Papillitis: a critical appraisal based on intraoperative radiomanometric evaluation

Disagreement still prevails over intraoperative diagnosis of papillitis as shown by the variability in incidence reported with a wide range of percentage. A study, concerning 2957 biliary operations for benign diseases has been carried out in order to analyse the incidence of papillary disorders. Two periods have been considered: before and after the intraoperative employment of radiomanometry. Primary benign stricture of the papilla, diagnosed in 0.1% of the cases in the first period, was not found in the second period; papillitis associated with lithiasis of the gallbladder was recognized in 2.5 and 0.3% of the cases respectively (no cases in the last four years); papillitis associated with common bile duct stones was found, according to the period considered, in 11.6 and 2.4% of cases (1.4% in the last four years). These results seem to suggest that benign papillary stenosis is a rare pathologic entity, often overdiagnosed or misjudged, and that planning of surgical treatment of common bile duct stones should be carefully considered, taking into account this remark in order to avoid unnecessary procedures.