[Laparoscopic cholecystectomy of large gallbladder calculi]

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Urology (Lithotripsy Techniques)

Background:

• Laparoscopic cholecystectomy presents challenges with large gallstones, often requiring incision enlargement or intraoperative lithotripsy for safe removal.
• Preoperative extracorporeal shock-wave lithotripsy (ESWL) was investigated as a potential method to facilitate gallbladder stone extraction in such cases.

Purpose of the Study:

• To evaluate the efficacy and feasibility of preoperative extracorporeal shock-wave lithotripsy (ESWL) for pulverizing large gallbladder stones prior to laparoscopic cholecystectomy.
• To compare the outcomes of ESWL with traditional mechanical lithotripsy in patients with large gallstones.

Main Methods:

• Ten patients with at least one gallbladder stone larger than 20 mm underwent ESWL within 24 hours before surgery.
• Outcomes were compared to a control group of 10 patients with similar stone sizes treated with mechanical lithotripsy.
• Data collected included the need for additional stone fragmentation or incision enlargement.

Main Results:

• Complete stone pulverization was achieved in only one of the ten ESWL patients.
• Seven patients required additional mechanical fragmentation with forceps.
• Five patients needed enlargement of the surgical incision.
• ESWL offered no discernible advantage over mechanical lithotripsy in terms of surgical facilitation.

Conclusions:

• Preoperative ESWL is not effective for complete pulverization of large gallbladder stones.
• ESWL does not simplify the extraction of large gallstones during laparoscopic cholecystectomy.
• The increased costs associated with ESWL, without clear benefits, preclude its recommendation for this indication.