PLACE OF EXTRACORPOREAL SHOCK-WAVE LITHOT RIPSY IN THE TREATMENT OF COMMON BILE-DUCT AND INTRAHEPATIC GALLSTONES

The management of intrahepatic and common bile duct stones has been mo dified by the advent of endoscopic sphincterotomy and percutaneous ext raction through a T-tube tract or transhepatic access. Occasionally, n onoperative extraction is incomplete. The use of extracorporeal lithot ripsy is reviewed in this setting. From May 1990 to February 1994, 18 patients (age 68.4 +/- 4.6 years)were treated by extracorporeal shockw ave lithotripsy combined with endoscopic sphincterotomy and retrograde extraction or percutaneous approach. 72% of patients had prevously un dergone a cholecystectomy and 44% exploration of the common duct. Pati ents were submitted to 1.56 +/- 0.17 session of lithotripsy (5.546 +/- 701 shockwaves). Hospital stay was 19.5 +/- 3.3 days. After the litho tripsy, 1.17 +/- 0.19 endoscopic or percutaneous procedures per patien t were necessary to clear the biliary tract. Seventy-eight percent of patients became stone-free. The five failures were treated by endobili ary prosthesis (n = 4) or cholecystectomy and bile duct exploration (n = 1). Lithotripsy in association with the usual therapeutic modalitie s contributes to clearing the bile duct from stones and avoids surgery in the majority of patients. A multidisciplinary approach is necessar y in order to obtain those results.