Stone Extraction Research Articles

Elimination of Large Bladder Stone-Obstructing Pelvic Canal in African Spurred Tortoise (Centrochelys sulcata) with Per-Cloacal Bladder Stone Removal Method without Utilizing an Endoscope

Bladder stone formation in reptiles arises from the accumulation and subsequent solidification of uric acid in the urinary bladder. The bladder stones vary in size and can migrate from the bladder to the pelvic canal. In cases where larger bladder stones enter the pelvic canal, they pose a risk of obstructing the digestive and urinary tracts of the tortoise. This study discusses managing bladder stone elimination in sulcata tortoises (Centrochelys sulcata) located in the pelvic canal without utilizing an endoscope. In 2023, four sulcata tortoises were presented at the Teaching Veterinary Hospital Universitas Brawijaya with diagnoses of large bladder stone-blocking pelvic canals that had been causing digestive and urinary tract obstruction. All of the tortoises have similar clinical signs, such as lethargy, anorexia, inability to defecate, and anuria. Physical examinations and radiography revealed the presence of bladder stones in the pelvic canal, exceeding the dimensions of the pelvic outlet and hindering passage through the cloaca. Treatment involved per-cloacal bladder stone removal. This procedure begins by anesthetizing the sulcata tortoise using ketamine and medetomidine combination, followed by fragmentation and extraction of the bladder stones from the pelvic canal through the cloaca. All procedures were performed without utilizing an endoscope. The success of the treatment was evidenced by radiographic examination, confirming the absence of bladder stones in the pelvic canal, and the recovery of normal defecation, urination, appetite, and activity levels.

A retrospective analysis of 500 ERCP procedures: outcomes, adverse events, and risk factors over two years

Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used procedure for both the diagnosis and management of biliary and pancreatic ductal diseases. While it has been largely replaced by non-invasive imaging techniques for diagnostic purposes, ERCP remains the gold standard for therapeutic interventions. This study aims to retrospectively analyze the outcomes, adverse events, and success rates of ERCP procedures performed on 500 patients over two years. Methods: A retrospective review of 500 ERCP procedures performed at a single center over 24 months was conducted. Patient demographics, indications for ERCP, procedural outcomes, and adverse event rates were collected and analyzed. Success rates for therapeutic interventions, as well as risk factors for post-procedural adverse events, were identified. Results: The study revealed that 448 (89.6%) of ERCP procedures were successful in achieving the primary therapeutic goal (e.g., stone extraction, stent placement). Adverse events occurred in 93 (18.6%) of cases, with post-ERCP pancreatitis being the most common adverse event (n: 73, 14.6%). Risk factors associated with adverse events included previous cholecystectomy (p

Rotomolded polypropylene‐ignimbrite composites: Giving a second life to mineral dust wastes

AbstractThe possibility of rotomolding polypropylene (PP) composites with high loadings of a silica‐based dust of ignimbrite, a byproduct of volcanic stone extraction is demonstrated. This study aims to establish the properties of composites with various ratios of mineral dust as a filler in PP matrices at loadings from 5 to 30 wt%, ultimately transforming mining residues into a valuable resource for composite production and creating a value chain around the traditional mining industry. Once the composites were obtained, they were subjected to several characterization techniques to comprehensively assess their mechanical and thermal properties. In general, a high percentage of ignimbrite powder has resulted in a reduction in the mechanical properties of neat PP, although no significant changes were observed for composites at lower loadings. Furthermore, the incorporation of this mineral material modified the thermal properties of the PP, enhancing its thermal stability. The blending of the matrix and filler resulted in a reduction in both the melting crystallization temperatures for highly‐filled composites. Rotomolded items with good aesthetics, with stone‐like appearance, were obtained without any modification on the mineral dust or even without any melt compounding, therefore not increasing the energy consumption during the composites production.Highlights Composites production is a suitable strategy for valorization of mineral residues. Welded ignimbrite residual dust has been used for the first time in composites. Mineral dust has been successfully used in composites obtained by rotomolding. Polypropylene with up to 30% of the stone dust can be processed. Good aesthetics and mechanical features can be obtained with mineral wastes.

OPTIMIZATION OF OPERATING PARAMETERS OF DIAMOND WIRE SAWING FOR ENHANCING NATURAL STONE EXTRACTION EFFICIENCY

Objective. The aim of the study is to improve the efficiency of natural stone cutting processes using diamond wire saw machines in quarries by optimizing operating parameters, particularly current strength. This will help reduce diamond wire wear, enhance cutting productivity, and decrease energy costs, ensuring the stability and economic viability of stone extraction processes. Methodology. The study was conducted at the Leznykiv Block Quarry using the MKS-55 diamond wire saw machine, whose main parameters include a main drive power of 55 kW, wire speed up to 40 m/s, and a wire length from 20 to 120 m. During the experiments, three levels of current strength were used: 55 A, 60 A, and 65 A, allowing the assessment of this parameter’s impact on cutting efficiency for monoliths of different sizes (6×2 m, 6×3 m, 6×6 m, 6×10 m, 6×12 m, 6×15 m, 6×18 m). Data on wire tension, movement speed, operating duration, and wire temperature were collected and processed using specialized software. The theoretical analysis included mathematical modeling of the effects of operating parameters on the process stability and energy efficiency of cutting. Results. Experimental studies showed that the highest cutting productivity was achieved at a current strength of 55 A for medium and large cutting areas. Maximum productivity (2.8 m²/h) was observed on an area of 108 m², which is 40% higher compared to smaller areas. This is due to the stability of wire tension and even diamond grain wear under optimal settings. Using a current strength of 65 A provided a higher initial cutting speed (up to 3.14 m²/h for an area of 36 m²) but led to wire overheating and significant productivity decrease after reaching an area of 72 m² (2.09 m²/h). This highlights the importance of temperature control to maintain process stability. Scientific Novelty. The study systematically analyzed, for the first time, the effects of various current strength levels on the performance of diamond wire machines in processing monoliths of different sizes. Recommendations for optimal cutting parameters were proposed based on the experimental data and theoretical modeling, taking into account the interrelationship between current strength, wire tension, cutting speed, and temperature mode. This enabled the development of approaches to optimize the cutting process, reducing diamond tool wear and enhancing process stability. Practical Significance. The study’s results can be applied to the setup of diamond wire saw machines at stone extraction enterprises. The most effective mode was found to be with a current strength of 55 A, providing an optimal combination of productivity and wire longevity for medium and large cutting areas. This reduces operating costs, extends equipment life, and lowers energy consumption, which is critical for ensuring the economic efficiency of production processes. Implementing the developed recommendations will improve cutting quality and productivity at stone extraction quarries. Keywords: diamond wire saw machine, stone cutting, cutting productivity, current strength, process optimization, quarrying, energy efficiency, natural stone extraction.

Percutaneous Transhepatic Cholangioscopy in Hepatolithiasis Associated With Decompensated Cirrhosis: A Retrospective Cohort Study.

Multiple and complicated hepatolithiasis can be associated with decompensated cirrhosis. Endoscopic retrograde cholangiopancreatography is unavailable for multiple and complicated hepatolithiasis, and the mainstay for decompensated cirrhosis is liver transplantation. However, due to the ethical factors and the complexity of operation, liver transplantation cannot be widely operated. This study aimed to evaluate percutaneous transhepatic cholangioscopy in the extraction of stones and the recompensation of cirrhosis in patients with hepatolithiasis associated with decompensated cirrhosis. Between January 2021 and February 2024, we retrospectively reviewed the clinical data of 21 patients with multiple and complicated hepatolithiasis associated with decompensated cirrhosis. Before PTCS, the 21 patients were all assessed by the Model for End-stage Liver Disease as having indications for liver transplantation. One-step PTCS (n = 19) and two-step PTCS (n = 2) were used to remove the stones. The technical success rate was 100%, and most stones were cleared 90.48% (19/21). After 3 months of PTCS, MELD score of the patients had significantly decreased (10.81 ± 3.31vs. 17.24 ± 3.40, p < 0.05), and it was lowest at 6 months after the operation (9.94 ± 4.31). After a median follow-up period of 18 months (up to 40 months), the stone recurrence rate was 28.57% (6/21), 13 patients survived without liver transplantation, three patients underwent liver transplantation and survived, and five patients died of liver failure or cancer (mortality rate 23.81%). PTCS can significantly improve patients' liver function in hepatolithiasis associated with decompensated cirrhosis.

Giant Primary Choledocholithiasis: A Rare Case Report and Comprehensive Review of Literature.

Choledocholithiasis is the second most common complication of gallstone disease. Giant primary choledocholithiasis is a rare occurrence. Ultrasonography is the initial mode of imaging, and endoscopic ultrasound is considered superior to other modalities. Endoscopic retrograde cholangiopancreatography can be used for stone extraction. Other treatment modalities include laparoscopic or open common bile duct (CBD) exploration. Many institutions in underdeveloped countries still practice open CBD exploration. Factors such as larger stone diameter, edema of the CBD, and the presence of multiple lithiasis can influence the treatment approach. In this article we are presenting a case of 62 years-old-female with no any known comorbidities had presented to emergency with severe upper quadrant pain and giant choledocholithiasis was diagnosed in ultrasound and computed tomography scan with no other features of complications and patient successfully underwent open CBD exploration with intraoperative choledochoscopy and primary closure.

Retrograde intrarenal surgery with or without ureteral access sheath: a systematic review and meta-analysis of randomized controlled trials.

The ureteral access sheath (UAS) is a medical device that enables repeated entrance into the ureter and collecting system during retrograde intrarenal surgery (RIRS). Its impact on stone-free rates, ureteral injuries, operative time, and postoperative complications remains controversial. Therefore, we performed a systematic review and meta-analysis comparing RIRS with versus without UAS for urolithiasis management. To compare outcomes from retrograde intrarenal surgery (RIRS) for stone extraction with or without ureteral access sheath (UAS); evaluating stone-free rate (SFR), ureteral injuries, operative time, and postoperative complications. We systematically searched PubMed, Embase, and Cochrane Library in June 2024 for randomized controlled trials (RCTs) evaluating the efficacy and safety outcomes of UAS use in RIRS for urolithiasis treatment. Articles published between 2014 and 2024 were included. Pooled risk ratios (RRs) and mean differences (MDs) were calculated for binary and continuous outcomes, respectively. Five RCTs comprising 466 procedures were included. Of these, 246 (52.7%) utilized UAS. The follow-up ranged from 1 week to 1 month. UAS reduced the incidence of postoperative fever (RR 0.49; 95% confidence interval [CI] 0.29-0.84; p=0.009), and postoperative infection (RR 0.50; 95% CI 0.30-0.83; p=0.008). There were no significant differences between groups in terms of SFR (RR 1.05; 95% CI 0.99-1.11; p=0.10), ureteral injuries (RR 1.29; 95% CI 0.95-1.75; p=0.11), operative time (MD 3.56 minutes; 95% CI -4.15 to 11.27 minutes; p=0.36), or length of stay (MD 0.32 days; 95% CI -0.42 to 1.07 days; p=0.40). UAS leads to a lower rate of post-operative fever and infection. However, UAS did not significantly reduce or increase the SFR or the rate of ureteral injuries during RIRS for patients with urolithiasis. The use of UAS should be considered to decrease the risk of infectious complications, particularly in those who may be at higher risk for such complications.

When acute myocardial infarction meets renal abscess: Case report and literature review.

Acute myocardial infarction (AMI) is the leading global cause of death from cardiovascular disease, and the mortality rate increases in the presence of comorbidities such as renal abscess. The treatment of AMI combined with renal abscess is challenging, especially in combination with urinary tract obstruction, as percutaneous coronary intervention (PCI) can lead to progression of the renal abscess and deterioration of renal function. Currently, there is no consensus on the treatment of renal abscess in AMI. We reported a case of a 74-year-old male patient with acute non-ST-segment elevation myocardial infarction combined with urinary tract obstruction. During his hospitalization, the hydronephrosis progressed to a renal abscess, which we punctured and drained. He ultimately underwent twice PCI and surgical relief of the ureteral obstruction shortly thereafter. He was diagnosed with acute non-ST elevation myocardial infarction on admission, unfortunately, his hydronephrosis progressed into a renal abscess after the first PCI, which made further treatment difficult. We performed 2 coronary angiography examinations and implanted a stent in the stenotic coronary artery during the second procedure, which was preceded by an aggressive regimen of antibiotics and puncture and drainage of the renal abscess, which set the stage for the second PCI. We successfully performed coronary revascularisation to treat his coronary artery disease. One month later, his renal abscess drain was removed and the ureteral obstruction was finally resolved after undergoing percutaneous nephrolithotripsy for ureteral stone extraction. The occurrence of renal abscesses is rare and may be unavoidable in those patients with preexisting structural lesions in the urinary tract where coronary angiography will increase the incidence of renal abscesses. Aggressive anti-infective therapy and drainage of pus by puncture will help the renal abscess to heal, and repeat coronary angiography has been shown to be safe in the meantime.

Comparative Success Rate and Adverse Effects of Endoscopic Sphincterotomy Versus Endoscopic Papillary Large Balloon Dilation in Large Common Bile Duct Stones Removal. A Propensity Scores Inverse Weighting Analysis.

Endoscopic sphincterotomy (EST) is a standard treatment for common bile duct (CBD) stones. Endoscopic sphincterotomy combined with endoscopic papillary large balloon dilation (EST-EPLBD) is an effective treatment for difficult CBD stones. This study aims to evaluate and compare the effectiveness and adverse effects of EST-EPLBD and EST in treating large CBD stones. We retrospectively analyzed the data of 85 patients with large CBD stones who underwent either EST or EST-EPLBD, resulting in successful CBD stone extraction from January 2018 to June 2022. Propensity score inverse weighting was performed to reduce the possible bias in baseline characteristics between the two treatment groups. The success rate of complete stone removal in the first session, mechanical lithotripsy use, and adverse events were analyzed by multivariable risk regression analysis. The rate of complete stone removal in one session of the EST-EPLBD group was higher than that of the EST group at 28.78% (95% confidence interval [CI] 4.43, 50.1; p = 0.003). Mechanical lithotripsy use was decreased in the EST-EPLBD group by 25.81% (95% CI 42.33,9.28; p = 0.002). However, the incidence of adverse events is comparable. EST-EPLBD may be utilized in the treatment of CBD stones that exceed a diameter of 10 mm. The EST-EPLBD increased the rate of complete stone removal in a single session and reduced the need for mechanical lithotripsy. Conversely, the incidence rate of adverse events is similar.

BN SO52 - Innovative Tools for Laparoscopic Bile Duct Exploration (LCBDE) in Torbay Hospital

Abstract Background Laparoscopic bile duct exploration (LCBDE) is a minimally invasive technique used to manage common bile duct (CBD) stones. The procedure has evolved significantly with the development of specialized tools that enhance efficacy and patient outcomes. This abstract aims to discuss the various tools employed for LCBDE at Torbay Hospital, highlighting their specific uses, benefits, and outcomes. Method We conducted a retrospective analysis of LCBDE procedures performed at Torbay Hospital. The tools used included the Pusen ‘Skinny scope’, Ambscope, Nathenson tipless basket, GB stone retrieval basket, and Rotacrusher. Data were collected on the types of tools used, procedural success rates, stone clearance rates, and any complications Results The Pusen ‘Skinny scope’ (3mm) was used in 60% of cases for transcystic exploration, showing high success in stone visualization and retrieval. The Ambscope (5mm) was used in 30% of cases for choledochotomy, effectively accessing larger stones. The Nathenson tipless basket retrieved up to 8mm stones in 45% of cases. The GB stone retrieval basket extracted non-disposable stones up to 2cm. The Rotacnsher, used for large stones in choledochotomy, was highly effective but needed larger port access. Laser and mechanical lithotripters fragmented stones larger than 1cm with an 85% success rate. Overall stone clearance was 90% with minimal complications. Conclusion The use of specialized tools in LCBDE at Torbay Hospital has significantly improved the management of CBD stones. The Pusen ‘Skinny scope’ and Ambscope provide excellent visualization and access, while the Nathenson tipless basket and GB stone retrieval basket offer reliable stone extraction capabilities. Advanced lithotripters further enhance the ability to manage larger stones. These tools collectively contribute to high success rates and favorable patient outcomes, reinforcing the value of LCBDE in modern surgical practice.

Comparison of the efficacy and safety of basket catheters and balloon catheters for endoscopic pancreatic duct stone clearance

BackgroundThe choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography (ERCP) for the clearance of pancreatic duct stones in patients with chronic pancreatitis (CP) remains controversial. This study compared the efficacy and safety of these two devices for pancreatic duct stone extractions. MethodsWe compared the efficacy and safety of basket and balloon catheters for pancreatic stone extractions. We enrolled CP patients who underwent ERCP for the first time at Changhai Hospital, Naval Medical University between February 2012 and December 2021. After propensity score matching (1:1), 101 patients were included in each group. The primary outcome was the rate of pancreatic stone clearance. Secondary outcomes included the rate of adverse events during hospitalization, long-term pain relief, and quality of life after one year follow-up period. ResultsThe rate of complete clearance was comparable between the two groups (86.1 % vs. 84.2 %, P = 0.692). In patients with stones ≥ 2 cm before extracorporeal shock wave lithotripsy (ESWL), the rate of complete clearance was significantly higher in the balloon catheter group when compared to the basket catheter group [100 % (19/19) vs. 70.0 % (14/20), P = 0.031]. In the multivariate analysis, ESWL prior to stone extraction was the only independent predictor of complete clearance [with ESWL 58.4 % (264/452) vs. without ESWL 41.6 % (188/452), odds ratio = 2.3, 95 % confidence interval: 1.2–4.3; P = 0.013]. No significant differences between groups were found regarding the rates of adverse events during hospitalization, quality of life, and pain relief after one year of follow-up. ConclusionsBasket and balloon catheters showed similar efficacy and safety for pancreatic stone extractions. However, the balloon catheter was superior to the basket catheter if the pancreatic stone size was ≥ 2 cm before ESWL.

RECURRENT INFECTION CAUSED BY NON-ABSORBABLE POST-CESAREAN SUTURES LEADING TO BLADDER CALCULUS: CASE REPORT AND REVIEW OF THE LITERATURE

Background: Bladder stones are a rare pathological condition in women, often secondary to any etiology. Further investigations are required to identify the various factors involved in their formation and the complications they cause. For a woman, the appearance of a bladder stone following a predisposing factor, in particular an intra-vesical foreign body is a source of recurrent urinary tract infections and calculus, manifested by dysuria and hypogastric heaviness. This study aimed to describe the case of the formation of a bladder calculus from the presence of a non-absorbable suture. Case presentation: The case of a 30-year-old woman with a bladder stone causing several recurrent urogenital infections despite years of medical treatment is reported. After several additional para-clinical investigations, an ultrasound diagnosis of a bladder stone with pre-renal failure was established. The patient underwent a median exploratory laparotomy below the umbilicus for surgical management, followed by an open cystolithotomy with the extraction of a large bladder stone on which an old suture was implanted, probably as a result of the previous cesarean section. Conclusion: Bladder stones are rare, but relatively rare in our environment, with limited diagnostic resources. In this case, it appears that the non-absorbable suture was inadvertently placed in the bladder during the cesarean section, which has unfortunately contributed to recurrent urogenital infections and the formation of bladder calculus.

Complete extraction of main pancreatic duct residual and microstones using an 8-wire basket catheter

Extracorporeal shock wave lithotripsy (ESWL), pancreatoscopy-guided electrohydraulic lithotripsy (EHL), and endoscopic retrograde cholangiopancreatography (ERCP) are primary treatments for symptomatic main pancreatic duct (MPD) stones. However, incomplete clearance of residual/microstones post-treatment may cause symptom recurrence. We hypothesized that the 8-wire biliary basket catheter could be suitable for MPD stone extraction and aimed to analyze its ability to achieve more complete clearance of MPD residual/microstones. Patients suspected to have MPD residual/microstones ≤5 mm because of abdominal symptoms, computed-tomography examination results, and pancreatography results after previous therapy, including ERCP, EHL, and ESWL, were retrospectively enrolled. Patients with severe MPD stenosis/biliary obstruction requiring ERCP drainage were excluded. Extraction of residual/microstones was attempted using an 8-wire basket that is widely expandable in the narrow pancreatic duct and can capture and sweep stones in the narrow pancreatic duct. Technical success was defined as the extraction of residual/microstones. The primary outcome was the technical success rate. Secondary outcomes were therapeutic details of stone extraction using the 8-wire basket catheter, including symptom improvements. The technical success rate was 100% for seven patients; 1–8 residual/microstones were extracted. An improvement was observed in five patients with symptoms after the previous therapy. Three patients underwent residual stone extraction after extraction using a dedicated basket. No patient experienced symptom recurrence during the 270-day follow-up period. The 8-wire basket resulted in successful MPD residual/microstone extraction and pancreatic symptom improvement. This method may prevent symptom recurrence caused by incomplete residual/microstone clearance.

Magnetic Kidney Stone Removal

Abstract Residual fragments can remain after kidney stone extraction which may necessitate another intervention. A new approach needs to be developedis needed to lower the risk of disease severe side effects caused by these fragments. Magnetic nanoparticles can be applied due to their properties of being able to bind to residual fragments and to be extracted by an external magnetic field. Fractals and magnetic nanoparticles have been synthesized and characterized thoroughly. The small nanoparticles bind covalently to the kidney stones and a magnetic extraction of calcium oxalate fractals with magnetic nanoparticles is possible. The aggregation of nanoscale iron oxide nanoparticles can be induced with the addition of salt which improves the extraction process. The separation is validated by simulation and experimentally in a porcine kidney as well as in artificial kidney models. This proof-of-concept study successfullyis the fundament for a new waydemonstrated of extracting kidney stones extraction and including their fractals and might pave the way for new procedures in urology.

Comparative study of Indocyanine Green fluorescence imaging versus conventional fiber-optic imaging in laparoscopic choledochotomy for stone extraction and immediate biliary incision suturing.

To explore the Advantages of Indocyanine Green (ICG) Fluorescence Imaging over Conventional Fiber-Optic Imaging in Laparoscopic Cholangiography and Immediate Suture for Stone Removal. The study is a randomized controlled descriptive research. Consecutive patient data were collected from October 2022 to January 2024 at the Second People's Hospital of Chengdu for those who underwent laparoscopic bile duct exploration and stone removal, totaling 72 cases. According to the order of admission, they were randomly assigned to either the study group or the control group, with 36 cases in each group. Ten minutes preoperatively, indocyanine green (ICG) was administered intravenously through a peripheral vein to the subjects in the study group, to enable real-time fluorescent tracing of the extrahepatic bile ducts during surgery. This study compares the efficiency of bile duct structure and boundary recognition, the timeliness of bile duct incision positioning, operative time, blood loss, and the incidence of bile duct injury between patients who were injected with ICG and those who were not. In addition, it assesses liver function and white blood-cell counts rechecked 24h postoperatively, the duration of postoperative hospital stay, and the occurrence of bile leakage. The study included 72 patients, with 36 in the indocyanine green (ICG) fluorescence group and 36 in the conventional fiber-optic group, comprising 26 males and 46 females. There were 18 patients with a history of previous biliary exploration surgery and 23 who had undergone previous cholecystectomy. During surgery, ICG fluorescence was successfully visualized in all 36 cases of the ICG group, allowing for a clear view of the anatomical structure and boundaries of the extrahepatic bile ducts. Compared to the control group, the ICG fluorescence group demonstrated a reduction in the time required for identification of the biliary system and positioning of the bile duct incision, as well as a decrease in operative time and postoperative hospital stay; intraoperative blood loss and the incidence of bile leakage were also relatively reduced, with statistically significant differences (P < 0.05). However, there were no statistically significant differences in postoperative serum alanine aminotransferase levels, white blood-cell counts, direct bilirubin, and indirect bilirubin between the two groups (P > 0.05). One case of bile duct injury occurred in the control group. The application of ICG fluorescence navigation in laparoscopic cholecystectomy can effectively enhance the visibility of the bile ducts, rapidly identify the location for bile duct incision, and is conducive to reducing both the duration of surgery and postoperative hospital stay. It also minimizes intraoperative blood loss, prevents bile leakage and bile duct injuries. This program has demonstrating significant clinical value.

ThP5.15 - "Unusual Impaction: A Rare Case of Gallstone Ileus''

Abstract Introduction Gallstone-related mechanical gastrointestinal tract obstruction is infrequent, manifesting in only 0.3%-0.5% of cholelithiasis cases. Typically, stones exceeding 2 cm find themselves lodged in the terminal ileum. However, in Bouveret's syndrome which is observed in 1 to 3% of instances the impaction occurs in the duodenum causing gastric outlet obstruction. The epidemiology and prevalence of gallstone impaction in the proximal jejunum remain inadequately documented, making this a rare case. Case Report An 83-year-old patient with known cholelithiasis and choledocholithiasis presented with acute abdominal pain and vomiting a week after undergoing ERCP, sphincterotomy and partial duct clearance. The presence of repeated bilious vomiting prompted investigation with abdominal CT scan. This revealed an approximately 4.5 cm gallstone impacted in the proximal jejunum, prompting emergency laparotomy which confirmed that the stone was impacted 10-15 cm from the dudeno-jejunal junction. Jejunotomy, stone extraction with primary closure was performed. Post-operative recovery was uneventful. Conclusion This case demonstrates gallstone impaction in the proximal jejunum causing bowel obstruction and necessitating emergency intervention. Timely diagnosis and prompt surgical intervention led to a successful outcome. The case highlights the need for awareness and consideration of the entire spectrum of possible gallstone-related complications in the acutely presenting patient with gall stones.

362.7: Utilization of single-use flexible ureterorenoscope for ex-vivo stone extraction in living kidney donors.

362.7: Utilization of single-use flexible ureterorenoscope for ex-vivo stone extraction in living kidney donors.

Current Gallstone Treatment Methods, State of the Art.

This study aims to provide valuable references for clinicians in selecting appropriate surgical methods for biliary tract stones based on patient conditions. In this paper, the advantages and disadvantages of various minimally invasive cholelithiasis surgical techniques are systematically summarized and innovative surgical approaches and intelligent stone removal technologies are introduced. The goal is to evaluate and predict future research priorities and development trends in the field of gallstone surgery. In recent years, the incidence of gallstone-related diseases, including cholecystolithiasis and choledocholithiasis, has significantly increased. This surge in cases has prompted the development of several innovative methods for gallstone extraction, with minimally invasive procedures gaining the most popularity. Among these techniques, PTCS, ERCP, and LCBDE have garnered considerable attention, leading to new surgical techniques; however, it must be acknowledged that each surgical method has its unique indications and potential complications. The primary challenge for clinicians is selecting a surgical approach that minimizes patient trauma while reducing the incidence of complications such as pancreatitis and gallbladder cancer and preventing the recurrence of gallstones. The integration of artificial intelligence with stone extraction surgeries offers new opportunities to address this issue. Regarding the need for preoperative preparation for PTCS surgery, we recommend a combined approach of PTBD and PTOBF. For ERCP-based stone extraction, we recommend a small incision of the Oddi sphincter followed by 30 s of balloon dilation as the optimal procedure. If conditions permit, a biliary stent can be placed post-extraction. For the surgical approach of LCBDE, we recommend the transduodenal (TD) approach. Artificial intelligence is involved throughout the entire process of gallstone detection, treatment, and prognosis, and more AI-integrated medical technologies are expected to be applied in the future.

Management of Common Bile Duct Stones: Evaluation of the Effect of Size of Stones as the Determinant for the Procedure for Treatment in Era of Laparoscopic and Endoscopic Surgery

Abstract Background Common bile duct stones (CBDS) are estimated to be present in 10–20% of individuals with symptomatic gallstones. A variety of imaging modalities can be employed to identify the condition while management of confirmed cases of CBDS may involve endoscopic retrograde cholangiopancreatography (ERCP), surgery and radiological methods of stone extraction. Clinicians are therefore confronted with a number of potentially valid options to treat individuals with suspected CBDS. Objective To determine if ERCP sphincterotomy and extraction is effective in management of CBDS ranging from 10 to 20 mm or if surgical intervention is preferred in a sample of patients with common bile duct stones. Patients and Methods In this study, the data of (30) patients with CBDS who presented for the first time to the department of General surgery at Ain Shams University hospitals, Cairo, Egypt. Were collected during the period of August 2021 to February 2022. Results In the current study, all patients received proper pre-operative assessment and were operated on using same endoscope set and by experienced operators. Also, all patients were observed for post ERCP complications. The current study found that ERCP stone extraction in stones ranging from 10-20 mm success rate shows no significant difference in comparison with results that were published in different recent researches studying ERCP success rate in different stone sizes. Conclusion The current study found that success rate of ERCP in CBD stones extraction in stones ranging from 10-20 mm in size is similar to success rate in stone extraction compared to other studies not specifying stone size range. Also, complication rate was comparable to other recent published studies’ complication rate.

Comparative analysis of the technological properties of natural and agglomerated stones in epoxy matrix

Brazil occupies a prominent position among the countries that produce the most ornamental stones in the world, with emphasis on the state of Espírito Santo. However, despite this success in production, the sector faces a considerable challenge in relation to waste generation. The objective of this study was to produce and evaluate the technological properties of an agglomerated stone using 87 wt% waste from the processing of Branco Fortaleza stone in a matrix with 13 wt% epoxy resin, using the vacuum vibro-thermo-compression process. The waste was characterized by X-ray fluorescence (XRF) and X-ray diffraction (XRD). The stones were subjected to evaluation of density, apparent porosity, water absorption, abrasion resistance test, staining, chemical attack, 3-point flexural strength and microstructural analysis (SEM). The results showed a density of 2.26 ± 0.02 g/cm3, water absorption of 0.24 ± 0.01%, apparent porosity of 0.55 ± 0.03%, abrasion resistance test of 1.38 mm and flexural strength of 30.13 ± 1.74 MPa. The results compared with the literature reveal a material with technical feasibility to be used as a coating in the construction sector, presenting high mechanical resistance, good interfacial adhesion, application on high traffic floors, as well as environments subject to liquid penetration such as sinks, floors and countertops. Using this waste to manufacturing new materials, such as agglomerated stones, can not only help reduce dependence on raw materials, but also play an important role in minimizing the environmental impact associated with the extraction and processing of natural stones.