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    Suggest treatment for acute cholecystitis

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Posted on Sat, 22 Apr 2017 in Digestion and Bowels
Question: My wife is70 years old and developed acute cholecystitis from a stone in the gallbladder. The gallbladder was gangrenous and had one large stone obstructing the cystic duct. A day prior to surgery she had a stent placed in the common bile duct and a cholangiogram was performed which revealed no stones in the bile duct. The gallbladder was removed by laparoscopic methods and she has done well. This was 1 month ago. Her gastroenterologist wants to remove the stent in May and do a sphincterotmy of the sphincter of Oddi at the same time. He said this will reduce stasis in the bile duct and prevent future stones. I have researched this quite a bit and could not find anywhere that a sphincterotomy is done prophylactically. I am also a physician. What is your opinion, as I know this procedure can have complications. Thanks
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
She should go for operation.

Detailed Answer:
Hello,
Thanks for choosing this forum.

The sphincter of Oddi refers to the smooth muscle that surrounds the end portion of the common bile duct and pancreatic duct. This muscle relaxes during a meal to allow bile and pancreatic juice to flow into the intestine. Endoscopic sphincterotomy: An operation to cut the muscle between the common bile duct and the pancreatic duct.

The sphincter of Oddi is a muscular valve that controls the flow of digestive juices (bile and pancreatic juice) through the ampulla of Vater into the second part of the duodenum.

Fatty acids in the lumen of the duodenum stimulate endocrine cells to release the hormone cholecystokinin (CCK). CCK stimulates contractions in the smooth muscle of the gallbladder. As well, CCK causes relaxation of the sphincter of Oddi, allowing bile release into the duodenum. Hence causing the already gangrenous and sick gall bladder to contract and release bile, but as gall bladder is already removed second potential site is bile duct where future stasis can take place.

Some procedures are done by surgeons on the basis of their experience. It not a compulsory operation but can be beneficial in long term to prevent reexploration of the site.

I think your surgeon is taking the right step.

Regards.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ramesh Kumar 12 hours later
Thank you for your response. I have just a few questions:
1 What is the incidence of stones in common bile duct following gall bladder removal when no sphincterotomy is performed?
2 What is the incidence of stones in common bile duct following gall bladder removal when sphincterotomy is later performed?
3 What is the incidence of complications after sphincterotomy and what might they be?
There must be some studies to reflect these numbers. Thanks
doctor
Answered by Dr. Ramesh Kumar 3 hours later
Brief Answer:
Follow up answer to patients query.

Detailed Answer:
Hi again,
Various trials and researches by scholars show different results.

Answer are -
1) 2-3% approx (Love and XXXXXXX surgery)
2) Most of the text favor's around 5%.
3) Most common post operative complications are hemorrhage, perforation both hemorrhage and perforation, cholangitis, pancreatitis impaction.

However, if the surgeon is experienced, take my words they are all very rare.
Yes, you can check the official website of NCBI for these numbers. I can't copy or paste the material of other websites as per rule.

Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ramesh Kumar 22 hours later
Dr. Kumar:
Thanks for your prompt answers. According to your answers of my 3 questions, it appears that a sphincterotomy does not do much to prevent future stones in the bile duct (2-3% without and about 5% with). Since my wife is totally asymptomatic and does not have any symptoms of SOD (sphincter of Oddi dysfunction), I see no reason to pursue a prophylactic sphincterotomy and subject her to the risks of complications you mentioned in #3. Even though she has a skilled gastroenterologist, things do sometimes happen. As the old saying goes "if it isn't broke, don't fix it. We as physicians abide by our oath "do no harm." Thanks again. XXXXXXX D. Shindle, M.D.
doctor
Answered by Dr. Ramesh Kumar 5 minutes later
Brief Answer:
Good luck!

Detailed Answer:
Hello again,
Never disturb a system unnecessarly.
Body should be touched only when it's the last option.
Yes donot harm!

Thanks and good luck.
Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2425 Questions

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