1259 Selection , management , and early outcome of 1 13 patients with symptomatic gall stones treated by percutaneous cholecystolithotomy

Abstract

Between January 1988 and December 1990, 283 patients with symptomatic gall stones were referred for non-operative treatment. After ultrasound scanning including a functional assessment, 220 (78%) patients were found to be suitable for percutaneous cholecystolithotomy. Of these, 113 underwent the procedure including 10 in whom extracorporeal shockwave lithotripsy or methyl tert-butyl ether therapy had failed. Forty four patients underwent extracorporeal shockwave lithotripsy, methyl tertbutyl ether therapy or rotary lithotripsy, 46 chose laparoscopic cholecystectomy or minicholecystectomy and 27 declined treatment. Percutaneous cholecystolithotomy was successfully performed in 100 patients. Thirty four patients were a high operative risk and 14 presented with an acute complication of gall stone disease. Complications developed in 15 patients, all ofwhom were managed conservatively and most occurred during development of the technique. Outcome has been assessed clinically and by ultrasound scauning in 92 patients with a median follow up period of 14 months (six to 37 months). Seventy nine per cent were completely cured oftheir symptoms. Ninety three per cent of gail bladders were shown to be functioning and nine (9.8%) contained stones, although five of these are believed to have developed from residual fragments. Percutaneous cholecystolithotomy is a safe, non-operative treatment for symptomatic gall stones and enabled the patient to fully recover within two to three weeks; it has a definite role in the management of the elderly and high risk patient but its use for the treatment of other groups is likely to remain controversial. (Gut 1992; 33: 1253-1259) Pancreatobiliary Unit, The Middlesex Hospital, London S Cheslyn-Curtis A R Gillams R C G Russell J J Donald S P Lake C A Ainley A RW Hatfield W R Lees Correspondence to: Mr R C G Russell, FRCS, Pancreatobiliary Unit, Middlesex Hospital, Mortimer St, London WIN 8AA. Accepted for publication 15 January 1992 In recent years, there has been a move away from open surgical techniques in biliary disease with an increasing use of therapeutic endoscopy for the extraction of bile duct stones and the stenting of biliary strictures. Similarly in the past decade, as recently reviewed,' several non-invasive and minimally invasive techniques have been pioneered for the management of gall bladder

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@inproceedings{Curtis20061259S, title={1259 Selection , management , and early outcome of 1 13 patients with symptomatic gall stones treated by percutaneous cholecystolithotomy}, author={S Cheslyn - Curtis and C G Russell and Spencer P. Lake and Christopher A. Ainley and Adrian R W Hatfield}, year={2006} }