Rationale for primary operations on the papilla of Vater.

A procedure is described which allows to objectify the indication for primary operations on the papilla of Vater. During operations on the gallbladder or biliary tract, a radiomanometric examination of the common bile duct is carried out. The study comprises 255 patients. Based upon the results of radiomanometry in 77 patients, a transduodenal revision (papilloplasty) of the papilla was performed. Biopsies from the papilla revealed a high incidence of histological changes. There was a significant correlation between pathological findings on the papilla and abnormal bile pressures. Biochemical signs of cholestasis also correlated significantly with bile pressures. The results of intraoperative manometry allowed therefore conclusions on the functional and morphological state of the papilla. By this method, the indication for operations on the papilla can be objectified and unnecessary papillotomies avoided.