Abstract
A method of biliary manometry is described which enables simultaneous recording of both the pressure changes in the common duct during perfusion and the cholangiographic appearances. This examination has been performed on 86 patients undergoing cholecystectomy for gallstone disease, 17 of whom had demonstrable stones in the common duct. Ten patients received opiates or similar drugs as premedication and are considered separately. The remaining 76 patients were anaesthetized by a standard technique involving no opiates. On the basis of the pressure tracings they could be divided into two groups: group I (56 patients, 4 with stones in the common bile duct) showed a minimal rise in pressure during infusion of the common bile duct, with a rapid return to basal level: group II (20 patients, 13 with demonstrable stones in the common bile duct) showed a marked rise in pressure, with a delayed and often incomplete return to basal level. In 2 patients in group II a sudden fall in pressure during perfusion was associated with the passage of a stone, and the evidence suggests that 6 of the 7 patients with no demonstrable stones in the duct had in fact small stones in the duct, some of which may have passed during the examination. Clinical follow-up of the patients showed that only 3 of the patients had significant postoperative abdominal symptoms, for which there was an apparent extra-biliary cause in all 3.
This study provides no evidence in support of the hypothesis that there is a condition of sphincteric spasm which can cause symptoms after cholecystectomy, and which can be detected by pressure studies at the time of cholecystectomy.