Transduodenal sphincteroplasty and transampullary septectomy for postcholecystectomy pain

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...

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Bibliographic Details
Published in:Annals of surgery 1983-05, Vol.197 (5), p.627-636
Main Authors: Moody, F G, Becker, J M, Potts, J R
Format: Article
Language:English
Subjects:
Abdomen
Ampulla of Vater - surgery
Cholecystectomy - adverse effects
Female
Follow-Up Studies
Humans
Male
Manometry
Middle Aged
Pain - etiology
Pain Management
Pancreatitis - etiology
Postoperative Complications
Pulmonary Embolism - etiology
Sphincter of Oddi - physiology
Sphincter of Oddi - surgery
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Summary: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.
ISSN:0003-4932
1528-1140
DOI:10.1097/00000658-198305000-00017