TEN years ago, Boyden1 stated: "To the surgeon and the internist the choledochol duodenal junction is one of the most important diminutive areas of the human body. Here is implanted an intricate musculature which causes the filling of the gall bladder, which regulates the outflow of bile and of pancreatic enzymes, and which directly or indirectly is a factor to be reckoned with in pancreatitis and the postcholecystectomy syndrome." This statement, by an eminent anatomist whose contributions to the understanding of this anatomical area are of major proportions, is equally true today.
Most patients with recurrent attacks of epigastric or pain in the right upper quadrant of the abdomen, consistent with chronic cholecystitis and cholelithiasis, are relieved by the removal of the stone-containing gall-bladder with choledochostomy, if indicated. A few will experience no relief and subsequent evaluation after further attacks will establish the presence of recurrent pancreatitis. The chronic