[Contribution of surgical endoscopy and extrahydraulic lithotripsy in complex biliopancreatic lithiasis]

Surgical endoscopy combined with electro-hydraulic lithotripsy was done on 17 patients selected for complex multiple bilio-pancreatic lithiasis. In the biliary tract (7 patients), per operatory lithotripsy was performed on 3 patients (impacted main duct stones n = 2, impacted left hepatic stones n = 1); it was done through a T-tube in 1 young patient with an impacted stone in the ampulla and percutaneously in 3 patients (1 gall bladder and 2 intra hepatic lithiasis, one of them with biliary cirrhosis and portal hypertension). Four of this patients had had iterative surgery, extracorporeal lithotripsy or retrograde endoscopy. Complete desobstruction was obtained in all patients with minimal morbidity (minor hemobilia n = 2, hemorrhage from oesophageal varicose n = 1). In the pancreas, the technique was performed on 10 patients with impacted stones in the Wirsung duct and cephalic obstruction. Mean duct diameter was 7 mm. Complete desobstruction was obtained in 9 cases and endoscopic maneuvers were associated with "double stream" operation: sphincterotomy and cephalic desobstruction plus latero-lateral wirsungo-jejunostomy. Morbidity was small (minor hemorrhage n = 3). To conclude, endoluminal electro-hydraulic lithotripsy is an interesting adjuvant technique for the treatment of obstruction from stones in complex bilio-pancreatic lithiasis, either during open surgery or trans-cutaneously.