Experience with Sphincteroplasty and Sphincterotomy in Pancreatobiliary Surgery

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Abstract
Review of a 26-yr experience with transduodenal sphincteroplasty and sphincterotomy was undertaken to analyze critically the indications for and results of these procedures and to determine which preoperative factors correlate with a good or poor outcome. Of 109 patients, 78 underwent sphincteroplasty, whereas 31 had a transduodenal sphincterotomy. Surgical indications included: group 1, 53 patients with common duct stones; group 2, 28 patients with dyskinesia or stenosis of the sphincter of Oddi (without choledocholithiasis or recurrent pancreatitis); and group 3, 28 patients with recurrent pancreatitis. Three elderly group 1 patients who presented with cholangitis died after surgery (a hospital mortality of 2.7%). Seventy-nine of the 103 patients (77%) in whom follow-up was obtained achieved an excellent or good result. Results were almost identical with sphincteroplasty and sphincterotomy. Abnormal preoperative liver function tests were the only predictors of a good postoperative outcome (P < 0.05). Group 3 patients (good results in 63%) had significantly poorer (P < 0.05) outcome than group 1 and 2 patients. Results were worst in group 3 patients who had undergone previous abdominal or pelvic surgery (P < 0.025) and in group 2 patients who were narcotic users (P < 0.025). Transduodenal sphincteroplasty or sphincterotomy can be performed relatively safely, but careful selection of patients is important when the indication for surgery is either ampullary stenosis or recurrent pancreatitis.