ANATOMICAL ABNORMALITIES OF THE PARAPAPILLARY ZONE AND THE DISTAL PART OF THE COMMON BILE DUCT

M.P. PAVLOVSKY, Ya. R. DUTKA, V.I. KOLOMIYTSEV

Анотація


The aim - the surgical results of 112 patients with choledocholithiasis
who had unsuccessful endoscopic therapy
because of anatomical abnormalities of the parapapillary
zone or the distal part of the common bile duct were analyzed.
Materials and methods
The anatomical variations related to failed endoscopic
therapy were analyzed and classified. Difficulties in the
performance of ERCP were related to anatomical features of
the stomach and duodenum, including: parapapillary
diverticula, severe edema of the intestinal mucosa with
pancreatitis, hypertrophy of intestinal mucosal folds, scars, and
pyloroduodenal stenosis; previous operations on the stomach
or duodenum (gastrectomy, B-II); abnormalities of the papilla
of Vater (stenosis or deformation); and abnormalities of the
distal part of the common bile duct.
Results and Discussion
In 79 (70.5%) patients, a biliodigestive anastomosis was
performed, but in 33 (29.5%) patients, external biliary
drainage was used. The indications for surgery and its results
were discussed.
Conclusions
Difficulties in performance of ERCP in these patients were more
often related to parapapillary diverticula (34.0%) and
narrowing of the distal part of the common bile duct (17.5%).
In cases of good bile passage through the duodenal papilla,
external drainage of the common bile duct is indicated; papilla
obstruction is an indication for biliodigestive anastomosis.
Key words: choledocholithiasis, sphincterotomy, biliodigestive
anastomosis

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