Abstracts
2000 Digestive Disease Week

# 2312 Laparoscopic Transduodenal Sphincteroplasty of the Minor Papilla.
Dennis L. Fowler, Nancy J. Hogle, Pittsburgh, PA

For patients with recurrent pancreatitis and pain caused by pancreas divisum and stenosis of the minor papilla, transduodenal sphincteroplasty of the minor papilla can reduce the incidence of recurrent pancreatitis and pain. We hypothesized that performing this procedure laparoscopically might result in similar benefits to those seen after other types of laparoscopic surgery. We report our experience with 6 cases of laparoscopic transduodenal sphincteroplasty of the minor papilla. The laparoscopic technique included 1) a lateral duodenotomy, 2) identification of the minor papilla, 3) opening the minor papilla widely, 4) laparoscopic suturing of the mucosa of the duct of Santorini to the duodenal mucosa, and 5) closure of the duodenum. Postoperative morbidity, mortality, and length of stay were documented. Each patient was followed for subsequent episodes of pain and pancreatitis. Five female and one male patient aged 43-71 years underwent successful identification of the minor papilla and laparoscopic completion of the sphincteroplasty. In 4 patients, Secretin was available to facilitate identification of the minor papilla, but in two patients it was not. Laparoscopic magnification facilitated identification of the minor papilla, and seemed very helpful in these patients without Secretin. Mean length of stay was 5.2d, and 4 patients went home on the fourth postoperative day. Two patients had complications (pneumonia treated as an outpatient in one and pancreatitis in one) and there was no mortality. Followup ranged from 1-22 months. 4 patients (2 with >1 yr followup) have sustained a good result with no episodes of pancreatitis and either no pain or only occasional pain requiring no narcotic. Another patient was pain free for 3 months, then developed recurrent stenosis and underwent repeat open sphincteroplasty. The other patient had recurrent stenosis and underwent successful endoscopic reopening of the sphincteroplasty site. Laparoscopic transduodenal sphincteroplasty is technically possible, can be done with acceptable morbidity, and results in a shortened recovery. After short term followup, control of pain and pancreatitis are similar to results after open surgery. It may be easier to identify the minor papilla laparoscopically. Documentation of long term results must await larger studies with longer followup.