The Effect of Hepatic Plexus Vagectomy on the Sphincter of Oddi in Humans

Abstract

Right upper quadrant billary type pain is classified in three types. Biliary group lll patients have only biliary type pain that is due to sphincter of Oddi dyskinesia and without any abnormalities. In these patients, endoscopic sphincterotomy is a current treatment method that is performed to decrease the choledochal pressure and to facilitate bile flow into the duodenum. In this prospective study, the effect of hepatic plexus vagectomy as an adjunct to cholecystectomy on the sphincter of Oddi was investigated in biliary group lll patients who were potential sufferers of postcholecystectomy syndrome. Common bile duct pressures in 62 cholelithiasis patients were recorded by means of a catheter introduced through the cystic duct after open cholecystectomy. The upper limit of normal choledochal pressure was hypothesized to be 15cm H 2 O. The perfusion pressures were above this limit in 15 patients. The first 7 patients formed the study group and the subsequent 8 patients were the controls. Hepatic plexus vagectomy was performed on the patients in the study group. The mean decrease of common bile duct pressure was 31.6% after hepatic plexus vagectomy and was significant (p<0.001). Neither right upper quadrant pain nor the pathologic symptoms due to vagectomy were reported in the study group during the follow up. Resisting right upper quadrant pain without an organic disorder was determined in 3 of the 8 patients in the control group and in 1 of the 47 remaining patients. Hepatic plexus vagectomy performed as an adjunct to cholecystectomy in biliary group lll patients eliminates the sphincter spasm that is the cause of biliary tract pain and it may be an alternative treatment to sphincterotomy.