Lithotripsy in the treatment of biliary stones

ERCP for refractory choledocholithiasis: An analysis of 64 cases

AIM: To evaluate the therapeutic value of endoscopic retrograde cholangiopancreatography (ERCP) for refractory choledocholithiasis.

METHODS: The clinical data for 64 patiens with refractory choledocholithiasis who underwent ERCP in the People's Hospital of Guangxi were retrospectively analyzed. Stones were removed by breaking them into pieces, changing body positions, repeated extractions, or balloon dilatation.

RESULTS: Stones were successfully removed in 53 patients, and the total success rate was 82.81%. Stones were successfully removed in 15 of 18 (83.33) patients with huge gallstones, 14 of 18 (77.78%) patients with common bile duct malformation, 16 of 19 (84.21%) patients with common bile duct dilatation or stenosis, and 8 of 9 (88.89%) patients with hard stones.

CONCLUSION: ERCP is effective for treating refractory choledocholithiasis.

Percutaneous intracorporeal lithotripsy of biliary calculi

The standard management for patients presenting with bile duct calculi is endoscopic retrograde cholangiopancreatography and sphincterotomy with stone retrieval. In failed cases and for intrahepatic duct stones, there are a number of non-operative alternative extraction methods. We describe two cases of percutaneous intracorporeal lithotripsy for biliary calculi and review the literature regarding the indications, complications and success rate.

Choledocholithiasis and gallstone pancreatitis

Gallstones are commonly found within the main bile duct (MBD) of patients undergoing cholecystectomy. Retained MBD stones are a common cause of obstructive symptoms and complications. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy (ES) is the recommended modality for both the detection of such stones and their extraction. Recent trials of ERCP in conjunction with laparoscopic cholecystectomy suggest that it should be reserved for use post-operatively. Gallstones within the MBD are the most common single cause of acute pancreatitis. Initial treatment is supportive, although new agents designed to suppress the systemic inflammatory response are under development and have proved beneficial in clinical trials. Severe cases should be treated with systemic antibiotics and early removal of the obstructing stones by ERCP and ES. Prophylactic cholecystectomy is recommended to prevent further attacks of gallstone pancreatitis.

The treatment of gall stones

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Current role of extracorporeal shockwave therapy in surgery

In urology the introduction of extracorporeal shockwave therapy brought a revolutionary change to the management of urinary calculi. This inspired the introduction of shockwave therapy in several fields of surgery; it has been applied as a potential alternative to several operative procedures but is still experimental. So far, the major application of shockwave therapy has been lithotripsy of stones in the gallbladder, common bile duct, pancreatic duct and salivary gland ducts. Other applications are in the non-operative management of bone healing disturbances and in the inhibition of tumour growth. Steps towards selective thrombus ablation and pretreatment of heavily calcified arteries have also been made. In this review, the applications of extracorporeal shockwave therapy in several areas of surgery are discussed. It is concluded that, for selected patients, shockwave treatment may serve as a useful addition to the surgical armamentarium.