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Sphincterotomy of Oddi's muscle through posterior distal duodenum: a modified technique with low morbidity and mortality.

BACKGROUND/AIMS
Today, most common bile duct stones are successfully removed with endoscopic and/or laparoscopic techniques; however, in a small number of cases these procedures fail and the stones have to be removed with older techniques. These techniques involve laparotomy and supraduodenal and/or transduodenal common bile duct approaches and are associated with complication rates that may be as high as 12%. We describe in this report a modification of the classic supraduodenal and transduodenal technique that results in substantial decrease of postoperative morbidity and mortality.


MATERIALS AND METHODS
Rather than approaching the common bile duct through the anterior wall of the duodenum we reflect the duodenum anteriorly and approach the common bile duct through a 5-10 mm long incision in the posterior wall of the third, horizontal duodenal segment. Prior to the advent of endoscopy and laparoscopy, we used this technique for sphincterotomy and bile duct stone removal in 212 patients.


RESULTS
Four to six weeks postoperatively, the common bile ducts were free of stones in 99% of patients, and there were no instances of duodenotomy dehiscence, fistula formation, pancreatitis, infection, hemorrhage, duodenal constriction, ascending cholangitis, or death.


CONCLUSIONS
The results shows that sphincterotomy and bile duct stone removal via a duodenotomy in the posterior wall of the horizontal duodenal segment has substantially lower complication rates than if the common bile duct is approached through the anterior duodenal wall. They also suggest that it is the procedure of choice in cases in which endoscopic and/or laparoscopic techniques have failed.