Simple division (5mm) of the anterior surface of the sphincter of Oddi (sphincterotomy) was utilized extensively in the mid 20th century for presumed biliary-pancreatic pain from biliary dyskinesia. Lack of success led to a more generous longer (2-3cm) division of the sphincter with formal sphincteroplasty with only marginal improvement in outcome. Our group and others have utilized a generous sphincteroplasty with division of the transampullary septum to include division of the pancreatic component of the sphincter; with this extended approach, we have achieved good to excellent results in appropriately selected patients. The rationale for the procedure is to allow free egress of bile and pancreatic juice into the duodenum after stimulation from ingestion of a meal. Stenting of even the septotomy can now be accomplished after endoscopic sphincteroplasty in experienced hands.
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