Ninety-two patients underwent a
transduodenal sphincteroplasty and transampullary septectomy (extended papilloplasty) for chronic, incapacitating upper
abdominal pain over an 11-year period. Seventy-nine had a prior
cholecystectomy; 42 of 56 patients with reported pathology had documented
gallstone disease. Serious morbidity included two moderately severe cases of postoperative
pancreatitis and a pulmonary
embolus. There were no deaths. Operative findings revealed stenosing
papillitis (n = 45), transampullary septitis (n = 40), and papillary dysfunction (n = 7). Histologic examination of septal biopsy specimens revealed
inflammation in 34 cases and
fibrosis in 19 cases. There were no microscopic abnormalities in 39 biopsy specimens. The results at 1 to 10 years in 83 patients is as follows: good in 36 patients (no
pain--43%), fair in 27 patients (occasional
pain--33%), and poor in 20 patients (unrelieved by the procedure--24%). Patients with prior sphincteroplasty (12 of 15 with a fair to good result) benefitted the most from the procedure. Those who underwent concomitant
cholecystectomy responded poorly. Risk factors for failure include
alcoholism,
drug addiction,
mental illness, and
duodenal ulcer disease. The finding of papillary cholesterolosis at operation also was accompanied by a less than optimal result.
Transduodenal sphincteroplasty with transampullary septectomy provides long-term benefit to carefully selected patients with chronic
abdominal pain after
cholecystectomy.