Extracorporeal shock wave lithotripsy in cholelithiasis with a recently developed mini-lithotripter

Background and objective: Extracorporeal shock wave lithotripsy (ESWL) of g allstones has until now required fixed, nearly room-sized and expensive equ ipment. If: has become even less cost-effective with an increase in the num ber of laparoscopic cholecystectomies. The authors have technically modifie d a mini-lithotripter, used for dissolving salivary stones, for application against gallstones (by changing the energy spectrum and depth of focus). Patients and methods: 125 consecutive patients with solitary gallstone unde rwent lithotripsy according to a standard protocol (including oral litholys is), 64 of them (average age 42.5 +/- 9.3 years; 44 women, 20 men) by conve ntional ESWL (with the Modulith), 62 (average age 41.6 +/- 10.1 years; 43 w omen, 13 men) with a modified mini-lithotripter (Minilith). Clinical and so nographic follow-up took place at 1, 3, 6 and 12 months. Quality of life wa s documented according to a point score (GIQL), developed specially for pat ients with gastrointestinal conditions. Results: The mini-lithotripter applied significantly lower voltage and more shock-wave impulses per treatment than the conventional ESWL (p < 0.01), w hile patient tolerance, measured with a visual analogue scale, was the same . Application of the mini-lithotripter was easier and quicker than with con ventional ESWL, namely 31 +/- 8 min vs 41 +/- 12 min (p < 0.01). Frequency of adequate stone fragmentation per patient was the same for both methods, 2.2 +/- 0.5 applications with the mini-lithotripter vs 1.6 +/- 0.3 with con ventional ESWL (p < 0.01). There was no significant difference between the methods with regard to improved quality of life (increase of GIQL scale of 16% with the conventional ESWL, 14% with the mini-lithotripter) or freedom from stone at 1 year after lithotripsy (conventional ESWL: 80%, minilithotr ipter: 82%). Colics recurred in 15 of 64 patients receiving conventional ES WL, and in 13 of 61 in the mini-lithotripter group (difference not signific ant). There were no other complications. Conclusion: The cheaper mini-lithotripter, costing only a third of the conv entional ESWL, is equally effective in the dissolution of gallstones.