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Painless lithotripsy by flashlamp-excited dye laser for impacted biliary stones: an experimental and clinical study
1Second Department of Surgery, Ehime University, Shitsukawa, Japan.
Objective:
To find out the appropriate dye laser output and frequency for each kind of stone experimentally, and to use flashlamp-excited dye laser for impacted biliary stones.
Design:
Prospective study.
Setting:
University hospital, Japan.
Subjects:
12 patients undergoing lithotripsy for both intrahepatic and extrahepatic impacted biliary stones.
Main Outcome Measures:
Appropriate dye laser output and frequency, histological changes in the bile duct wall, and outcome.
Results:
Stones were pulverised, and required a median 155 pulses (range 80-205) at 40 mJ for bilirubin stones and 355 pulses (range 205-405) at 50 mJ for cholesterol stones. At the standard energies used, the laser caused only superficial damage to the serosa of the common bile duct. It was successful in fragmenting 133/135 stones (99%), and in addition pulverised 125/135 stones (93%). No patients complained of pain during laser lithotripsy even under local anaesthesia. All patients were discharged from the hospital after an uneventful recovery, and no recurrent stones have been found at outpatient follow-up ranging between 2 and 85 months.
Conclusion:
Flashlamp-excited dye laser with a small choledochoscope seems to be safe and painless way of treating biliary stones, even if they are impacted in the peripheral biliary tree and patients are at high risk.