Pancreatic sphincteroplasty: indications and outcome.

Twenty patients received transduodenal pancreatic sphincteroplasty for one of three indications: post-cholecystectomy pain with a strongly positive Nardi test (n = 5), recurrent attacks of idiopathic acute pancreatitis (n = 7) and chronic pancreatitis (n = 8). Three patients had an accessory sphincteroplasty in addition to double sphincteroplasty at the major papilla (transampullary septectomy). Pain was relieved in four of the five post-cholecystectomy patients at a median 21 months after sphincteroplasty. On a scale from 0-10 the mean pain score decreased from 9.1 to 2.8, and the preoperative rise in serum amylase with morphine-prostigmine provocation was abolished. None of the patients with recurrent pancreatitis has had a further attack postoperatively, though one had transient pain without hyperamylasaemia. Performed as an adjunct to other pancreatobiliary procedures in five cases, sphincteroplasty has contributed to a satisfactory result in all but two of those with chronic pancreatitis. The only serious complication was an infected pancreatic collection in two patients with concomitant resection or drainage of the distal pancreas.