Surgical sphincterotomy in the early management of non-malignant obstructive jaundice. Indications and results

Biliary obstruction by non-malignant lesions can be treated either by biliary-enteric anastomosis or by sphincterotomy or sphincteroplasty. In the present report, 153 jaundiced patients operated on by sphincterotomy, were retrospectively examined. Proper indications for surgical sphincterotomy have been considered as follows: stones in the common bile duct (49.7%), biliary stones with secondary stenosis of Oddi (26.8%), impacted ampullary stones (17.6%), primary stenosis of Oddi (3.9%), stenosis of Oddi by perivaterian chronic pancreatitis (2.0%). Preoperative early diagnosis was recognized by US, ERCP, PTC, CT. The overall operative mortality was 2.6% and determined by acute renal failure in 2.0% and acute pancreatitis in 0.6%. Postoperative complications occurred in 4.6% and consisted in acute pancreatitis in 3.3% and bleeding from sphincterotomy in 1.3%. One hundred and twenty-three patients (82.5%) were followed up by questionnaire and by both X-ray studies and ultrasonography. Good results were observed in 80.5%, fair results in 17.1% and poor results in 2.4%. The presents study suggests further indications for surgical sphincterotomy in the treatment of benign biliary obstruction. The effectiveness of this procedure in the early management of non-malignant jaundice is also stressed.