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Surgical sphincteroplasty in 446 patients
James A Madura1, James A Madura, Stuart Sherman
1Department of Surgery, The Indiana University Medical Center, Indianapolis, USA. jmadura1@comcast.net
Archives of Surgery (Chicago, Ill. : 1960)
|May 18, 2005
Summary
Surgical sphincteroplasty offers good outcomes for pancreaticobiliary sphincter dysfunction when diagnosed with manometry. Careful patient selection is key to successful treatment of sphincter of Oddi dysfunction and pancreas divisum.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Diagnostic Endoscopy
Background:
- Pancreaticobiliary sphincter disease diagnosis relies on manometry.
- Sphincter of Oddi dysfunction and pancreas divisum are key conditions.
Purpose of the Study:
- To evaluate the efficacy of surgical sphincteroplasty for pancreaticobiliary sphincter dysfunction.
- To determine the role of manometry in patient selection and outcome prediction.
Main Methods:
- Retrospective review of prospectively collected data from 446 patients.
- Surgical sphincteroplasty with biopsies, utilizing intraoperative manometry in 214 patients.
- Analysis of outcomes based on diagnosis (sphincter of Oddi dysfunction vs. pancreas divisum) and manometric results.
Main Results:
- Excellent or good results achieved in 86.8% for sphincter of Oddi dysfunction and 63.5% for pancreas divisum.
- Post-sphincteroplasty pressures normalized; 82.4% showed improved pancreatic duct and sphincter manometry.
- Complications occurred in 34.8%, with pancreatitis and infections being most common; 1 death reported.
Conclusions:
- Surgical sphincteroplasty yields good to excellent results in pancreaticobiliary sphincter dysfunction.
- Manometry is crucial for accurate patient selection, improving surgical outcomes.
- Reduction in pancreatic duct and sphincter pressures post-surgery predicts a favorable outcome.