Surgical sphincteroplasty in 446 patients.
OBJECTIVE
Pancreaticobiliary sphincter disease is reliably diagnosed by endoscopic and intraoperative manometry.


METHODS
Retrospective review of prospectively collected data.


METHODS
A 400-bed urban university hospital.


METHODS
Between May 1, 1978, and March 27, 2002, 446 patients were treated surgically for dysfunction of the pancreaticobiliary sphincters. There were 376 females and 70 males (mean +/- SD age, 41.6 +/- 12.5 years). There were 372 patients with sphincter of Oddi dysfunction, and 74 with pancreas divisum. Symptoms included abdominal pain (100.0%), nausea/vomiting (80.5%), back pain (57.2%), and pancreatitis (22.4%).


METHODS
Perfusion manometry has evolved as the gold standard for diagnosis, and intraoperative manometry was done in 214 patients. All patients underwent transduodenal sphincteroplasty and biopsies of the ampullae and transampullar septa.


RESULTS
Excellent or good results were seen in 86.8% of the patients with sphincter of Oddi dysfunction and in 63.5% of the patients with pancreas divisum. Common duct and sphincter of Oddi pressures were 0 mm Hg in all patients after sphincteroplasty. Pancreatic duct and pancreatic sphincter manometry results were improved in 82.4% of the patients. Biopsy results of the main and accessory sphincters demonstrated inflammation and/or fibrosis in 33.9% of ampullae and 43.5% of transampullar septa, but this did not correlate with outcome. There was 1 death from a duodenal leak. Complications occurred in 34.8% of patients, with pancreatitis (8.8%), asymptomatic hyperamylasemia (6.0%), and wound/abdominal infection (7.1%) the most common. Predictive factors for good outcome were reduction in pancreatic duct and sphincter pressures following sphincteroplasty.


CONCLUSIONS
Good to excellent results may be achieved by surgical sphincteroplasty when careful patient selection by manometry is used.
Madura
James A
JA
Department of Surgery, The Indiana University Medical Center, Indianapolis, USA. jmadura1@comcast.net
Madura
James A
JA
Sherman
Stuart
S
Lehman
Glen A
GA
D000328:Adult; D003137:Common Bile Duct Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D010182:Pancreatic Diseases / Q000601:surgery*; D018579:Patient Selection; D012189:Retrospective Studies; D009803:Sphincter of Oddi; D013105:Sphincterotomy, Transduodenal; D016896:Treatment Outcome