THE PERCUTANEOUS ROTARY LITHOTRITE - A NEW APPROACH TO THE TREATMENT OF SYMPTOMATIC CHOLECYSTOLITHIASIS

This report evaluates the use of a new device for destruction of gall stones, the Kensey-Nash Lithotrite (Baxter Corporation, California, US A). The principle of the instrument is that of a liquidiser with an im peller that emulsifies stones. Twenty five patients were treated; 13 p atients were considered unfit for conventional treatment (complex grou p) and 12 elected to have the procedure (non-complex group). In the co mplex group nine patients were treated under local anaesthesia. Only s ix of the 13 patients had a clear gall bladder at the end of the first procedure, but after further treatments that included cholecystoscopy , endoscopic sphincterotomy, and percutaneous cholecystolithotomy 11 p atients had a gall bladder free of stones. The morbidity was high, mai nly due to pain and bile leaks, causing prolonged stays in hospital (m edian 18 days). In the non-complex group six patients had the procedur e performed under local anaesthesia. Ten patients had a successful cle arance of the gall bladder, and the remaining two patients had the sto nes removed at cholecystoscopy. Despite good clearance, the morbidity was high, with eight emergency admissions on account of complications and a prolonged duration of stay (median 13 days). In conclusion the t echnique is effective, but the morbidity is high. Further development is required if this technique is to be included in the alternative tre atments for the management of gall stones.