Split Tip Bougie for Sphincteroplasty Fumio NAKAYAMA
S I N C E its introduction in 1952 by Jones and Smith 1 sphincteroplasty has been widely used for stenosis of duodenal papilla and to form a wide opening at the distal end of the common duct to provide for stones descending from the intrahepatic ducts in case of hepatolithiasis. Placement of hemostats or sutures at the duodenal papilla before its division is recommended, because of the ease of securing choledochal mucosa to include it in the interrupted suture with the duodenal mucosa. Difficulty is often encountered in inserting mosquito hemostats as recommended by Jones z or putting a needle accurately in the orifice of the duodenal papilla. Therefore, split tip bougie* was fashioned out of the urethral bougie as shown in Fig. 1. T h e exact dimension of the bougie is shown in Fig. 2. After choledochotomy, the bougie is inserted into the distal common bile duct via choledochotomy opening until firm resistance is felt. Duodenotomy is made on the duodenal wall just opposite to the tip of the bougie inserted. A small curved non-cutting needle with a braided silk suture is inserted into the orifice via a slit on the tip of the bougie at 10 to 12 o'clock position and tied (Fig. 3). The papilla is divided between
Fig. 1. Photograph of split tip bougie for sphincteroplasty.
@ " - ' - - 2/1
r
p
o
5
1tO
1~5 in
Fig. 2.
2;
2;
crfl
Detailed dimensions of split tip bougie.
From the Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan * Available from Sakura Seiki Co., Nihonbashi Honcho 3-9, Chuoku Tokyo, 103 Japan. JAPANES'~JOURNALOF SURGERY,VOL. 9, No. 3, pp. 251-252, 1979
252
2pn. or. Surg. Sept. 1979
Nakayama
Split tip bougie. . . . . ~ . /
~--DuodenaI papilla
\
Fig. 3. Insertion of needle through the orifice of duodenal papilla with the aid of split tip bougie. the two sutures. This procedure is repeated several times until the opening created is equal to the largest part of the common duct. The use of split tip bougie makes the placement of the hemostat or needle in the papilla e~sier by providing just enough space for their insertion which otherwise is at times quite difficult when usual urethral bougie or Bakes dilator with round tip is used. (Received for publication on September 26, 1978) References 1. Jones, S. A. and Smith, L. L. : Transduodenal sphlncteroplasty for recurrent pancreatitis, Ann. Surg. 136: 937-947, 1952. 2. Jones, S.A.: Sphlncteroplasty (not sphinctero-
tomy) in the treatment of biliary tract disease, Surg. Clin. N. Am. 53: 1123-1137, 1973.
S I N C E its introduction in 1952 by Jones and Smith 1 sphincteroplasty has been widely used for stenosis of duodenal papilla and to form a wide opening at the distal end of the common duct to provide for stones descending from the intrahepatic ducts in case of hepatolithiasis. Placement of hemostats or sutures at the duodenal papilla before its division is recommended, because of the ease of securing choledochal mucosa to include it in the interrupted suture with the duodenal mucosa. Difficulty is often encountered in inserting mosquito hemostats as recommended by Jones z or putting a needle accurately in the orifice of the duodenal papilla. Therefore, split tip bougie* was fashioned out of the urethral bougie as shown in Fig. 1. T h e exact dimension of the bougie is shown in Fig. 2. After choledochotomy, the bougie is inserted into the distal common bile duct via choledochotomy opening until firm resistance is felt. Duodenotomy is made on the duodenal wall just opposite to the tip of the bougie inserted. A small curved non-cutting needle with a braided silk suture is inserted into the orifice via a slit on the tip of the bougie at 10 to 12 o'clock position and tied (Fig. 3). The papilla is divided between
Fig. 1. Photograph of split tip bougie for sphincteroplasty.
@ " - ' - - 2/1
r
p
o
5
1tO
1~5 in
Fig. 2.
2;
2;
crfl
Detailed dimensions of split tip bougie.
From the Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan * Available from Sakura Seiki Co., Nihonbashi Honcho 3-9, Chuoku Tokyo, 103 Japan. JAPANES'~JOURNALOF SURGERY,VOL. 9, No. 3, pp. 251-252, 1979
252
2pn. or. Surg. Sept. 1979
Nakayama
Split tip bougie. . . . . ~ . /
~--DuodenaI papilla
\
Fig. 3. Insertion of needle through the orifice of duodenal papilla with the aid of split tip bougie. the two sutures. This procedure is repeated several times until the opening created is equal to the largest part of the common duct. The use of split tip bougie makes the placement of the hemostat or needle in the papilla e~sier by providing just enough space for their insertion which otherwise is at times quite difficult when usual urethral bougie or Bakes dilator with round tip is used. (Received for publication on September 26, 1978) References 1. Jones, S. A. and Smith, L. L. : Transduodenal sphlncteroplasty for recurrent pancreatitis, Ann. Surg. 136: 937-947, 1952. 2. Jones, S.A.: Sphlncteroplasty (not sphinctero-
tomy) in the treatment of biliary tract disease, Surg. Clin. N. Am. 53: 1123-1137, 1973.
