[Combined non-operative intervention for retained bile duct stones]

Basket lithotriptor, piezoelectric shock wave lithotripsy, electrohydraulic shock wave lithotripsy, and endoscopic papillosphincterotomy were used to manage respectively 10, 15, 14, and 15 patients with retained intra and extrahepatic bile duct stones that could not be removed with a Dormia basket. In these four group patients the stones ranged from 5 to 25 mm in diameter. A residual stone was fragmented with a basket lithotriptor if its diameter exceeded that of the T tube tract. Shock-wave was used when mechanical lithotripsy was unsuccessful. Endoscopic papillosphincterotomy was carried out in patients with stenosis of the sphincter, or impacted stone at the Ampulla of Vater. Combined biliary lavage, Dormia basket, and choledochoscopy after lithotripsy accelerated clearance of fragments. In these four groups, stone-free rates and reoperation rates were 90, 46.7, 85.7, and 100 percent and 10, 6.6, 14.3, and 0 percent respectively. There were no serious complications.