EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY OF COMMON BILE-DUCT STONES IN PATIENTS WITH INCREASED OPERATIVE RISK

Objective: Assessment of efficacy of extracorporeal shock wave lithotr ipsy (ESWL) of stones in the common bile duct. Design: Prospective cli nical study. Setting: Department of Surgery, University Hospital Rotte rdam, Rotterdam,The Netherlands. Subjects: 90 patients with stones in the common bile duct and at increased operative risk (median age 73 ye ars, range 27-95). Interventions: After failure of endoscopic measures , the first 13 patients were treated under general anaesthesia with a first generation lithotriptor. Of the next 77 patients, treated with a second generation lithotriptor, only one required general anaesthesia and 68 intravenous analgesia and sedation. Eight patients needed no a nalgesia at all. Main outcome measures: Fragmentation, clearance, and recurrence of stones. Results: Fragmentation of stones was achieved in all the first 13 patients and 63 of the 90 patients (69%). There were minor complications (macroscpic haematuria and subcapsular haematoma of the right kidney) in 13 and serious complications (bacteraemia) in 2. At follow-up (median 28 months), 2 patients had recurrent stones. C onclusion: ESWL of stones in the common bile duct is safe and effectiv e and should be considered high risk patients.