Endoscopic intracorporeal lithotripsy for sialolithiasis.

PURPOSE

This article describes a technique of salivary gland endoscopy using a 2.1-mm endoscope with a 1-mm working channel. The technique allows intracorporeal lithotripsy under endoscopic control. Two types of energy to produce calculi fragmentation were analyzed.

PATIENTS AND METHODS

Of 39 patients who presented with obstructive sialoadenitis, endoscopic treatment was possible in 27. Eighteen had a diagnosis of sialolithiasis. Intracorporeal lithotripsy was done under endoscopic control in these patients. Laser energy was used to produce fragmentation in 3 cases and pneumobalistic energy in 9. In 6 cases, the calculi were extracted with forceps.

RESULTS

Fifteen patients are free of stones and symptoms after a 6-month follow-up. Fragmentation and extraction of the calculi were not possible in 3 patients. Two of these patients required open surgery. The other patient is under observation.

CONCLUSIONS

The use of endoscopes with a working channel allows irrigation to improve visibility during exploration. Both extraction of calculi and lithiasis fragmentation using different energies can be carried out through the channel. In this series, pneumoballistic energy (Lithoclast) has been shown to produce calculus fragmentation with more efficiency than lasertripsy (Dornier Impact). When dilation and placement of a cannula (Abocath 16 G) was done 2 days preoperatively, endoscopy was performed more easily. Postoperative drainage has proven effective in avoiding complications.