Surgical Strategy for Choledocal Stones Associated with Juxtapapillary Duodenal Diverticula using Intraoperative Cholangiomanometory

Yasuhiko Nagano, Hitoshi Sekido, Noboru Yoshimoto, Yoshiro Fujii, Kaoru Nagahori, Shinji Togo and Hiroshi Shimada

Yokohama City University School of Medicine, Second Department of Surgery

Material and method: We conducted variable loading cholangiomanometory on 40 patients with common bile duct stones and cholangiomanometory under the load of duodenal pressure on 17 patients with juxtapapillary diverticula. The catheter was introduced into the common bile duct after choledocholithotomy. The biliary pressure was measured by the manometer while varying the flow rate using infusion pump. A linear relationship was obtained between flow rate and biliary pressure, the gradient of the line was calculated as the resistance value (R value) and the pressure at flow rate zero was calculated as P value. Results: (1) P value of the patients with juxtapapillary diverticula were significantly lower than those without diverticula (84.0±29.1 v.s. 156.7±67.4mmH₂O). (2) Two patients had a recurrence, and 2 had cholangitis, and 3 of all 4 had a juxtapapillary diverticula. (3) Two of the 17 with juxtapapillary diverticula had a great increase of R value more than 8 units on cholangiomanometory under the load of duodenal pressure and developed recurrence and cholangitis, on the other hands, one of the 15 had a slightly increase less than 2 units developed recurrence. Conclusion: The results suggest that suffering recurrence patients with juxtapapillary diverticula have a greater increase of the R value on cholangiomanometory under the load of duodenal pressure and need additional surgery on the inferior bile duct.

Key words
choletithiasis, cholangiomanometory, juxtapapillary duodenal diverticula

Reprint requests
Yasuhiko Nagano Second Department of Surgery, Yokohama City Univercity School of Medicine 3-9 Hukuura, Kanazawaku, Yokohama City, 236-0024 JAPAN

Accepted
March 28, 2001

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