[Cholelithiasis. Post-choledochostomy intraductal pressure (without and with sphinctero-infundibulostomy]

In 72 patients operated on for lithiasis of the main biliary duct (MBD), the intraductal pressure was measured through the choledochostomy T-tube. This measure was done, both in upright and lying positions, fasting and after lunch. Two groups were considered: A (of 52 cases) and B (of 20 cases). In both groups a choledochotomy was performed, and only in group B a long, although partial, sphincterotomy was also done. Three patients in group B had the upper part of the sphincter of Oddi (SO) dilated by big stones. 1) When groups A and B were compared, no significant differences of pressures in MBD was found. 2) Highly significant differences (p = 0.0001) were always found when paired data related to positions were compared: in the upright position pressures in MBD were higher than on the lying position. Group A, during fasting (9.90 +/- 4.1 cm H2O, in upon position, and 7.76 +/- 3.6 when lying) and group B, also at fasting (8.95 +/- 3.0 in the upright position and 6.57 +/- 3.0, when lying). The three patients included in group B with big stones impacted in the upper part of SO, showed low pressures in MBD, specially one (2 and 1 cm H2O, upright lying positions), but the group is too small have statistical significance. We conclude that the long but partial sphincterotomy does not modify significantly the pressures in MBD whether upright or lying, and when paired data related to positions were compared, upright pressures were always higher than on the lying position (p = 0.0001).