The influence of cholecystectomy on the porcine sphincter of oddi

Abstract

Introduction Post cholecystectomy pain syndrome is reported to occur in about 5 % of patients following cholecystectomy. The aetiology of a proportion of such cases have been attributed to sphincter of Oddi (SO) dyskinesia. Neural pathways pass between the duodenum, gallbladder and SO and will be disrupted by cholecystectomy possibly altering the response of the SO to regulatory hormonal control. The porcine and human SO respond similarly to CCK. The porcine model may therefore be a useful to01 in the investigation of post cholecystectomy pain and SO dysfunction. The action of morphine sulphate (MS) on the porcine SO has not been reported to date but stimulates contraction in the human SO. Hypothesis: Cholecystectomy may lead to an alteration in the hormonal response of the SO. Aims: 1) To compare the action of CCK and MS on the SO following either a sham laparotomy or cholecystectomy. 2) To develop an animal model of SO dyskinesia. Methods: Fourteen pigs either underwent a cholecystectomy (Chole) or a laparotomy with manual manipulation of the gallbladder (sham laparotomy (SL)) and were recovered. 7-8 weeks later a laparotomy and duodenotomy was performed SO manometry was carded out using a perfused triple lumen catheter (Wilson-Cook, USA). A 30 minutes base line recording was made. CCK octapeptide (Sigma Chemicals, UK) was then infused intravenously at a rate of 10ng/kg/min for 30 minutes. A 30 minute washout period was then recorded. A bolus of MS (5mg) was then given intravenously and further measurements taken. Results: The data is represented below by the median values (25-75 th percentiles).