Extracorporeal shockwave lithotripsy of gallstones and the importance of operative cholangiography during laparoscopic cholecystectomy.

Our institute participated in a national study. We had 68 patients (two-thirds had solitary and one-third multiple gallstone calculi). Our extracorporeal lithotripsy results at 9-18 months' follow-up showed 25% to be free of stone (fragment). Forty-four percent required a second session. This technique has limitations and needs further improvement in the aiming devices available and the size of fragments in order to be useful to a larger group of patients. Laparoscopic cholecystectomy is a new modality for endoscopic removal of the stone-filled gallbladder. It can be performed safely in a well-selected group of elective cases. It represents a final cure because the diseased stone-containing gallbladder is removed. Patients have distinct advantages: less postoperative pain, a short hospital stay, and early return to work. Intraoperative cholangiography is of help to define the anatomy. Surgeons need to be competent in laparoscopy before using this technique to perform endoscopic cholecystectomy. It will play a dominant role in the future treatment of symptomatic cholelithiasis.