Lithotripsy Of Gallbladder Stones Research Articles

Lithotripsy of gallbladder stones

Lithotripsy of gallbladder stones

Percutaneous Rotational Lithotripsy of Gallbladder Stones

Ten patients (aged 39–94 years) with cholecystolithiasis were selected for percutaneous rotational lithotripsy with the Rotolith lithotriptor either because they were considered high-risk patients for cholecystectomy or because they had refused surgery. The procedure was completed in 7 patients. Five of these were stone-free at cholangiography 1 to 2 days after lithotripsy. Conclusive cholangiograms were not obtained in 2 patients due to gallbladder leakage, which in itself did not cause any serious sequelae. At ultrasonography after one month, one of these 2 patients had no visible gallbladder, the other one had small residual gallbladder stones. Rotational lithotripsy is an alternative to cholecystectomy in patients at high surgical risk, especially elderly patients who have undergone cholecystostomy as an emergency treatment for acute cholecystitis.

Results of extracorporeal shock wave lithotripsy of gall bladder stones in 693 patients: a plea for restriction to solitary radiolucent stones.

During a period of 24 months 693 consecutive patients with symptomatic gall bladder stones (526 males, 167 females; mean age 51 years, range 18-89) were treated by extracorporeal shock wave lithotripsy with a Piezolith 2300. The procedure was carried out on an out-patient basis without analgesics or sedatives. Concomitant chemolitholytic treatment (ursodeoxycholic and chenodeoxycholic acid 7.5 mg/kg/day each) was administered until three months after total fragment clearance for a maximum therapy period of 1.5 years. In 601 patients with radiolucent stones complete clearance of all fragments was obtained after three, six, 12, and 18 months in respectively 20, 41, 64, and 78%. Actuarial analysis of the subgroups according to the stone mass (size and number) selected an ideal patient population with solitary stones less than 20 mm diameter (84% stone free after one year). The results are significantly less good when the greater the number of stones or their maximal diameter increases. Treatment was interrupted in 3.6% of the patients. In 90 sludge or fragments remain present. Twenty five patients were lost to follow up for non-biliary reasons. Stone recurrence was 5.7% at one year and was observed both in patients with solitary and multiple stones. A cost effectiveness analysis suggests that laparoscopic cholecystectomy is the most effective and economic solution, although extracorporeal shock wave lithotripsy for solitary radiolucent stones less than 2 cm is cheaper than conventional cholecystectomy. Extracorporeal shock wave lithotripsy for multiple stones is the most expensive and least effective option.

Percutaneous Rotational Lithotripsy of Urinary Bladder Stones

Mechanical rotational lithotripsy of urinary bladder stones, up to 20 mm in diameter, was performed in 6 male patients with the Rotolith lithotriptor. the lithotriptor was introduced through a 10 F (OD 3.3 mm) suprapubically inserted sheath, and the procedure was performed under intermittent fluoroscopy and inspection through a transurethral cystoscope. In 3 patients, the bladder stones were fragmented to pieces small enough to be evacuated through the cystoscope. the instrument, which is designed for lithotripsy of gallbladder stones, was less efficient for fragmentation of urinary bladder calculi, primarily due to the large volume of the human urinary bladder, and possibly because of the higher gravity of bladder stones. There was no substantial damage to the mucosa of the urinary bladder.

Lithotripsy of gallbladder stones in 1992: Improved indications and actual results

ESWL of gallbladder stones and subsequent adjuvant oral dissolution is a safe and comfortable therapy of symptomatic cholecystolithiasis. This method is limited on highly selected 10 to 15% of patients. Recent experience indicates that the ideal indication is given in patients with radiolucent solitary gallstones (diameter ≤2 cm) which are harboured in a gallbladder with unimpaired contractility. 1 year after ESWL 80% of those patients present with a stone free gallbladder. Computed tomography of gallstones may probably improve selection of patients and therapeutic success.

Aggressive extracorporeal shock wave lithotripsy of gall bladder stones within wider treatment criteria: fragmentation rate and early results.

Two hundred and twenty patients with a total of 412 gall bladder stones of between 8 and 38 mm in size were treated with extracorporeal shock wave lithotripsy, using the overhead module Lithostrar Plus. Fifty six per cent of stones were solitary (mean (SD) diameter 23 (5) mm) and 9.5% of the patients had more than three stones. Stones were successfully disintegrated in 218 patients (fragmentation size less than 5 mm in 80%, less than 10 mm in 19%). Some 65% of patients required one treatment and the rest two or three. A mean (SD) of 4100 (1800) shock waves with a pressure of 700 bar were applied. Twenty four to 48 hours after lithotripsy a transient but significant increase in serum transaminase activities (31%) and in bilirubin (29%), urinary amylase (27%), and blood leukocyte (62%) values was observed. In 29% of patients there was a transient microhaematuria, in 2% transient macrohaematuria, and in 25% painless petechiae of the skin. Ultrasound showed temporary gall bladder wall oedema in 13%, temporary distension of the gall bladder in 11%, and transient common bile duct distension in 8% after treatment. After discharge from hospital, 31% of patients complained of recurrent colic that responded to simple analgesics. Four to eight weeks after therapy, four patients developed biliary pancreatitis and 11 biliary obstruction that was managed by endoscopy. To date, 105 patients have been followed for over 12 months. Sixty one of these had a solitary stone, 17 had two, and 27 had three or more stones. A total of 59 patients, including 44 with a primary solitary stone, eight with two stones, and seven with three or more stones are completely stone free.

Extracorporeal shock wave lithotripsy of gallbladder stones: a pessimistic view.

Extracorporeal shock wave lithotripsy of gallbladder stones: a pessimistic view.

Continuous Alfentanil Infusion for Extracorporeal Shock Wave Lithotripsy of Gallbladder Stones

Extracorporeal shock wave lithotripsy has recently been introduced in clinical trials for the treatment of cholelithiasis. General anesthesia, epidural anesthesia, and intravenous opiates have been used in the anesthetic management of patients undergoing this procedure. This report details our anesthetic management, which was used in 23 patients who underwent 27 procedures, and presents three illustrative cases. A continuous infusion of alfentanil and a 0.625-2.5-mg dose of droperidol were administered to the patients who were easily arousable during the procedure, and were able to cooperate with positioning change requests. Our patients did not develop apnea, hemodynamically significant bradycardia, or chest wall rigidity. One patient became nauseated, and one patient experienced a hypotensive episode that was unheralded by a change in respiratory rate, heart rate, or oxygen saturation. The patients were comfortable throughout the procedure, alert upon arrival to the postanesthesia care unit, and satisfied with this technique. A continuous infusion of alfentanil can be successfully used for the management of patients undergoing biliary lithotripsy.

Extracorporeal shock wave (ESW) lithotripsy of gallbladder stones: A randomized trial comparing two lithotriptors

Extracorporeal shock wave (ESW) lithotripsy of gallbladder stones: A randomized trial comparing two lithotriptors

Shock-wave lithotripsy of gallbladder stones: How many patients are suitable?

Shock-wave lithotripsy of gallbladder stones: How many patients are suitable?

Shock waves: a new physical principle in medicine.

Shock wave therapy of kidney- and gallstones, i.e. extracorporeal shock wave lithotripsy (ESWL), is a new, noninvasive technique to destroy concrements in the kidney, the gallbladder and in the ductus choledochus. This method was developed by the Dornier Company, Friedrichshafen, FRG, and tested in animal experiments at the Institute for Surgical Research of the University of Munich. In the meantime, kidney lithotripsy has gained world-wide acceptance. More than 60,000 patients suffering from urolithiasis have been treated successfully, what made surgical removal of their kidney stones obsolete. Gallstone lithotripsy is, however, still at the very beginning of clinical trial. Lithotripsy of gallbladder stones will have to be applied in combination with urso- or chenodesoxycholic acid in order to obtain complete dissolution of the fragments. Potential hazards to living tissues are briefly mentioned. Since the lung is particularly susceptible, shock waves must enter the body at an angle which ensures that lung tissue is not affected.