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Endoscopic Sphincterotomy and Extraction of Gallstones S. Ikeda 1,2 , H. Itoh 1 , M. Tanaka 1 1The First Department of Surgery, Kyushu Univeryity School of Fukuoka pp.667-678
Published Date 1980/6/25
DOI https://doi.org/10.11477/mf.1403106909
  • Abstract
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 We report the results of endoscopic sphincter0tomy with a long tip cutting wire and basket catheter extraction of gallstones. From November 1974 till March 1979, sphincterotomy was attempted in 104 patients: 63 with retained or recurrent common bile duct stones after cholecystectomy, 10 with hepatocl'1oledocholithiasis after cholecystectomy, 27 with choledocholithiasis of poor operative risk with a gallbladder in place, and 4 with other miscellaneous diseases involving the ampullary region. Half of the 100 patients with common duct stones (49 patients) in this series had at least one operative risk factor. The procedure was successful in 101 patients (97%) in total, and in 97 of 100 patients with gallstones. Of these 97 patients, common duct stones were eliminated in 94 (97 %). The success rate of stone removal was high when compared with other series previously reported. It seemed to be attributable to our aggressive attitude towards extraction of even large stones. Complications of sphincterotomy included three cases of bleeding, two of cholangitis, two of pancreatitis and one of stone impaction which led to the only fatality in the present series. Thus morbidity was 7.7 per cent and mortality 1.0 per cent.

 Although long-term consequences especially in terms of restenosis and reflux cholangitis remain to be defined to make a conclusive assessment of the value of this procedure, it would currently be of great value to remove recurrent or retained common duct stones after previous surgery, or to obtain a biliary drainage in urgent cases of cholangitis.

 We have also stressed the clinical significance of removal of common duct stones by endoscopic sphincterotomy preceding cholecystectorny to reduce an operative burden imposed upon aged or high-risk patients with stones in both of the gallbladder and common duct.


Copyright © 1980, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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