title: Surgical pancreatic sphincteroplasty. Historic or history ? A review.
abstract: BACKGROUND
  Minimal invasive techniques represent a constantly expanding field of medicine and numerous well-established operative procedures have gradually been replaced. Likewise, surgical pancreatic sphincteroplasty, which has been the cornerstone in the management of pancreatic flow disorders for decades, has been largely replaced by endoscopy. Endoscopic pancreatic sphincterotomy however, is still not widespread and carries a significant risk of complications. In this study we attempt to review the role of the surgical approach in the modern era.
  
  
  METHODS
  Pubmed database was searched for reports concerning surgical pancreatic sphincteroplasty alone or in comparison with endoscopy, without other limitations.
  
  
  RESULTS
  Initially, 44 studies were obtained. Finally, 22 full papers were selected, pertaining review articles, case series or clinical studies. Only four of them were recent (after 2002) series of surgical sphincteroplasty, pertaining 561 patients. No randomized-controlled trials or meta-analyses were revealed.
  
  
  CONCLUSIONS
  Pancreatic sphincterotomy, either surgical or endoscopic offers good to excellent long-term results in several disorders, like Sphincter Oddi dysfunction, especially when underlying parenchymal disease is limited. Surgical sphincteroplasty is nowadays indicated in most cases of endoscopic failure and in cases that the papilla cannot be approached. Bariatric patients with gastric by-pass and sphincter Oddi dysfunction in particular, have reported to show excellent outcome after surgery. Regardless the method, patient selection is still a very important determinant of success.
authors.affiliation: 1st Department of Surgery, Asklepieion Voulas General Hospital, Athens, Greece. geogianno@hotmail.com
authors.forename: G A
authors.initials: GA
authors.lastname: Giannopoulos
authors.forename: M K
authors.initials: MK
authors.lastname: Digalakis
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D010179:Pancreas / Q000002:abnormalities; D018579:Patient Selection; D009803:Sphincter of Oddi / Q000473:pathology / Q000601:surgery*; D046628:Sphincter of Oddi Dysfunction / Q000601:surgery; D013105:Sphincterotomy, Transduodenal / Q000379:methods*; D016896:Treatment Outcome