A retrospective analysis of 3 year's experience of an interdisciplinary approach to gallstone disease including shock-waves.
1206 patients with gallstone disease were treated between January 1985 and December 1987, using an interdisciplinary concept that included surgery, endoscopic sphincterotomy, and extracorporeal shock-wave lithotripsy (ESWL). Twenty-five per cent of the patients who were admitted for gallbladder stones were treated by ESWL, whereas 75% underwent surgery. Mortality of elective treatment for gallbladder stones amounted to 0.25% (0.4% in surgery, 0% in ESWL). Postoperative complication rate was low (4.2% in surgery, 7.0% in ESWL). After ESWL treatment, 80% of the patients were free of stones after a follow-up period of 1 year. Recurrence rate in these patients amounted up to 10%; in seven of 70 patients, mean follow-up period was 6 months after complete disappearance of stones. Twenty-seven per cent of all patients who were admitted for bile duct stones underwent surgery, whereas in the other 73%, calculi were removed via endoscopy. ESWL treatment was used additionally, if necessary. Fragments were left behind in three of 75 patients (4.0%) after surgical treatment, and in 7 of 200 patients (3.5%) after endoscopic and ESWL treatment, respectively. In the latter group, three patients (1.5%) required an additional operation. There were no deaths in either of the groups. The use of ESWL for treatment of gallbladder stones needs to be evaluated in long-term follow-up studies. Thus far, surgery remains the dominating method. Endoscopic procedures, eventually combined with ESWL, represent the preferred treatment for patients with bile duct stones.
Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilian-University, Munich, West Germany.
G
G
Heberer
G
G
Paumgartner
T
T
Sauerbruch
M
M
Sackmann
H J
HJ
Krämling
M
M
Delius
W
W
Brendel
D000368:Aged; D002769:Cholelithiasis / Q000601:surgery / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy; D008297:Male; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies