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Extracorporeal Shock Wave Lithotripsy of Biliary Duct Calculi: Nova Scotian Experience

  • Richard W. Norman
  • Lazlo A. Fried
  • G. Paul LeBrun
  • Mark C. Taylor

Abstract

Extracorporeal shock wave lithotripsy (ESWL*) has revolutionized the management of upper urinary tract stones. Its success and safety have led to a proliferation of machines and of urologists trained in their use. Therefore, it is not surprising that at some institutions urologists have been asked to apply their expertise to fragment biliary duct calculi.

At Dalhousie University 32 patients (13 males, 19 females) with a mean age of 63 (range, 25 to 92 years) have been treated with an unmodified Dornier HM3 lithotripter. These patients had gallstones in the cystic duct (3 patients), hepatic duct (5 patients), or common bile duct (28 patients). All patients had been operated upon previously by a general surgeon and subsequently were evaluated by an interventional radiologist. Time from open surgery to extracorporeal shock wave cholelithotripsy ranged from eight days to 22 years. All stones were considered inappropriate for percutaneous or endoscopic manipulation because of size or location (13 patients), previous unsuccessful attempts at such procedure (11 patients), or were retained postoperatively (8 patients). Stones varied from 2 mm to 21 mm (mean 13 mm); one was calcified, and the others were radiolucent. Nine patients had more than one stone. Imaging was possible by introducing contrast media through cholecystostomy tubes (1 patient), transhepatic tubes (7 patients), nasobiliary tubes (10 patients) or T-tubes (14 patients). Ten patients required repeat therapy. The average number of shock waves required per session was 3,012 (range, 525 to 8,000) at 18 kV to 25 kV. Twenty-four patients either passed the fragments within one month (30 patients) or had them fragmented small enough to be removed by percutaneous or endoscopic techniques (10 patients). One patient required further open surgery. Morbidity was limited to transient elevation of LDH, transaminase, alkaline phosphatase, and the development of asymptomatic hemobilia and hematuria. One patient developed pancreatitis.

Because the number of situations in which shock wave lithotripsy can be used is limited, it may be difficult for physicians other than urologists to acquire and maintain the necessary skills to operate a lithotripter. Until specific biliary lithotripters become widely available, urologists may continue to be asked to assist in the management of patients with gallbladder stones.

Keywords

Shock Wave Cystic Duct Shock Wave Lithotripsy Extracorporeal Shock Wave Lithotripsy Stone Size 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Ferracci JT: Biliary lithotripsy: a preview. J litho Stone Dis 1: 3, 1989.Google Scholar
  2. 2.
    Sauerbruch T, Delius M, Paumgartner G, et al: Fragmentation of gallstones by extracorporeal shock waves. NEJM 314: 818, 1986.PubMedCrossRefGoogle Scholar
  3. 3.
    Sackmann M, Delius M, Sauerbruch T, et al: Shock wave lithotripsy of gallbladder stones. NEJM 318: 393, 1988.PubMedCrossRefGoogle Scholar
  4. 4.
    Fried LA, Lebrun GP, Norman RW, et al: Extracorporeal lithotripsy in the management of bile duct stones. AJR 151: 923, 1988.PubMedCrossRefGoogle Scholar
  5. 5.
    Taylor MC, Marshall JC, Fried LA, et al: Extracorporeal shock wave lithotripsy in the management of complex biliary tract stone disease. Ann Surg 208: 586, 1988.PubMedCrossRefGoogle Scholar
  6. 6.
    Sauerbruch T and Stern M: Fragmentation of bile duct stones by extracorporeal shock waves. Gastroenterol 96: 146, 1989.Google Scholar

Copyright information

© Springer Science+Business Media New York 1989

Authors and Affiliations

  • Richard W. Norman
    • 1
  • Lazlo A. Fried
    • 1
  • G. Paul LeBrun
    • 1
  • Mark C. Taylor
    • 1
  1. 1.Departments of Urology, Radiology, and SurgeryDalhousie UniversityHalifaxCanada

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