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Lin H, Liang Y, Zhao W, Cao J, Wang T, Wang C. Reassessing the role of nitric oxide in the pathogenesis of sphincter of Oddi dysfunction. Gastroenterol Rep (Oxf) 2025; 13:goaf001. [PMID: 40046950 PMCID: PMC11882319 DOI: 10.1093/gastro/goaf001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 07/25/2024] [Accepted: 09/13/2024] [Indexed: 04/11/2025] Open
Abstract
The pathogenic mechanisms underlying sphincter of Oddi dysfunction (SOD) remain incompletely understood, and it often leads to severe symptoms encompassing nausea, vomiting, and abdominal pain. New evidence now suggests correlations between nitric oxide (NO) and SOD. In this review, we summarized the factors influencing SOD pathogenesis via NO and its derivative, the peroxynitrite anion. NO appears to enhance SOD progression by modulating sphincter of Oddi (SO) contractions via NO-sGC-cGMP signaling or inducing the apoptosis of enteric neurons, interstitial cells of Cajal, smooth muscle cells, and other cellular components via peroxynitrite anion-mediated organelle damage. Thus, a comprehensive understanding of SOD will provide a foundation for the identification of potential drugs and treatment approaches.
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Affiliation(s)
- Haonan Lin
- Department of General Surgery, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang, P. R. China
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Yixuan Liang
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
- School of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Wangqiang Zhao
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
- School of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Junwei Cao
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
- School of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Tianqi Wang
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Changmiao Wang
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
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Walia S, Zaidi MY, McGuire S, Milam C, Fogel EL, Sherman S, Lehman G, Pitt HA, Nakeeb A, Schmidt CM, House MG, Ceppa EP, Timsina L, Zyromski NJ. Contemporary Outcomes of Transduodenal Sphincteroplasty: the Importance of Surgical Quality. J Gastrointest Surg 2023; 27:2885-2892. [PMID: 38062321 DOI: 10.1007/s11605-022-05539-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/04/2022] [Indexed: 02/04/2024]
Abstract
BACKGROUND Sphincter of Oddi dysfunction (SOD) is managed primarily by endoscopic sphincterotomy (ES); however, surgical transduodenal sphincteroplasty (TDS) is a treatment option for select patients. In our high-volume pancreatico-biliary practice, we have observed variable outcomes among TDS patients; therefore, we sought to determine preoperative predictors of durable improvement in quality of life. METHODS SOD patients treated by TDS between January 2006 and December 2015 were studied. The primary outcome measure was long-term changes in quality of life after sphincteroplasty. The secondary outcome measure examined postoperative outcomes, including postoperative complications, need for repeat procedures, and readmission rates. Perioperative data were abstracted, and the SF-36 quality-of-life (QoL) survey was administered. Standard statistical analysis included non-parametric methods to examine bivariate associations. RESULTS Eighty-eight patients had an average follow-up duration of 6.7 (± 2.9) years. Thirty (34%) patients were naïve to endoscopic therapy. Patients with prior endoscopy averaged 2.1 procedures (range 1 to 13) prior to surgery. Perioperative morbidity was 27%; one postoperative death was caused by severe acute pancreatitis. Twenty-nine (33%) patients required subsequent biliary-pancreatic procedures. QoL analysis from available patients showed that 66% were improved or much improved. With multivariable analysis including SOD type and prior endoscopic instrumentation, freedom from surgical complication was the only variable that correlated significantly with a good outcome (p < 0.02). CONCLUSION Surgical transduodenal sphincteroplasty provides durable symptom management for select patients with sphincter of Oddi dysfunction. Minimizing surgical complications optimizes long-term outcomes.
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Affiliation(s)
- Sonal Walia
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall 519, Indianapolis, IN, 46202, USA
| | - Mohammad Y Zaidi
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall 519, Indianapolis, IN, 46202, USA
| | - Sean McGuire
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall 519, Indianapolis, IN, 46202, USA
| | - Claire Milam
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall 519, Indianapolis, IN, 46202, USA
| | - Evan L Fogel
- Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University Medical Center, 550 N. University Boulevard, UH 4100, Indianapolis, IN, 46202, USA
| | - Stuart Sherman
- Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University Medical Center, 550 N. University Boulevard, UH 4100, Indianapolis, IN, 46202, USA
| | - Glen Lehman
- Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University Medical Center, 550 N. University Boulevard, UH 4100, Indianapolis, IN, 46202, USA
| | - Henry A Pitt
- Department of Surgery, Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall 519, Indianapolis, IN, 46202, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall 519, Indianapolis, IN, 46202, USA
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall 519, Indianapolis, IN, 46202, USA
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall 519, Indianapolis, IN, 46202, USA
| | - Lava Timsina
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall 519, Indianapolis, IN, 46202, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall 519, Indianapolis, IN, 46202, USA.
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Lewellen KA, Maatman TK, Zyromski NJ. Transduodenal Sphincteroplasty: A Visual Case Study. J Gastrointest Surg 2023; 27:2665-2666. [PMID: 37787871 DOI: 10.1007/s11605-023-05842-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/09/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Sphincter of Oddi dysfunction is a challenging and rare clinical entity resulting in pancreatobiliary pain and stasis of bile and pancreatic juice. This problem was classically treated with surgical therapy, but as classification of the disease has changed and newer methods of endoscopic evaluation and therapy have evolved, operative transduodenal sphincteroplasty is now generally reserved as a final therapeutic option for these patients. In this video and manuscript, we describe our approach to operative transduodenal sphincteroplasty in a patient with type I Sphincter of Oddi dysfunction. METHODS A 50-year-old female with history of Roux-en-Y gastric bypass presented with episodic right-upper-quadrant and epigastric abdominal pain with associated documented elevations in liver chemistries. Preoperative cross-sectional imaging demonstrated dilation of her common bile duct. After multidisciplinary discussion, the decision was made to pursue operative transduodenal sphincteroplasty. RESULTS All key operative steps of the transduodenal sphincteroplasty are demonstrated in the embedded video. Key operative steps include laparotomy, generous Kocher maneuver, and duodenotomy over the ampulla, allowing access for sequential biliary and pancreatic sphincterotomies and sphincteroplasties with absorbable suture. The duodenotomy and abdominal fascia are then closed. Our patient underwent sequential diet advancement and was discharged to home on postoperative day five. At clinic follow-up, pancreatobiliary-type pain had resolved. CONCLUSION The embedded video demonstrates a case of operative transduodenal sphincteroplasty, which can provide durable results in appropriate patient populations.
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Affiliation(s)
- Kyle A Lewellen
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 519, Indianapolis, IN, 46202, USA
| | - Thomas K Maatman
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 519, Indianapolis, IN, 46202, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 519, Indianapolis, IN, 46202, USA.
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Kegnæs M, Novovic S, Shabanzadeh DM. Dysfunction of Biliary Sphincter of Oddi-Clinical, Diagnostic and Treatment Challenges. J Clin Med 2023; 12:4802. [PMID: 37510917 PMCID: PMC10381482 DOI: 10.3390/jcm12144802] [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: 07/03/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Biliary Sphincter of Oddi dysfunction (SOD) is one of the main causes of post-cholecystectomy pain. In this review, we aimed to provide an update on the current knowledge on biliary SOD, with an emphasis on diagnostics and therapy. Overall, current but scarce data support biliary sphincterotomy for patients with type 1 and 2 SOD, but not for type 3. However, sphincterotomy is associated with post-treatment pancreatitis rates of from 10% to 15%, thus calling for improved diagnostics, patient selection and treatment modalities for SOD. The role of pharmacologic therapy for patients with SOD is poorly explored and only two randomized controlled trials are available. Currently, studies comparing treatment outcomes are few. There is an unmet need for randomized sham/placebo-controlled clinical trials related to both pharmacological and non-pharmacological treatments of SOD.
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Affiliation(s)
- Marina Kegnæs
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, 1172 Copenhagen, Denmark
| | - Srdan Novovic
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, 1172 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 1172 Copenhagen, Denmark
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Zheng H, Yan S, Li D, Xue Y, Deng X. Influence of periampullary diverticula on endoscopic retrograde cholangiopancreatography. Exp Ther Med 2021; 21:410. [PMID: 33692841 DOI: 10.3892/etm.2021.9841] [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: 02/28/2020] [Accepted: 01/08/2021] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to explore the influence of the presence of periampullary diverticula (PAD) on the implementation of endoscopic retrograde cholangiopancreatography (ERCP). A total of 388 patients with pancreaticobiliary disease who underwent ERCP for the first time between January 2017 and December 2018 were included and they were divided into a PAD group (n=179) and non-PAD (N-PAD) group (n=209) according to the presence or absence of PAD. A logistic regression model was used to analyze the risk factors for PAD. The prevalence of PAD in males was higher than that in females [odds ratio (OR)=2.250, 95% CI: 1.670-3.801]. The prevalence of PAD in patients with bile duct stone was 57.92% and higher than that in patients without stone (OR=4.475, 95% CI: 2.932-7.679). The morbidity of PAD in elderly patients with bile duct stone was higher than in those without stone (OR=6.728, 95% CI: 3.790-11.943). Among the elderly patients, the constituent ratio of males in the PAD group was higher than that in the N-PAD group (χ2=13.543, P<0.001). The constituent ratio of patients who underwent endoscopic sphincterotomy (EST) was lower than that in the N-PAD group (χ2=10.800, P<0.001). In conclusion, the occurrence of PAD was high in elderly males and closely related to the occurrence of bile duct stones.
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Affiliation(s)
- Hailun Zheng
- Department of Gastroenterology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Shanjun Yan
- Department of Gastroenterology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Dapeng Li
- Department of Gastroenterology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Yongju Xue
- Department of Gastroenterology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Xiaojing Deng
- Department of Gastroenterology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
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Lv Y, Liu N, Wu H, Li Z. Etiological classification and treatment strategies for secondary bile duct dilatation. Exp Biol Med (Maywood) 2021; 246:281-285. [PMID: 33167690 PMCID: PMC7876649 DOI: 10.1177/1535370220966767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Secondary intra- and extrahepatic bile duct dilatation is a very common condition that can be caused by several diseases. However, it has been rarely discussed in the specialized literature. Moreover, no distinct etiology can be determined in some cases, which hampers the diagnosis and treatment. Here, we discuss the etiological classification and treatment strategies of secondary intra- and extrahepatic bile duct dilatation based on an extensive literature review, as well as our experimental research and clinical experience. The etiology of secondary intra- and extrahepatic bile duct dilatation can be classified in different ways. From a clinicopathological perspective, it can be classified into obstruction-, lesion-, and compression-induced dilatation. Treatment varies depending on the cause. For example, endoscopic dilation or stenting is used for biliary strictures, laparoscopic choledochectomy for stone removal, and resection for cholangiocarcinoma.
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Affiliation(s)
- Yunfu Lv
- Department of General Surgery, Hainan General Hospital (Hainan Medical College Affiliated People's Hospital), Haikou 570311, China
| | - Ning Liu
- Department of General Surgery, Hainan General Hospital (Hainan Medical College Affiliated People's Hospital), Haikou 570311, China
| | - Hongfei Wu
- Department of General Surgery, Hainan General Hospital (Hainan Medical College Affiliated People's Hospital), Haikou 570311, China
| | - Zhuori Li
- Department of General Surgery, Hainan General Hospital (Hainan Medical College Affiliated People's Hospital), Haikou 570311, China
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7
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Abstract
Nearly 20,000 pediatric patients undergo cholecystectomy annually, and abnormal gallbladder emptying ("biliary dyskinesia") has replaced cholelithiasis as the leading indication for this operation in the USA. Nonetheless, patients with abnormal gallbladder emptying nuclear medicine scans do not uniformly benefit from cholecystectomy. This article reviews the available data on presentation, workup and treatment of patients with abnormally low and high rates of gallbladder emptying.
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Affiliation(s)
- M Coluccio
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 818 Ellicott St, Buffalo, New York, 14203, USA
| | - A J Claffey
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 818 Ellicott St, Buffalo, New York, 14203, USA
| | - D H Rothstein
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 818 Ellicott St, Buffalo, New York, 14203, USA; Department of Pediatric Surgery, John R. Oishei Children's Hospital, 818 Ellicott St, Buffalo, New York, 14203, USA.
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Ungur M, Babes PA, Maghiar A, Pop GM, Feder B. Diagnosis and Therapeutic Management in Postcholecistectomy Alithiasic Cholangitis. MÆDICA 2019; 14:247-253. [PMID: 31798740 DOI: 10.26574/maedica.2019.14.3.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Introduction:The objective of the current retrospective study is to present the results of a personal research on the prevalence and treatment of alithiasic cholangitis in hospitalized patients. Material and methods:The research was based on the following criteria: case selection according to gender, age and diagnosis, anamnesis information, clinical, paraclinical, imagery and laboratory investigation methods, therapeutic approach. Results:Between 2016-2018, 109 cases had a discharge diagnosis of postcholecystectomy cholangitis following clinical and paraclinical examinations. In a large percentage, cholangitis was alithiasic, imagery assessments showing only a dilation of the intra- and/or extra-hepatic biliary ducts (81 cases, 91.01%). Conclusions:Alithiasic cholangitis has been the main biliary cause in the postcholecystectomy pathology in this reference study (91.01%). In hospitalized people with alithiasic cholangitis as main diagnosis, highlighted endoscopic retrograde cholangiopancreatography (ERCP) represented a modern therapeutic approach; this allows the improvement of sphincter Oddi functional disorders through sphincterotomy/sphincteroplasty (6.75%).
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Affiliation(s)
- Mariana Ungur
- Faculty of Medicine and Pharmacy, University of Oradea, Romania
| | | | - Adrian Maghiar
- Faculty of Medicine and Pharmacy, University of Oradea, Romania
| | | | - Bogdan Feder
- Faculty of Medicine and Pharmacy, University of Oradea, Romania
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Schwartz PB, Easler JJ, Lancaster WP, House MG, Zyromski NJ, Schmidt C, Nakeeb A, Ceppa EP. Sphincter of Oddi Dysfunction After Gastric Bypass: Surgical or Endoscopic Therapy? J Surg Res 2019; 238:41-47. [DOI: 10.1016/j.jss.2019.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/27/2018] [Accepted: 01/04/2019] [Indexed: 12/12/2022]
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Yang Y, Wang K, Wang CM. Current situation and problems in diagnosis and treatment of sphincter of Oddi dysfunction. Shijie Huaren Xiaohua Zazhi 2018; 26:1735-1741. [DOI: 10.11569/wcjd.v26.i30.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Sphincter of Oddi dysfunction (SOD) is a clinical syndrome referring to the loss of normal physiological function of the sphincter of Oddi with upper abdominal pain from the gallbladder and pancreas, postprandial abdominal bloating, elevation of liver or pancreatic enzymes, common bile duct dilation, pancreatitis and so on. SOD is more common in patients after cholecystectomy. Although the established criteria for diagnosing and treating SOD have been applied in clinical practice, its diagnosis and treatment have long been a controversial topic since the best diagnostic and treatment methods are still unconfirmed, partly because of its natural course, disease treatment process, and long-term follow-up outcomes that have not been determined in large controlled studies. This article briefly reviews the latest research of SOD and comprehensively analyzes the current status and existing problems in the diagnosis and treatment of SOD, with an aim to provide appropriate advice for clinicians to diagnose and treat this disease.
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Affiliation(s)
- Ying Yang
- Department of General Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Kai Wang
- Department of General Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Chang-Miao Wang
- Department of General Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
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Afghani E, Lo SK, Covington PS, Cash BD, Pandol SJ. Sphincter of Oddi Function and Risk Factors for Dysfunction. Front Nutr 2017; 4:1. [PMID: 28194398 PMCID: PMC5276812 DOI: 10.3389/fnut.2017.00001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/10/2017] [Indexed: 12/14/2022] Open
Abstract
The sphincter of Oddi (SO) is a smooth muscle valve regulating the flow of biliary and pancreatic secretions into the duodenum, initially described in 1887 by the Italian anatomist, Ruggero Oddi. SO dysfunction (SOD) is a broad term referring to numerous biliary, pancreatic, and hepatic disorders resulting from spasms, strictures, and relaxation of this valve at inappropriate times. This review brings attention to various factors that may increase the risk of SOD, including but not limited to: cholecystectomy, opiates, and alcohol. Lack of proper recognition and treatment of SOD may be associated with clinical events, including pancreatitis and biliary symptoms with hepatic enzyme elevation. Pharmacologic and non-pharmacologic approaches are discussed to help recognize, prevent, and treat SOD. Future studies are needed to assess the treatment benefit of agents such as calcium-channel blockers, glyceryl trinitrate, or tricyclic antidepressants in patients with SOD.
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Affiliation(s)
| | - Simon K. Lo
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Cui L, Xu Z, Ling XF, Wang LX, Hou CS, Wang G, Zhou XS. Laparoscopic hepaticoplasty using gallbladder as a subcutaneous tunnel for hepatolithiasis. World J Gastroenterol 2014; 20:3350-3355. [PMID: 24695884 PMCID: PMC3964406 DOI: 10.3748/wjg.v20.i12.3350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/14/2014] [Accepted: 02/27/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the feasibility, efficacy and safety of laparoscopic hepaticoplasty using gallbladder as subcutaneous tunnel and sphincter-of-Oddi preservation for hepatolithiasis.
METHODS: From January 2010 to July 2013, six patients with hepatolithiasis were treated at our institution. All the patients underwent laparoscopic surgery. The procedures included common hepatic duct exploration, stone clearance by fiberoptic choledochoscopy, hilar bile duct hepaticoplasty with preservation of the sphincter of Oddi, anastomosis between the hilar bile duct and neck of the gallbladder, and establishment of a subcutaneous tunnel with the gallbladder. Two patients underwent left lateral hepatectomy simultaneously. Clinical data including operation time, intraoperative blood loss, operative morbidity, hospital mortality, stone clearance, and recurrence rate were analyzed.
RESULTS: All patients successfully completed laparoscopic surgery. The mean length of hospital stay was 4.5 ± 0.9 d (range: 3-6 d). The mean blood loss of the hepatectomy was 450 mL (range: 200-700 mL), and the blood loss of the other four was 137 ± 151 mL (range: 50-400 mL). The mean operative time was 318 ± 68 min (range: 236-450 min). The operative morbidity and hospital mortality were zero. The immediate stone clearance rate was 100%. All patients were followed up for an average of 17 mo (range: 7-36 mo). One of the six patients had abdominal mass with pain, and subcutaneous tunnel cholangiography showed severe gallbladder-biliary anastomotic stricture at 4 mo postoperatively. There was no stone recurrence and no cholangitis during follow-up.
CONCLUSION: Laparoscopic hepaticoplasty using gallbladder with a subcutaneous tunnel and preserving the sphincter of Oddi is feasible, safe and effective for hepatholithiasis.
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Matthews JB, Melvin WS. Current Concepts and Controversies in Foregut Motility: the 2012 Kelly and Carlos Pellegrini SSAT/SAGES Joint Symposium. J Gastrointest Surg 2013; 17:1545-6. [PMID: 23801520 DOI: 10.1007/s11605-013-2256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/10/2013] [Indexed: 01/31/2023]
Abstract
The 2012 Kelley and Carlos Pellegrini SSAT/SAGES Joint Symposium covered the topic "Current Concepts and Controversies in Foregut Motility". This article summarizes the high points of this session, which included the diagnosis and management of achalasia, gastroparesis, and biliary dyskinesia.
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