LATE DEVELOPMENT OF BILE-DUCT CANCER AFTER SPHINCTEROPLASTY - A 10 TO22-YEAR FOLLOW-UP-STUDY

Background. Transduodenal sphincteroplasty is designed to destroy the sphincteric muscle fibers, producing a terminal choledochoduodenostomy . In the absence of Oddi's sphincter, intestinal contents with both ac tivated pancreatic juice and bacterial flora are refluxed into the bil e duct and remain there for a prolonged time. The long-term effect of producing the reflux has not been evaluated to date. Methods. One hund red nineteen consecutive patients undergoing transduodenal sphincterop lasty between February 1973 and July 1984 were included in this study. Postoperative clinical courses of 108 patients could be evaluated by means of a retrospective review of the hospital records. Median follow -up was 18 years. Results. Eight cases (7.4%) of primary bile duct can cer were found among the 108 cases at intervals of 1 to 20 years after s sphincteroplasty. Two patients had concurrent hepatolithiasis. The p atency of sphincteroplasty was confirmed in all cases, and the bile wa s infected in seven cases. Pathologic specimens obtained demonstrated cholangiocarcinomas and various degrees of atypical hyperplastic lesio ns under the background of chronic cholangitis. Conclusions. Chronic c holangitis can be an important causative factor in late development of bile duct cancer after sphincteroplasty. Any patients treated with ch oledochoduodenostomy should be closely monitored for late cholangiocar cinoma.