A new technique for variable-load cholangiomanometry. Implication for biliary tract surgery.
OBJECTIVE
Variable-load cholangiomanometry was performed to obtain data on terminal biliary function during the surgical treatment of cholelithiasis. The decision of whether or not to perform a definitive biliary drainage procedure was based on the results of this test.


METHODS
The rate of perfusion was reduced in four steps from 15.3 ml/min to 1.2 ml/min, and the resultant perfusion pressures were plotted. The gradient produced by the straight line was considered the resistance, R. The baseline pressure without perfusion was regarded as the static pressure, P.


RESULTS
A review of 444 patients with cholelithiasis who underwent intraoperative cholangiomanometry during the past 11 years led to the following indications for definitive biliary drainage: (1) R > 10 units and P > 200 mm H2O, (2) if only R or P is elevated, priority is given to R, and (3) if the elevation of R or P is borderline, the presence of a type I curvature in the segment of low flow rate is an indication for surgery.


CONCLUSIONS
By performing an intraoperative cholangiomanometry concrete indications for a biliary drainage procedure can be defined.
Nagakawa
T
T
Department of Health Science, School of Medicine, Kanazawa University, Ishikawa, Japan.
Konishi
I
I
Ueno
K
K
Ohta
T
T
Kayahara
M
M
Yoshimitsu
Y
Y
Suzaki
Y
Y
Tukioka
Y
Y
Sanada
H
H
Miyazaki
I
I
D002769:Cholelithiasis / Q000601:surgery*; D004322:Drainage; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008365:Manometry / Q000379:methods*; D011312:Pressure; D012189:Retrospective Studies