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Extracorporeal shock wave lithotripsy of common bile duct stones in patients with increased operative risk
R L van der Hul1, P W Plaisier, M van Blankenstein
1Department of Surgery, University Hospital Rotterdam, The Netherlands.
Objective:
Assessment of efficacy of extracorporeal shock wave lithotripsy (ESWL) of stones in the common bile duct.
Design:
Prospective clinical study.
Setting:
Department of Surgery, University Hospital Rotterdam, Rotterdam, The Netherlands.
Subjects:
90 patients with stones in the common bile duct and at increased operative risk (median age 73 years, range 27-95).
Interventions:
After failure of endoscopic measures, the first 13 patients were treated under general anaesthesia with a first generation lithotriptor. Of the next 77 patients, treated with a second generation lithotriptor, only one required general anaesthesia and 68 intravenous analgesia and sedation. Eight patients needed no analgesia at all.
Main Outcome Measures:
Fragmentation, clearance, and recurrence of stones.
Results:
Fragmentation of stones was achieved in all the first 13 patients and 63 of the 90 patients (69%). There were minor complications (macroscopic haematuria and subcapsular haematoma of the right kidney) in 13 and serious complications (bacteraemia) in 2. At follow-up (median 28 months), 2 patients had recurrent stones.
Conclusion:
ESWL of stones in the common bile duct is safe and effective and should be considered in high risk patients.