GALLSTONE LITHOTRIPSY - THE ROTTERDAM EXPERIENCE

In the period between September 1988 and September 1992, 133 patients (34 males and 99 females; mean age 49 years [range 24-81]) underwent 2 99 extracorporeal shockwave lithotripsy sessions with adjuvant oral bi le acid therapy. The mean number of extracorporeal shockwave lithotrip sy sessions was 2.5 (1-7) and the mean number of shock waves 2,817 (75 -4000), while the mean duration per session was 62 minutes (35-210). N inety-eight patients (73.7%) required intravenous analgo-sedation. At last follow-up (mean: 17.7 months [2-46]), 37 patients (27.8%) were fr ee of stones and 30 (22.6%) had undergone cholecystectomy. At 1 year a fter the first session of extracorporeal shockwave lithotripsy, 51.0% of the patients with a solitary stone and 8.3% of the patients with 2- 10 stones were free of concrements (p < 0.0001). Fourteen per cent [6/ 43] of the patients developed recurrent stones. Major complications co mprised pancreatitis (n = 4; 3.0%) and acute cholecystitis (n = 1; 0.8 %). Our results reconfirm that extracorporeal shockwave lithotripsy is safe and moderately effective in selected patients. Because of the wi de acceptance of the laparoscopic cholecystectomy, extracorporeal shoc kwave lithotripsy should be restricted to patients at increased surgic al risk and patients who refuse surgery. In view of the poor results i n multiple stones, extracorporeal shockwave lithotripsy should be perf ormed only on solitary stones.