Osman GÜLER, Muammer KARAAYVAZ, Metin AYDIN, Osman Nuri DİLEK

The effect of hepatic plexus vagectomy on the sphincter of Oddi in humans

Right upper quadrant billary type pain is classified in three types. Biliary group lll patients have only biliary type pain that is due to sphincter of Oddi dyskinesia and without any abnormalities. In these patients, endoscopic sphincterotomy is a current treatment method that is performed to decrease the choledochal pressure and to facilitate bile flow into the duodenum. In this prospective study, the effect of hepatic plexus vagectomy as an adjunct to cholecystectomy on the sphincter of Oddi was investigated in biliary group lll patients who were potential sufferers of postcholecystectomy syndrome. Common bile duct pressures in 62 cholelithiasis patients were recorded by means of a catheter introduced through the cystic duct after open cholecystectomy. The upper limit of normal choledochal pressure was hypothesized to be 15cm H 2 O. The perfusion pressures were above this limit in 15 patients. The first 7 patients formed the study group and the subsequent 8 patients were the controls. Hepatic plexus vagectomy was performed on the patients in the study group. The mean decrease of common bile duct pressure was 31.6% after hepatic plexus vagectomy and was significant (p

PDF

___

1. Botoman VA, Kozarek RA, Novell LA et al. Long–term outcome after endoscopic sphincterotomy in patients with biliary colic and suspected sphincter of Oddi dysfunction. Gastrointest Endosc 1994; 40: 165–70. 2. Hogan WJ, Geenen JE, Biliary dyskinesia. Endoscopy 1988; 20: 179–83. 3. Chuttani R. Carr–locke DL. Motility and dysmotility of the biliary tract and sphincter of Oddi. In: Sleisenger MH, Fordtran JS eds. Gastrointestinal disease. W.B. Saunders Co. Philadelphia, 1993, pp: 1777–1788. 4. Schein CJ, Benevantono TC. Choledochal dynamics in man. Surg Gynecol Obstet 1968; 126: 591–6. 5. Amdrup BM, Griffith CA. The effects of vagotomy upon biliary function in dogs. J Surg Res 1970; 10: 209–12. 6. Sener M. Çilingiroglu K. The influence of hepatic plexus vagectomy as an adjunt to cholecystectomy on the sphincter of Oddi (Experimental study in dogs). Turkish J Surg 1986; 3: 31–8. 7. Gregg JA, Carr–Locke DL. Endoscopic pancreatic and biliary manometry in pancreatic, biliary, and papillary disease, and after endoscopic sphincterotomy and surgical sphincteroplasty. Gut 1984; 25: 1247–54. 8. Carr–Locke DL. Sphincter of Oddi manometry: the control population. Ital J Gastroenterol 1985; 17: 341–5. 9. Meshkinpour H, Mollot M, Eckerling GB, Bookman L. Bile duct dyskinesia: clinical and manometric study. Gastroenterology 1984; 87: 759–62. 10. Toouli J, Roberts–Thomson IC, Dent J, Lee J. Manometric disorders in patients with suspected sphincter of Oddi dysfunction. Gastroenterology 1985; 88: 1243–50. 11. Gadacz TR. Anatomy and physiology of the gallbladder and extrahepatic billary ducts. In: Shackelford RT, Zuldema GD eds. Surgery of the alimentary tract. W.B. Saunders Co. Philadelphia, 1983, pp 163–71. 12. Dahlstrand C. The vagal nerves and peptides in the control of extrahepatic biliary motility. An experimental study in the cat. Acta Physiol Scand Suppl 1990; 589: 1–52. 13. Doran FS. The sites to which pain is referred from the common bile duct in man and its implication for the theory of referred pain. Br J Surg 1967; 54: 599–606. 14. Brandstatter G. Kratochvil P, Wurzer H. Dysfunction of the sphincter of Oddi as a cause of so–called postcholecystectomy syndrome. Wien Klin Wochenschr 1991; 103: 577–80. 15. Tooli J, Roberts–Thomson IC, Dent J, Lee J, Sphincter of Oddi motility disorders in patients with idiopathic recurrent pancreatitis. Br J Surg 1985; 72: 859–63. 16. Chuttani R, Carr–lock DL. Pathophysiology of the sphincter of Oddi. Surg Clin North Am 1993$ 73: 1311-22. 17. Sung JY, Leung JW, Shaffer EA et al. Ascending infection of the biliary tract after surgical sphincterotomy and biliary stending. J. Gastroenterol Hepatol 1992: 7: 240-5. 18. Calabuig R, Ulrich-Baker MG, Moody FG, Weems WA. The propulsive behavior of the opossum sphincter of Oddi. Am J Physiol 1990; 258 138-142. 19. Calabuig R, Weems WA, Moody FG. Choledochoduodenal flow: Effect of the sphincter of Oddi in opossums and cats. Gastroenterology 1990;258: 138-142. 19. Calabuig R, Weems WA, Moody FG. Choledochoduodenal flow: Effect of the sphincter of Oddi in opossums and cats. Gastroenterology 1990; 99: 1641-6. 20. Didio LJA, Boyden EA. The choledochoduodenal junction in the horse, a study of the musculature around the ends of the bile and pancreatic ducts in a species without a gallbladder. Anatomy records 1962; 143: 61-6.