[Treatment of bile duct calculi with extracorporeal lithotripsy]. / Tratamiento de los cálculos de los conductos biliares con litotripsia extracorpórea.

Currently there are several non-surgical procedures on biliary duct stones treatment; one of them is extracorporeal shock-waves lithotripsy (ESWL), which has advantages over the others. It is safe, effective and non invasive method, that does not need direct contact with the stone and has low morbidity. We treated 10 patients with ESWL generated by a piezoelectric system with ultrasonic localization. The stones were fragmented in 80% of the patients and eventually the concrements were eliminated in 63%. The complications were one case of hemobilia and another of pancreatitis.

[Surgery for choledocholithiasis following extracorporeal lithotripsy in 3 patients]. / Cirugía por litiasis coledociana después de litotripsia extracorpórea en tres pacientes.

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.