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PubMedDate not supplied

[Surgery for choledocholithiasis following extracorporeal lithotripsy in 3 patients].

Extracorporeal lithotripsy has been used as a therapeutic modality for gallbladder and common duct stones. When duct stones are fragmented and do not pass to the duodenum or endoscopic extraction is not possible, a surgical intervention seems justified. At operation under these circumstances we have appreciated an unusual increment of vascularity and inflammation that makes the operation somewhat difficult. In the last year we have operated three patients that had common duct stones and received lithotripsy. In two cases the procedure failed. Even when postlithotripsy cholangiogram showed fragmentation of stone, in one patient those fragments could not be evacuated transendoscopically and patient was operated few days later. During operation small fragments were found and probably they could have been eliminated through the sphincterotomy. Thus, we suggest to obtain a new cholangiogram before operating such cases.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1990

[Extracorporeal shockwave lithotripsy (ESWL)--a new procedure for treating choledocholithiasis].

UNLABELLED: ESWL offers a new possibility for the treatment of patients suffering from bile duct stones, in cases where endoscopic methods failed. From September 1987 to June 1989 80 patients (56 women, 24 men; mean age: 66 years) had been selected for ESWL at the Charité-Hospital. Indications were: Impacted stones (30 patients), very large stones (22 patients), stones above bile duct strictures (28 patients). 79 patients have been treated by device "Lithostar" (Siemens) during 114 sessions in abdominal position under X-ray visualization. ESWL-treatment was impossible in one patient because of technical reasons. Per treatment session 1000 to 5000 shock waves with an energy of 19 kV, directed on a single or distributed among several stones, have been applied. In 79 cases out of 114 treatments complete or partial fragmentation (69.3%) was attained. Stone fragments were removed endoscopically in 56 patients and in 1 patient percutaneously via biliary drainage. In 5 cases the fragments passed spontaneously. On the total, in 72.2% of our patients stones clearance was achieved. No severe side effects could be observed. CONCLUSION: ESWL represents a proper method increasing the effectiveness and lowering the risks of non-operative therapy by bile duct stones.

Aged↗
PubMed1990

[The current aspects of treating residual choledocholithiasis].

Taking into consideration the seriousness of the problem residual calculosis of the common bile duct, the authors analyse the noninvasive methods of treatment during the past 20-30 years. Available data in the literature are adduced pointing to the importance of endoscopic papillotomy and extraction of the calculi. Indications and contraindications for performing this procedure are defined. The different methods of treatment are evaluated on the basis of a follow up of three patients with residual calculosis of the common bile duct, treated by noninvasive method and the experience of treatment of nine patients with this disease for a period of nine years at the Department of Propedeutics of Surgical Diseases, Medical Academy in Sofia, on the one hand, and the experience with 984 patients in whom endoscopic papillotomy has been performed at the Workers Hospital "Dr. R. Angelov" in Sofia, on the other. Preference is given to endoscopic papillotomy with extraction of the calculi in residual common bile duct calculosis over operative treatment, with observance of definite indications. Excellent results of this therapeutic approach are reported: total percentage of early complications 1.52, late complications 1, ineffectiveness of the method 0.4 and case fatality rate 0.6. Another advantage is the limited contraindications and possibility for operative correction.

Adult↗
PubMedDate not supplied

[Usefulness of nasobiliary catheter during treatment of choledocholithiasis with extracorporeal lithotripsy].

From April to June 1990, five female patients with a mean age of 47 years, with previous cholecystectomy and the presence of bile duct stones, were treated by extracorporeal shock wave lithotripsy. Pain and jaundice was present in 4, one patient only had jaundice. In 3 patients the stones were located in the intrahepatic bile ducts, in the other 2 they were located in the common bile duct but were judged to be to large for endoscopic treatment. In all patients a sphincterotomy was performed and a nasobiliary catheter was inserted, after which extracorporeal shock wave lithotripsy was performed. Saline solution was infused through the nasobiliary tube (1 ml per minute) for 24 hours. In all the patients except one, the problem was solved in one session. Saline infusion through a nasobiliary catheter was useful as a complement of shock wave lithotripsy of bile duct stones to prevent the obstruction of the bile duct by fragments.

Catheterization↗
PubMedDate not supplied

[Endoscopic sphincterotomy in choledocholithiasis: analysis of an experience of 530 interventions].

We report the experience of 530 consecutive cases of choledocolithiasis treated through Endoscopic Sphincterotomy (ES) between January 1980 and January 1988 (74% of total patients submitted to ES in the same period). 73% had more than 60 years and 47% more than 70 years. A slight majority (52%) had previous cholecystectomy (1/3 still with T-tube drainage) and the remaining had gallbladders insitu (lithiasic in 82%). Therapeutic goals (achieved drainage and complete stone removal) have been achieved in 95% of patients with a low immediate morbidity (9%) and mortality (1%). Delayed mortality, until 30th day (3%) includes 6 cases of obstructive cholangitis with sepsis, unaltered by emergent ES. Follow-up showed a 3% incidence of reintervention from restenosed ES. Patients with lithiasic gallbladder had a 33% cholecistectomy rate, mostly elective during first month post-ES. Our experience confirms ES as an efficient and safe routine treatment for choledocolithiasis. It should be the first choice in patients with previous cholecystectomy or alithiasic gallbladder and a largely applicable tool in those with associated gallbladder stones. Decision about post-ES cholecystectomy in these patients must be weighed on clinical grounds and according to surgical risk groups.

Adult↗
PubMed1990

Endoscopic management of choledocholithiasis during pregnancy.

Extrahepatic biliary obstruction by gallstones during pregnancy is a difficult management problem. We present five patients--four with acute cholangitis and one with gallstone pancreatitis--in whom a surgical procedure was avoided by endoscopic sphincterotomy. All five women delivered healthy babies at term. Endoscopic retrograde cholangiopancreatography and sphincterotomy can be performed safely in pregnancy with minimal exposure to radiation. Endoscopic management should be considered in women presenting with acute cholangitis or gallstone pancreatitis during pregnancy.

Adult↗
PubMed1990

[How great is the risk in surgical treatment of choledocholithiasis?].

With a success-rate of approximately 95 percent non-operative removal of bile duct stones following endoscopic sphincterotomy is a valuable alternative to operative treatment. If the gallbladder has not been removed previously an acute cholecystitis may develop in up to 20 percent of the patients. Approximately 50 percent of complications following non-operative treatment require emergency surgery. The most serious complications following operative treatment are retained bile duct calculi (2.8%), wound infection and biliary fistulae. In our experience with 499 patients postoperative morbidity was 16.0% and mortality 3.8%. Cause of death was related to surgical bile duct exploration in only two patients (0.4%). Operative treatment of bile duct stones remains the treatment of choice. Endoscopic intervention is a valuable alternative for the removal of retained stones or in frail patients not fit for general anaesthesia.

Adolescent↗