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Andrew L. Warshaw, MD

Arch Surg. 2005;140:513.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Madura et al¹ report their large experience over 24 years with surgical sphincteroplasty for presumed sphincter of Oddi dysfunction (SOD) or accessory papilla stenosis with pancreas divisum. Their patients were selected for operation by clinical judgment, principally based on pain (100%), because only 25% had objective evidence of pancreatitis. They attempted to validate this judgment post hoc by intraoperative assessment of flow and pressure in the bile duct (at least in those with SOD). Overall, 82% of patients had an excellent or good outcome (no criteria given) after follow-up of at least several months if their symptoms were totally relieved.

This study, consistent with other reports, reconfirms the following: (1) the Nardi test (morphine sulfate–neostigmine methylsulfate [Prostigmine]) results, the Caroli test (antegrade flow rate and pressure in the common bile duct) results, or the results of intraoperative perfusion manometry of the sphincter were abnormal in only . . . [Full Text of this Article]

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