title: Fragmentation of biliary calculi in 71 patients by use of intracorporeal electrohydraulic lithotripsy.
abstract: OBJECTIVE
  Failure of percutaneous or endoscopic removal of biliary calculi is often associated with impacted stones or stones larger than 1.5 cm. In these difficult cases, intracorporeal electrohydraulic lithotripsy (EHL) is a method that allows large stones to be fragmented and removed percutaneously or endoscopically. In this study, the authors expand their experience with EHL and further evaluate the safety and efficacy of this technique to remove biliary tract calculi.
  
  
  METHODS
  Intracorporeal electrohydraulic lithotripsy was used to treat 71 patients with calculi in the bile ducts (n = 35) or gallbladder (n = 36). Access was obtained by means of a surgical T-tube tract (n = 16), percutaneous transhepatic biliary drainage (n = 14), percutaneous cholecystostomy (n = 36), an intraoperative approach during common duct exploration (n = 2), and at endoscopic retrograde cholangiopancreatography (n = 3).
  
  
  RESULTS
  EHL lithotripsy was effective in fragmenting all biliary stones in 69 of the 71 patients (97%). All of the stone fragments were removed in 67 of these 69 patients (94%). Major complications, including bile peritonitis and gallbladder necrosis, occurred in five patients; however, all major complications were related to the initial percutaneous drainage or tract dilation. No significant complications were directly attributable to the EHL procedure.
  
  
  CONCLUSIONS
  Intracorporeal EHL is a safe and effective method that can be used to improve the success of percutaneous and endoscopic biliary calculi removal.
authors: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis.
authors: K E
authors: KE
authors: Burton
authors: D
authors: D
authors: Picus
authors: M E
authors: ME
authors: Hicks
authors: M D
authors: MD
authors: Darcy
authors: T M
authors: TM
authors: Vesely
authors: M A
authors: MA
authors: Kleinhoffer
authors: G P
authors: GP
authors: Aliperti
authors: S A
authors: SA
authors: Edmundowicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged