[Immediate and long-term results of endoscopic or surgical Oddi sphincterotomy in the treatment of lithiasis of the common bile duct].
Ninety-one patients with choledocholithiasis were admitted for endoscopic (51 cases) or surgical (40 cases) sphincterotomy of Oddi's muscle, and were followed up on a yearly basis thereafter for a period spanning 1 to 5 years. The study protocol included clinical examinations, ultrasonographic investigations and biochemical tests. The post-surgery mortality rate was 3.9% following endoscopic sphincterotomy versus 0% after surgery. Postoperative complications occurred in 3.9% of patients treated endoscopically (bleeding, angiocholitis) and in 5% of surgical patients (bronchopneumonia, suppuration of abdominal wall). Attempts to remove calculi via endoscopic Oddian sphincterotomy failed in 37% of cases. Long-range results were classified as excellent or good in 92% of patients treated endoscopically, and in 100% of cases treated surgically. Endoscopic division of Oddi's sphincter was unsuccessful in 4 patients (8%), who either had recurrent bile-duct stones (2 cases) or developed sphincteric stenosis. Among biochemical indices of biliary stasis, only alkaline phosphatase contents showed a greater increase following endoscopic sphincterotomy than after surgical treatment. Ultrasonographic studies of the bile duct evidenced a greater incidence of air entrapment in the bile ducts of patients subjected to surgical sphincterotomy.
Ratto
G B
GB
Cattedra di Semeiotica Chirurgica la, Viale Benedetto, Gênes, Italie.
Saitta
S
S
Silvestri
E
E
Motta
G
G
D000328:Adult; D000368:Aged; D004384:Duodenoscopy; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013105:Sphincterotomy, Transduodenal / Q000009:adverse effects / Q000379:methods* / Q000401:mortality
Résultats immédiats et à distance de la sphinctérotomie oddienne endoscopique ou chirurgicale dans le traitement des lithiases de la voie biliaire principale.