[Surgery for choledocholithiasis following extracorporeal lithotripsy in 3 patients]

Extracorporeal lithotripsy has been used as a therapeutic modality for gallbladder and common duct stones. When duct stones are fragmented and do not pass to the duodenum or endoscopic extraction is not possible, a surgical intervention seems justified. At operation under these circumstances we have appreciated an unusual increment of vascularity and inflammation that makes the operation somewhat difficult. In the last year we have operated three patients that had common duct stones and received lithotripsy. In two cases the procedure failed. Even when postlithotripsy cholangiogram showed fragmentation of stone, in one patient those fragments could not be evacuated transendoscopically and patient was operated few days later. During operation small fragments were found and probably they could have been eliminated through the sphincterotomy. Thus, we suggest to obtain a new cholangiogram before operating such cases.