catholic Medical College.
These were 6 cases of primary common bile duct stones, 9 cases of descended intrahepatic bile duct stones, 5 cases of common bile duct stones which migrated from the gallbladder and 2 cases of recurrert pancreatitis.
The results are as follow:
1. In the distal portion of the common bile duct wall, the intrinsic circular muscle fibers of the Vaterian segment are located not only at the submucosal layer of the duodenal wall, as of Cddi´s muscle, but also extend through the whole layer of the duodenal wall and up to 2 mm outside the duodenal wall. The length of the Vaterian segment averages 1. 8 cm.
2. Therefore, in order to do a complete sphincteroplasty, one must cut the Vaterian segment until the outer layer of the ducdenal wall is reached so that the sphincter muscle of the distal portion of the common bile duct is completely severed.
3. By this procedure, the distal portion of the common bile duct is converted into ducdenal lumen and thus, stasis of bile and interruption of stone passage are eliminated.
4. This extended sphincteroplasty is also beneficial for relapsing and recurrent pancreatitis due to gall stones, fibrosis of papilla of Vater, or organic change of the pancreatic duct.
5. In performing this transduodenal extensive sphincteroplasty, the complications of ducdenal fistula or bile leakage can be prevented by precise surgical technique.
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