[The significance of the duodenal papilla within the framework of diseases of gallbladder and bile ducts].

On the basis of 3185 biliary tract operations performed at the city hospitals of Braunschweig and Lüneburg, 12% of which included papillotomies, the frequency and pathogenesis of Vater's papilla stenosis is discussed. About 5% of all stenoses of Vater's papilla do not appear in connection with lithiasis in the biliary tract; these are defined as primary stenoses. 95% of Vater's papilla stenoses occur with lithiasis and inflammatory diseases of biliary tract. Stenosis of Vater's papilla is most often seen in connection with severe cholecystitis and pericholecystitis. There exists in most cases a purely inflammatory swelling of papillas mucosa which decreases following sanitation of the biliary tract. Intraoperative findings show good dilatation through catheterization and Vater's papilla should therefore not be discised. In opposite the concommitant stenoses of Vater's papilla caused by choledocholithiasis, chiefly in case of calculus near the papilla, are signed by severe deforming alterations even concerning deeper layers of papilla wall. The high grade destruction of muscle tissue leads to a not retrogressive stenosis, even after sanitation of biliary tract, which principally should be discised. 211 biopsies of papilla were taken and histologically analyzed. A specific pathologic-anatomic substrate of stenosis of Vater's papilla could not be found.