TRANSDUODENAL SPHINCTEROPLASTY: A VISUAL CASE STUDY
Kyle A. Lewellen*, Thomas K. Maatman, Sonal Walia, Alexandra M. Roch, Nicholas J. Zyromski
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
Background
Sphincter of Oddi dysfunction (SOD) is a rare disorder. Endoscopy allows minimally invasive diagnosis and therapy. Open transduodenal sphincteroplasty (TDS) is an option for SOD.
Methods
The video shows TDS on a female with gastric bypass diagnosed with Type I SOD and choledochocele.
Results
Laparotomy and Kocher maneuver performed. Intraoperative ultrasound identifies ampulla and duodenotomy site. Pediatric feeding tube cannulates common bile duct, facilitating sphincterotomy. Sphincteroplasty is performed with absorbable suture. Feeding tube acts as a pancreatic stent during duodenotomy closure.
Conclusion
TDS is an option for SOD patients whose anatomy is unfavorable for endotherapy.
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