Sphincteroplasty and choledochoduodenostomy for benign biliary obstructions

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Surgical Interventions for Biliary Tract Diseases

Background:

• Choledocholithiasis, terminal bile duct stenosis, and pancreatitis necessitate surgical intervention.
• Sphincteroplasty and choledochoduodenostomy are established procedures for managing these conditions.

Purpose of the Study:

• To present patient selection, technical details, and comparative analysis of sphincteroplasty and choledochoduodenostomy.
• To evaluate the outcomes and limitations of both surgical techniques in benign biliary operations.

Main Methods:

• Retrospective review of 73 patients undergoing sphincteroplasty or choledochoduodenostomy within a series of 600 benign biliary operations.
• Analysis of operative mortality, complications, symptom recurrence, and specific indications for each procedure.

Main Results:

• Sphincteroplasty (60 patients) showed no operative mortality or serious complications, with 5 patients experiencing residual pain.
• Choledochoduodenostomy (13 patients) resulted in no mortality or significant complications, with 12 symptom-free and one developing sump syndrome.
• Sphincteroplasty was favored for drainage and ampullary inspection, while choledochoduodenostomy was used for poor-risk elderly patients or those with specific pancreatic/duodenal conditions.

Conclusions:

• Both sphincteroplasty and choledochoduodenostomy are valuable surgical options for choledocholithiasis, stenosis, and pancreatitis.
• The choice between sphincteroplasty and choledochoduodenostomy depends on patient-specific factors, technical considerations, and desired outcomes.
• Surgeons should consider the unique advantages and limitations of each procedure rather than exclusively favoring one.