ROLE OF EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY IN HEPATO-BILIARY-PANCREATIC SURGERY

Since the early 1980s extracorporeal shock wave lithotripsy (ESWL) has partially replaced major operative procedures in various fields of su rgery. In the interest of the patient, it is important to determine th e exact role of ESWL in surgery. Comparing our own prospectively follo wed patients with other patient series, we have tried to assess this r ole. We treated 133 patients with cholecystolithiasis, 80 patients wit h choledocholithiasis, and 17 patients with pancreatic stones using a second-generation lithotriptor, the Siemens Lithostar (Siemens, Erlang en, Germany). The results suggest a limited role of ESWL for cholecyst olithiasis, in which it is reserved for patients with high operative r isk and patients who reject an operation. For choledocholithiasis ESWL seems to become an integral part of the treatment in the elderly pati ent in whom endoscopic stone removal proved impossible. Finally, ESWL could become a first option for the treatment of intractable pain in p atients with chronic calcifying pancreatitis.