Transduodenal sphincteroplasty - reappraisal of an effective biliary drainage procedure in the endoscopic and laparoscopic era

ABSTRACT

With the advent of interventional endoscopic procedures and with growing experience with laparoscopic surgery, the indications for open biliary procedures have become limited. This prospective study reviews the changing trends in the indications of transduodenal sphincteroplasty and presents the short-term and long-term outcomes of this procedure in the present minimally invasive surgical era. Transduodenal sphincteroplasty was performed for various benign obstructive biliary pathologies. Various parameters recorded were the demographic data, indications for surgery, early and late complications and longterm outcome of the procedure. The changing trend in the current indications of the procedure was reviewed. Results of transduodenal sphincteroplasty on 67 consecutive patients over a 7 year period are presented. Mean age was 48.7 years with male to female ratio of 12.7. Thirty-nine [58.2%] patients presented with obstructive jaundice and 40.3% had cholangitis. Common indications of surgery included multiple common duct calculi [46.3%], impacted ampullary stones [37.3%] and ampullary stenosis [11.9%]. Overall hospital morbidity was 13.4% with zero mortality. After a mean follow up of 7.2 years, 95.4% patients had "good" or "fair" and 4.5% reported "poor" results. Most of the biliary pathologies may be dealt with by laparoscopic and endoscopic procedures; open drainage procedures may still be indicated in selected patients. Transduodenal sphincteroplasty remains an effective biliary drainage procedure with acceptable morbidity and mortality. The procedure should be regarded as essential in the general surgical knowledge and training