[Surgical and non-surgical treatments of gallstones]

Comparisons were made of therapeutic modalities for gallstones. Four-hundred thirty-five patients with gallstones were operated on with the mortality rate of 0.7%. Extracorporeal shock-wave lithotripsy (ESWL) was performed in 84 patients with gallbladder stones. Complete stone disappearance rate at 1 year was 31% in patients with one to three radio-lucent stones not larger than 3cm in diameter and 57% in solitary stones up to 2cm with the US pattern of Ia or Ib. There was no major complication. Endoscopic sphincterotomy (EST) was performed in 131 patients with common bile duct stones. The success rate was for stone extraction, was 97%. Immediate complications occurred in 8% cases, yielding the mortality rate of 0.8%. Common bile duct stones recurred in 2 of 113 patients (3%). Acute cholecystitis was experienced in 2 of 43 patients with the gallbladder left in situ; 2 of 12 with and none of 31 without gallbladder stones. In conclusion, ESWL is a safe and effective treatment in selected patients. EST can be the first-choice modality in the treatment of not only the post-cholecystectomy cases but also the patients with the gallbladder without stones.