Extracorporeal shock wave lithotripsy of gallbladder stones: a pessimistic view

Percutaneous Rotational Lithotripsy of Gallbladder Stones

Ten patients (aged 39–94 years) with cholecystolithiasis were selected for percutaneous rotational lithotripsy with the Rotolith lithotriptor either because they were considered high-risk patients for cholecystectomy or because they had refused surgery. The procedure was completed in 7 patients. Five of these were stone-free at cholangiography 1 to 2 days after lithotripsy. Conclusive cholangiograms were not obtained in 2 patients due to gallbladder leakage, which in itself did not cause any serious sequelae. At ultrasonography after one month, one of these 2 patients had no visible gallbladder, the other one had small residual gallbladder stones. Rotational lithotripsy is an alternative to cholecystectomy in patients at high surgical risk, especially elderly patients who have undergone cholecystostomy as an emergency treatment for acute cholecystitis.

Role of extracorporeal shock wave lithotripsy in hepato-biliary-pancreatic surgery

Since the early 1980s extracorporeal shock wave lithotripsy (ESWL) has partially replaced major operative procedures in various fields of surgery. In the interest of the patient, it is important to determine the exact role of ESWL in surgery. Comparing our own prospectively followed patients with other patient series, we have tried to assess this role. We treated 133 patients with cholecystolithiasis, 80 patients with choledocholithiasis, and 17 patients with pancreatic stones using a second-generation lithotriptor, the Siemens Lithostar (Siemens, Erlangen, Germany). The results suggest a limited role of ESWL for cholecystolithiasis, in which it is reserved for patients with high operative risk and patients who reject an operation. For choledocholithiasis ESWL seems to become an integral part of the treatment in the elderly patient in whom endoscopic stone removal proved impossible. Finally, ESWL could become a first option for the treatment of intractable pain in patients with chronic calcifying pancreatitis.

Fragmentation of biliary calculi in 71 patients by use of intracorporeal electrohydraulic lithotripsy

PURPOSE

Failure of percutaneous or endoscopic removal of biliary calculi is often associated with impacted stones or stones larger than 1.5 cm. In these difficult cases, intracorporeal electrohydraulic lithotripsy (EHL) is a method that allows large stones to be fragmented and removed percutaneously or endoscopically. In this study, the authors expand their experience with EHL and further evaluate the safety and efficacy of this technique to remove biliary tract calculi.

PATIENTS AND METHODS

Intracorporeal electrohydraulic lithotripsy was used to treat 71 patients with calculi in the bile ducts (n = 35) or gallbladder (n = 36). Access was obtained by means of a surgical T-tube tract (n = 16), percutaneous transhepatic biliary drainage (n = 14), percutaneous cholecystostomy (n = 36), an intraoperative approach during common duct exploration (n = 2), and at endoscopic retrograde cholangiopancreatography (n = 3).

RESULTS

EHL lithotripsy was effective in fragmenting all biliary stones in 69 of the 71 patients (97%). All of the stone fragments were removed in 67 of these 69 patients (94%). Major complications, including bile peritonitis and gallbladder necrosis, occurred in five patients; however, all major complications were related to the initial percutaneous drainage or tract dilation. No significant complications were directly attributable to the EHL procedure.

CONCLUSION

Intracorporeal EHL is a safe and effective method that can be used to improve the success of percutaneous and endoscopic biliary calculi removal.