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Ide T, Ito K, Tanaka T, Noshiro H. Influence of previous gastrectomy on postoperative bile leakage after laparoscopic liver resection. BMC Surg 2025; 25:139. [PMID: 40189533 PMCID: PMC11974140 DOI: 10.1186/s12893-025-02873-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 03/25/2025] [Indexed: 04/09/2025] Open
Abstract
BACKGROUND Postoperative bile leakage (POBL) is a common cause of major morbidity following liver resection. Although the use of laparoscopy for liver surgery has expanded rapidly, POBL has been poorly described in patients undergoing laparoscopic liver resection (LLR). This study aimed to identify the risk factors for POBL after LLR. METHODS We enrolled 510 consecutive patients who underwent LLR for hepatic tumors between January 2009 and December 2023. POBL was defined according to the International Study Group of Liver Surgery, and its incidence, consequences, clinicopathological factors, and surgical details were evaluated retrospectively. Risk factors for POBL were determined using a multivariable logistic regression analysis. RESULTS POBL occurred in nine patients (1.8%). POBL was significantly associated with advanced age (81 vs. 72 years, p = 0.005), history of gastrectomy (3/9 vs. 25/501, p = 0.002), high incidence of postoperative complications (9 vs. 26, p = 0.001), and prolonged hospital stay (57 vs. 8 days, p = 0.001). In the multivariable analysis, POBL was significantly associated with a history of gastrectomy (OR 7.71, 95% CI 1.744-34.043, p = 0.007). In the management of POBL, all patients were successfully treated with percutaneous drainage alone or with additional treatment using endoscopic nasobiliary drainage. CONCLUSION Previous gastrectomy was an independent risk factor for POBL in patients undergoing LLR.
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Affiliation(s)
- Takao Ide
- Department of Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Kotaro Ito
- Department of Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Tomokazu Tanaka
- Department of Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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Moriyama T, Ohuchida K, Ohtsuka T, Shindo K, Ikenaga N, Nakata K, Nakamura M. Higher incidence of cholelithiasis with Roux-en-Y reconstruction compared with Billroth-I after laparoscopic distal gastrectomy for gastric cancer: a retrospective cohort study. Langenbecks Arch Surg 2024; 409:75. [PMID: 38409456 DOI: 10.1007/s00423-024-03267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Cholelithiasis occurs often after gastrectomy. However, no consensus has been established regarding the difference in the incidence of postgastrectomy cholelithiasis with different reconstruction methods. In this study, we examined the frequency of cholelithiasis after two major reconstruction methods, namely Billroth-I (B-I) and Roux-en-Y (R-Y) following laparoscopic distal gastrectomy (LDG) for gastric cancer. METHODS Among 696 gastric cancer patients who underwent LDG between April 2000 and March 2017, after applying the exclusion criteria, 284 patients who underwent B-I and 310 who underwent R-Y were examined retrospectively. The estimated incidence of cholelithiasis was compared between the methods, and factors associated with the development of cholelithiasis in the gallbladder and/or common bile duct were investigated. RESULTS During the median follow-up of 61.2 months, 52 patients (8.8%) developed cholelithiasis postgastrectomy; 12 patients (4.2%) after B-I and 40 (12.9%) after R-Y (p = 0.0002). Among them, choledocholithiasis was more frequent in patients who underwent R-Y (n = 11, 27.5%) vs. B-I (n = 1, 8.3%) (p = 0.0056). Univariate and multivariate analyses revealed that male sex, body mass index > 22.5 kg/m2, and R-Y reconstruction were significant predictors of the development of postLDG cholelithiasis. CONCLUSION Regarding cholelithiasis development, B-I reconstruction should be preferred whenever possible during distal gastrectomy.
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Affiliation(s)
- Taiki Moriyama
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
- Seiryo Iwasato Hospital, Hita, Oita, Japan
| | - Kenoki Ohuchida
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan.
| | - Takao Ohtsuka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Kagoshima, Japan
| | - Koji Shindo
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
| | - Naoki Ikenaga
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
| | - Kohei Nakata
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
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Berger Z, S AMM. Paradoxical Stimulatory Response of Remanent Sphincter of Oddi to Buscapina After Endoscopic Sphincterotomy. J Neurogastroenterol Motil 2021; 27:632-638. [PMID: 34642284 PMCID: PMC8521478 DOI: 10.5056/jnm20180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/21/2020] [Accepted: 12/28/2020] [Indexed: 11/20/2022] Open
Abstract
Background/Aims Endoscopic removal of bile duct stones has become the treatment of choice, which includes endoscopic sphincterotomy (EST) in the majority of cases, destroying at least partially the Oddi sphincter (OS). Loss of sphincter function in variable grade has been described, but changes in innervation are not known. Methods Endoscopic manometry of OS was performed in 14 patients after EST with specialized perfused catheter. Pressure values were registered before and after 10 mg Buscapina injected intravenously. Results Choledocho-duodenal pressure gradient was absent in all of 14 patients. Basal OS pressure was zero in 7 and conserved in normal range in the remaining 7. Phasic motor activity was registered in 11 patients and was absent in 3 patients. After 10 mg Buscapina intravenous injection, instead of habitual inhibition, increase in basal OS pressure and in frequency of phasic contractions was observed in 9 patients. This response was not related to age of patients, neither with time elapsed between the EST and manometry, nor the estimated size of papillotomy orifice. Duodenal peristalsis was invariably inhibited in all patients. Conclusions EST destroys not only the smooth muscle of OS, also alters the innervation interrupting the duodeno-sphincteric nerve circuit. This finding questions the use of Buscapina or other anticholinergic agent as spasmolytic in patients after EST.
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Affiliation(s)
- Zoltán Berger
- Division of Gastroenterology, Clinical Hospital Universidad de Chile, Santiago, Chile
| | - Ana María Madrid S
- Division of Gastroenterology, Clinical Hospital Universidad de Chile, Santiago, Chile
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Shaikh L, Sharma A, Secrest S. Imaging diagnosis--duodenobiliary reflux of barium sulfate during esophagogastrography in a dog. Vet Radiol Ultrasound 2014; 56:E36-9. [PMID: 25066011 DOI: 10.1111/vru.12190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/22/2014] [Indexed: 11/27/2022] Open
Abstract
A 4-year-old Australian cattle dog presented for regurgitation, 2 months after duodenal resection and anastomosis for a perforated duodenal ulcer. Duodenobiliary reflux of barium sulfate suspension was detected during fluoroscopic esophagogastrography. Follow-up radiography 2 hours later demonstrated persistence of the barium in the gallbladder and biliary tree. Ultrasonography showed an open sphincter of Oddi but no other morphological abnormalities with the gallbladder or biliary system. No side effects or bloodwork abnormalities were noted. This is the first case report of duodenobiliary reflux of barium in a dog. The pathophysiology of this phenomenon and its incidence and significance in human medicine are discussed.
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Affiliation(s)
- Layla Shaikh
- University of Georgia College of Veterinary Medicine, 501 D.W. Brooks Drive, Athens, GA, 30606
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Zhu YG, Ben H, Ye YY, Xu QY. Regulatory effect of electroacupuncture at auriculo-body acupoints on the functions of the biliary system and actions of the vagus nerve. Shijie Huaren Xiaohua Zazhi 2012; 20:552-557. [DOI: 10.11569/wcjd.v20.i7.552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the mechanism of electroacupuncture at auriculo-body acupoints in treating disorders of the biliary system and the actions of the vagus nerve in regulating biliary functions.
METHODS: A rabbit model of common bile duct stones was created. The influence of the vagus nerve on the functions of the biliary system was evaluated using bile current capacity, biliary duct pressure, and Oddi sphincter myoelectricity. The changes in these parameters were observed after electroacupuncture at a frequency of 20 Hz for 30 minutes at "Yi-Dan" area, Auriculo-acupoint and "Danshu".
RESULTS: A pathological increase in bile current capacity, biliary duct pressure, and Oddi sphincter myoelectricity was observed in rabbits with common bile duct stones. Oddi sphincter myoelectricity was transformed from orderly electric discharge into disorder and paroxysmal discharge. Electroacupuncture at ear-body acupoints further increased bile current capacity. The myotensity of the Oddi sphincter was decreased and myoelectricity was restored into rhythmicity. The regulatory effect of electroacupuncture at ear-body acupoints on biliary duct functions was not obvious in rabbits whose vagus nerve was removed. Increased bile current capacity and reduced biliary duct pressure were observed 30 minutes after stopping electroacupuncture.
CONCLUSION: The integrity of the vagus nerve is necessary for maintaining the normal functions of the biliary system in rabbits. Electroacupuncture at ear-body acupoints regulates biliary duct function mainly through modulating the vagus nerve.
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Liu YK, Li ZH, Liu NZ, He Q, Lin H, Wang XJ, Li XW, Dong JH. Reduced myoelectric activity in the sphincter of Oddi in a new model of chronic cholangitis in rabbits: an in vivo and in vitro study. Neurogastroenterol Motil 2010; 22:927-34, e238-9. [PMID: 20426800 DOI: 10.1111/j.1365-2982.2010.01500.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic cholangitis caused by hepatolithiasis is a common disease in Southeast Asia. Few studies have addressed the effects of chronic cholangitis on cyclic activity of the sphincter of Oddi (SO). In this study, we investigated the changes of myoelectric activity in rabbits with chronic cholangitis in vivo and in vitro. METHODS Chronic cholangitis was induced in rabbits by initially introducing three pieces of 2-0 silk suture and sequentially injecting E. coli into the choledochus through the tube in ductus cysticus. In in vivo experiments, myoelectric activity of SO was recorded by a circular electrode through the jejunum stump in conscious animals. In in vitro experiments, the SO was completely isolated and the myoelectric activity was recorded by a circular electrode in a 10-mL organ bath filled with Krebs solution, with or without addition of cholecystokinin-8 (CCK-8), KCl, ionomycin or induction of capacitative calcium entry (CCE). KEY RESULTS In comparison with control and non-infected rabbits, the rabbits with chronic cholangitis showed higher levels of alkaline phosphatase and gamma-glutamyltransferase and significant pathological changes including increased inflammatory infiltration and collagen deposition in mucosae or muscular layer. Cyclic myoelectric activity of SO at phases 2 and 3 of migrating motor complex and the excitatory response to CCK-8 were dramatically decreased in animals with chronic cholangitis. Myoelectric activity of SO was also significantly decreased in vitro with or without agonists or with induction of CCE. CONCLUSIONS & INFERENCES Myoelectric activity of SO and its response to agonists are decreased in rabbits with chronic cholangitis both in vivo and in vitro.
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Affiliation(s)
- Y-K Liu
- Hepatobiliary Surgery Institute, Southwest Hospital, Third Military Medical University, Chongqing, China
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Zhang ZH, Wu SD, Wang B, Su Y, Jin JZ, Kong J, Wang HL. Sphincter of Oddi hypomotility and its relationship with duodenal-biliary reflux, plasma motilin and serum gastrin. World J Gastroenterol 2008; 14:4077-81. [PMID: 18609694 PMCID: PMC2725349 DOI: 10.3748/wjg.14.4077] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To detect whether patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux by measuring the radioactivity of Tc99m-labeled diethylene triamine penta-acetic acid (DTPA) in the bile and whether the patients with duodenal-biliary reflux have sphincter of Oddi hypomotility, by measuring the level of plasma and serum gastrin of the patients. Finally to if there is close relationship among sphincter of Oddi hypomotility, duodenal-biliary reflux and gastrointestinal peptides.
METHODS: Forty-five patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group. The level of plasma and serum gastrin of the patients and of 12 healthy volunteers were measured by radioimmunoassay. Thirty-four were selected randomly to undergo choledochoscope manometry. Sphincter of Oddi basal pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duration of contractions (SOD), duodenal pressure (DP) and common bile duct pressure (CBDP) were scored and analyzed.
RESULTS: Sixteen (35.6%) patients were detected to have duodenal-biliary reflux. SOBP, SOCA and CBDP in the reflux group were much lower than the control group (t = 5.254, 3.438 and 3.527, P < 0.001). SOD of the reflux group was shorter than the control group (t = 2.049, P < 0.05). The level of serum gastrin and plasma motilin of the reflux group was much lower than the control group (t = -2.230 and -2.235, P < 0.05). There was positive correlation between the level of plasma motilin and SOBP and between the level of serum gastrin and SOBP and CBDP.
CONCLUSION: About 35.9% of the patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux. Most of them have sphincter of Oddi hypomotility and the decreased level of plasma motilin and serum gastrin. The disorder of gastrointestinal hormone secretion may result in sphincter of Oddi dysfunction. There is a close relationship between sphincter of Oddi hypomotility and duodenal-biliary reflux.
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Chang XR, Yan J, Liu YQ, Hong-Zhang, Yi SX, Lin YP. Effects of electroacupuncturing at Zuyangming and Zushaoyang Jingxue on stomach and gallbladder kineses and related brain-gut peptide in rabbits. Shijie Huaren Xiaohua Zazhi 2006; 14:1662-1668. [DOI: 10.11569/wcjd.v14.i17.1662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the correlation between the meridians and zang-fu as well as the specific effect of the points on their related zang-fu.
METHODS: Atropine was intravenously injected in the rabbits to inhibit the myoelectric activities of the stomach and the sphincter of oddi (SO). After electroacupuncturing at Zusanli and Yanglingquan points, the myoelectric activities of the stomach and SO were observed, and the levels of motilin (MTL) and cholcystokinin (CCK) in the antrum, SO and plasma were measured.
RESULTS: After atropine injection, the mean amplitudes for the high activity of myoelectric slow wave and fast wave were significantly decreased (P = 0.028, P = 0.001). Moreover, the average frequency of myoelectric slow wave was not significantly changed. The mean amplitudes for the myoelectric slow wave and fast wave were enhanced to some extent after electroacupuncturing at Zusanli and Yanglingquan points. The levels of MTL (P = 0.000) and CCK (P = 0.001) in the antrum, SO and plasma were increased markedly after electroacupuncturing at Zusanli and Yanglingquan points. The levels of MTL in the antrum (P = 0.020) and plasma (P = 0.001) and CCK in plasma (P = 0.001) were obviously increased after electroacupuncturing at Zusanli point, whereas the levels of MTL in SO and CCK in the antrum and SO were notably increased after electroacupuncturing at Yanglingquan point. There was a positive effect on the release of MTL and CCK after electroacupuncturing at the points.
CONCLUSION: The inhibition for the myoelectric activities of the stomach and SO are improved after electroacupuncturing at Zusanli and Yanglingquan points. The possible mechanism may be that the acupuncture influences the release of MTL and CCK, so as to regulate the activity of the alimentary canal.
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Woods CM, Mawe GM, Toouli J, Saccone GTP. The sphincter of Oddi: understanding its control and function. Neurogastroenterol Motil 2005; 17 Suppl 1:31-40. [PMID: 15836453 DOI: 10.1111/j.1365-2982.2005.00658.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The most common functional disorders of the biliary tract and pancreas are associated with disordered motility of the sphincter of Oddi (SO). The SO is a neuromuscular structure located at the junction of the bile and pancreatic ducts with the duodenum. The primary functions of the SO are to regulate the delivery of bile and pancreatic juice into the duodenum, and to prevent the reflux of duodenal contents into the biliary and pancreatic systems. Disordered motility of the SO leads to the common and painful clinical conditions of SO dysfunction and acute pancreatitis. In order to understand normal SO motility, studies have been performed addressing SO function, control of spontaneous SO activity, responses to bioactive agents, SO innervation, and reflexes with other gastrointestinal organs. These studies have led to the current understanding of how the SO functions and may permit the development of targeted therapy for SO dysfunction and acute pancreatitis. This review summarizes the current knowledge regarding the control and regulation of SO motility, highlighting laboratory based and clinical research performed over the last 5 years.
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Affiliation(s)
- C M Woods
- Pancreatobiliary Research Group, Department of General and Digestive Surgery, Flinders University, Flinders Medical Centre, Bedford Park, Australia
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Sanmiguel C, Soffer EE. Intestinal dysmotility and its relationship to sphincter of Oddi dysfunction. Curr Gastroenterol Rep 2004; 6:137-9. [PMID: 15191693 DOI: 10.1007/s11894-004-0041-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Sphincter of Oddi dysfunction (SOD) is a clinical entity that presents with pain as the predominant symptom, and patients may require invasive procedures for its proper diagnosis. Those with abnormal sphincter of Oddi manometry (SOM) are commonly treated with endoscopic ablation of the sphincter. The results of such therapy vary and depend on the type of SOD. In the past several years, evidence has emerged of an association between SOD, intestinal dysmotility, and visceral hyperalgesia. This article reviews the evidence supporting such an association.
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Affiliation(s)
- Claudia Sanmiguel
- Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Grivell MB, Woods CM, Grivell AR, Neild TO, Craig AG, Toouli J, Saccone GTP. The possum sphincter of Oddi pumps or resists flow depending on common bile duct pressure: a multilumen manometry study. J Physiol 2004; 558:611-22. [PMID: 15169843 PMCID: PMC1664969 DOI: 10.1113/jphysiol.2004.061663] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The sphincter of Oddi (SO) regulates trans-sphincteric flow (TSF) by acting primarily as a pump or as a resistor in specific species. We used the Australian possum SO, which functions similarly to the human SO, to characterize SO motility responses to different common bile duct (CBD) and duodenal pressures. Possum CBD, SO and attached duodenum (n= 18) was mounted in an organ bath. External reservoirs were used to impose CBD (0-17 mmHg) and duodenal (0, 4, 7 mmHg) pressure. Spontaneous SO activity was recorded using four-lumen pico-manometry and TSF was measured gravimetrically. Temporal analysis of manometric and TSF recordings identified three functionally distinct biliary-SO regions, the proximal-SO (juxta-CBD), body-SO and papilla-SO. At CBD pressures < 3 mmHg the motor activity of these regions was coordinated to pump fluid. Proximal-SO contractions isolated fluid within the body-SO. Peristaltic contraction through the body-SO pumped this fluid through the papilla-SO (17-27 microl contraction), which opened to facilitate flow. CBD pressure > 3.5 mmHg resulted in progressive changes in TSF to predominantly passive 'resistor'-type flow, occurring during proximal-SO-body-SO quiescence, when CBD pressure exceeded the pressure at the papilla-SO. Progression from pump to resistor function commenced when CBD pressure was 2-4 mmHg greater than duodenal pressure. These results imply that TSF is dependent on the CBD-duodenal pressure difference. The papilla-SO is pivotal to TSF, relaxing during proximal-SO-body-SO pumping and closing during proximal-SO-body-SO quiescence. The pump function promotes TSF at low CBD pressure and prevents bile stasis. At higher CBD pressure, the papilla-SO permits TSF along a pressure gradient, thereby maintaining a low pressure within the biliary tract.
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Affiliation(s)
- Marlene B Grivell
- Department of General and Digestive Surgery, Centre for Digestive Sciences, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia
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Wei JG, Wang YC, Liang GM, Wang W, Chen BY, Xu JK, Song LJ. The study between the dynamics and the X-ray anatomy and regularizing effect of gallbladder on bile duct sphincter of the dog. World J Gastroenterol 2003; 9:1014-9. [PMID: 12717848 PMCID: PMC4611364 DOI: 10.3748/wjg.v9.i5.1014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the relationship between the radiological anatomy and the dynamics on bile duct sphincter in bile draining and regulatory effect of gallbladder.
METHODS: Sixteen healthy dogs weighing 18 kg to 25 kg were divided randomly into control group and experimental group (cholecystectomy group). Cineradiography, manometry with perfusion, to effect of endogenous cholecystokinin and change of ultrastructure were employed.
RESULTS: According to finding of the choledochography and manometry, in control group the intraluminal basal pressure of cephalic cyclic smooth muscle of choledochal sphincter cCS was 9.0 ± 2.0 mmHg and that of middle oblique smooth muscle of choledochal sphincter (mOS) was 16.8 ± 0.5 mmHg, the intraluminal basal pressure of cCS segment was obviously lower than that of mOS (P < 0.01) in the interval period of bile draining, but significant difference of intraluminal basal pressure of the mOS segment was not found between the interval period of bile draining (16.8 ± 0.5 mmHg) and the bile flowing period (15.9 ± 0.9 mmHg) (P > 0.05). The motility of cCS was mainly characterized by rhythmically concentric contraction, just as motility of cCS bile juice was pumped into the mOS segment in control group. And motility of mOS segment showed mainly diastolic and systolic activity of autonomically longitudinal peristalsis. There was spasmodic state in cCS and mOS segment and reaction to endogenous cholecystokinin was debased after cholecystectomy. The change of ultrastructure of cCS portion showed mainly that the myofilaments of cell line in derangement and mitochondria is swelling.
CONCLUSION: During fasting, the cCS portion has a function as similar cardiac "pump" and it is main primary power source in bile draining, and mOS segment serves mainly as secondary power in bile draining. The existence of the intact gallbladder is one of the important factors in guaranteeing the functional coordination between the cCS and mOS of bile duct sphincter. There is dysfunction in the cCS and mOS with cholecystectomy.
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Affiliation(s)
- Jing-Guo Wei
- Radiology Department of Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, Shaanxi Province, China.
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Nabae T, Yokohata K, Otsuka T, Inoue K, Yamaguchi K, Chijiiwa K, Tanaka M. Effect of truncal vagotomy on sphincter of oddi cyclic motility in conscious dogs. Ann Surg 2002; 236:98-104. [PMID: 12131091 PMCID: PMC1422554 DOI: 10.1097/00000658-200207000-00015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the effects of truncal vagotomy at the diaphragmatic level on the sphincter of Oddi (SO) motility. SUMMARY BACKGROUND DATA Cholelithiasis is a well-known late complication after gastrectomy and/or vagotomy. The mechanism of gallstone formation is only partly understood, and few studies address the effects of vagotomy on SO cyclic motility in conscious subjects. METHODS In conscious dogs, SO motility was recorded by retrograde infusion manometry through a duodenal cannula before and after bilateral truncal vagotomy at the diaphragmatic level. Effects of cholecystokinin-octapeptide and feeding were also evaluated before and after vagotomy. RESULTS SO cyclic motility and the gastroduodenal migrating motor complex continued to occur during postvagotomy fasting. Intermittent inhibitions of the SO and duodenal contractions disappeared during phase 3 of the migrating motor complex. SO basal pressure significantly decreased, whereas the amplitude significantly increased. Cholecystokinin-octapeptide inhibited SO contractions before and after vagotomy. The amplitude of SO contractions increased and their frequency decreased after feeding; however, these effects disappeared after vagotomy. CONCLUSIONS SO cyclic motility and the effects of feeding change after truncal vagotomy at the diaphragmatic level. These facts may at least partly explain gallstone formation after gastric surgery and/or vagotomy.
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Affiliation(s)
- Toshinaga Nabae
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Konomi H, Simula ME, Meedeniya ACB, Toouli J, Saccone GTP. Induction of duodenal motility activates the sphincter of Oddi (SO)-duodenal reflex in the Australian possum in vitro. AUTONOMIC & AUTACOID PHARMACOLOGY 2002; 22:109-17. [PMID: 12568128 DOI: 10.1046/j.1474-8673.2002.00251.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1 The aim of this study was to determine if stimulation of duodenal motility by duodenal fluid distension or by administration of carbachol, activates the sphincter of Oddi-duodenal reflex, in an in vitro preparation from the Australian possum. 2 Duodenal distension was achieved by infusion of Krebs solution (0-8 cm H2O). In separate experiments, the sphincter of Oddi (SO) was partitioned from the duodenum and carbachol (10(-7) - 5 x 10(-6) M) added to the duodenal compartment. 3 Fluid distension increased duodenal motility to 120-600% of control activity. These treatments induced increased SO motility (to 120-390% of control) in six preparations, reduced activity (to 60% of control) in one and no response in another. 4 Addition of carbachol to the duodenal compartment resulted in increased duodenal motility. SO motility was increased in seven preparations, reduced in another two and no response were evoked in two others. All SO responses were blocked by tetrodotoxin pretreatment. 5 These data suggest that the SO receives inputs from duodenal mechano and/or stretch receptors resulting in excitatory or inhibitory responses, with the excitatory response dominating. These findings support the role for the SO-duodenal reflex in preventing duodenobiliary/pancreatic reflux during periods of elevated duodenal activity.
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Affiliation(s)
- H Konomi
- Department of General and Digestive Surgery, Centre for Digestive Sciences and the Centre for Neuroscience, Flinders Medical Centre, Flinders University, PO Box 2100, Adelaide 5000, South Australia, Australia
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Ohtsuka T, Yokohata K, Inoue K, Nabae T, Takahata S, Tanabe Y, Sugitani A, Tanaka M. Biliary sphincter motility after neural isolation of the pancreatoduodenal region in conscious dogs. Surgery 2002; 131:139-48. [PMID: 11854691 DOI: 10.1067/msy.2002.118953] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several neural and hormonal factors are known to affect the motility of the sphincter of Oddi. However, the precise mechanisms of the control of sphincter motility have not been completely explored. We investigated the relationship of canine biliary sphincter motility when it is extrinsically denervated by neural isolation of the pancreatoduodenal region. METHODS Interdigestive and postprandial sphincter motility in a denervated pancreatoduodenal segment and effects of cholecystokinin-octapeptide were studied in 7 conscious dogs. Data were compared with those of 7 neurally intact control dogs. RESULTS After extrinsic denervation of the pancreatoduodenal region, sphincter motility exerted a cyclic change in concert with the duodenal myoelectric cycles; this change involved short cyclic bursts of motor activity, which gradually increased in intensity. The increase in the cyclic bursts of motor activity was also cyclic and associated with an increase in the plasma motilin concentration. Neural isolation of the pancreatoduodenal region increased sphincter basal pressure and motility index (integral per minute). In the denervated biliary sphincter, the feeding pattern and temporary inhibitory effect of feeding, as seen in controls, were absent, which suggests the role of extrinsic nerves in delivering bile into the duodenum after feeding. In the denervated dogs, cholecystokinin-octapeptide caused excitation of the sphincter activity, instead of relaxation observed in controls. CONCLUSIONS Extrinsic innervation to the pancreatoduodenal region has an inhibitory effect on biliary sphincter motility. Abnormalities in extrinsic innervation to the biliary sphincter might increase the resistance of the sphincter to the bile flow and induce bile stagnation.
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Affiliation(s)
- Takao Ohtsuka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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