PMID- 1069407
OWN - NLM
STAT- MEDLINE
DCOM- 19770129
LR  - 20061115
IS  - 0300-5178 (Print)
IS  - 0300-5178 (Linking)
VI  - 61
DP  - 1976
TI  - [Perduodenal Sphincterotomy (author's transl)].
PG  - 1-18
AB  - In spite of immaculate surgical technique conventional transduodenal 
      sphincterotomy is attended by a non-lethal complication rate of about 5.8% and a 
      mortality rate of about 4.5%, the most frequent cause being dehiscence of the 
      duodenal suture. The primary and secondary pathogenesis hereof is explained by 
      the particular predisposition duodenal laceration on account of its special 
      anatomy and operative vulnerability. Bearing these facts in mind, the method of 
      so-called perduodenal sphincterotomy (p. sph.) seemed to offer more promising 
      results for the following reasons: 1. Splitting of the sphincter through a minute 
      incision in the duodenum (stab incision with a tenotome). 2. The advantage of 
      primary closure of the cystic duct in the transcystic approach with medium-sized 
      probes for the splitting. Experimental evidence shows the cystic duct to be very 
      resistent towards dilation and rupture, especially in the presence of 
      inflammatory processes. From 1967 to 1973 in 1441 cases of gall-bladder surgery 
      p. sph. was performed 374 times and transduodenal sphincterotomy only 121 times. 
      The statistic evaluation of the outcome of both methods showed significantly 
      better results with p. sph. with regard to the incidence of postoperative 
      non-lethal complications and duration of hospitalization. Assessment of 
      non-lethal postoperative mortality and follow-up studies on 79% of the operated 
      patients over a period from 3 to 9 years showed that the results of both methods 
      were equal. In our experience the p. sph. is not only advisable when 
      sphincterotomy is generally indicated, but also in the following special 
      situations: a) as so-called "emergency papillotomy" in poor-risk patients; b) if 
      the transduodenal approach is impossible awing to technical difficulties (poor 
      accessibility, low site of the papilla); c) if the indication for papilotomy is 
      dubious it can be chosen as the less dangerous method; d) for reoperation on the 
      sphincter. On account of its prevailing advantages this new method for repairing 
      papillary drainage is practicable as a routine method in sphincteric surgery.
FAU - Walzel, C
AU  - Walzel C
LA  - ger
PT  - English Abstract
PT  - Journal Article
TT  - Die perduodenale Sphinkterspaltung. (Ein neues Verfahren zur Behebung papillarer 
      Abflussstorungen).
PL  - Austria
TA  - Wien Klin Wochenschr Suppl
JT  - Wiener klinische Wochenschrift. Supplementum
JID - 0357046
SB  - IM
MH  - Adult
MH  - Aged
MH  - Ampulla of Vater/*surgery
MH  - Cholecystitis/surgery
MH  - Cholelithiasis/surgery
MH  - Chronic Disease
MH  - Duodenum/*surgery
MH  - Female
MH  - Humans
MH  - Intestinal Fistula/epidemiology
MH  - Male
MH  - Methods
MH  - Middle Aged
MH  - Postoperative Complications/epidemiology
MH  - Sphincter of Oddi/*surgery
EDAT- 1976/01/01 00:00
MHDA- 1976/01/01 00:01
CRDT- 1976/01/01 00:00
PHST- 1976/01/01 00:00 [pubmed]
PHST- 1976/01/01 00:01 [medline]
PHST- 1976/01/01 00:00 [entrez]
PST - ppublish
SO  - Wien Klin Wochenschr Suppl. 1976;61:1-18.