Split tip bougie for sphincteroplasty

SINCE its introduction in 1952 by Jones and Smith 1 sphincteroplasty has been widely used for stenosis of duodenal papilla and to form a wide opening at the distal end of the common duct to provide for stones descending from the intrahepatic ducts in case of hepatolithiasis. Placement of hemostats or sutures at the duodenal papilla before its division is recommended, because of the ease of securing choledochal mucosa to include it in the interrupted suture with the duodenal mucosa. Difficulty is often encountered in inserting mosquito hemostats as recommended by Jones z or putting a needle accurately in the orifice of the duodenal papilla. Therefore, split tip bougie* was fashioned out of the urethral bougie as shown in Fig. 1. The exact dimension of the bougie is shown in Fig. 2. After choledochotomy, the bougie is inserted into the distal common bile duct via choledochotomy opening until firm resistance is felt. Duodenotomy is made on the duodenal wall just opposite to the tip of the bougie inserted. A small curved non-cutting needle with a braided silk suture is inserted into the orifice via a slit on the tip of the bougie at 10 to 12 o'clock position and tied (Fig. 3). The papilla is divided between