Rational indications for sphincterotomy through intraoperative cholangiomanometry

Area of Science:

• Gastroenterology and Hepatology
• Surgical Gastroenterology

Background:

• Sphincter of Oddi dysfunction (SOD) can result from sclerosis due to lithiasic or alithiasic phlogosis.
• Loss of function of the sphincter of Oddi is the sole rational indication for sphincterotomy.

Purpose of the Study:

• To propose and evaluate an operative test for assessing sphincter of Oddi function.
• To determine the incidence of sphincter of Oddi dysfunction in patients undergoing biliary surgery.

Main Methods:

• Development of an original manometric procedure for operative testing of sphincter of Oddi function.
• Application of the manometric test in a cohort of 567 patients undergoing biliary surgery.

Main Results:

• The manometric test successfully identified sphincter of Oddi dysfunction in 53 out of 567 patients (9.4%).
• Sphincterotomy was performed in the 53 patients diagnosed with loss of sphincter of Oddi function.

Conclusions:

• The proposed manometric test is effective in diagnosing sphincter of Oddi dysfunction during surgery.
• Loss of sphincter of Oddi function, identified via manometry, is a key indication for sphincterotomy in selected surgical patients.