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Intraoperative removal of common bile duct stone through the intact papilla by flushing with saline solution combined with pharmacologic sphincter relaxation
Author(s) -
Ohta Tetsuo,
Nagakawa Takukazu,
Arakawa Hajime,
Kayahara Masato,
Ueno Keiichi,
Miyazaki Itsuo
Publication year - 1994
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/bf01211919
Subject(s) - major duodenal papilla , flushing , sphincter of oddi , saline , sphincter , medicine , common bile duct , cholecystectomy , bile duct , surgery , anesthesia , endocrinology
In two patients with bile duct stones in the distal common bile duct the stones were successfully removed through the intact papilla without choledochotomy. In both patients, the stone was discovered on the intraoperative cholangiogram just after cholecystectomy. The stone was removed by intraoperative flushing with saline solution, combined with pharmacologic sphincter relaxation. This new technique employs glyceryl trinitrate and butylscopolamine bromide to relax the sphincter of Oddi, followed by intermittent flushing with saline solution to augment pressure in the the distal common bile duct. The saline flushing was initiated 3 min after the agents were administered. This technique is simple and less invasive than conventional methods of choledocholithotomy. We recommend this method as the first choice for the removal of common bile duct stones.