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Quoraishi S et al, 2017: Lessons learnt from a case of extracorporeal shockwave lithotripsy for a residual gallbladder stone.

Quoraishi S, Ahmed J, Ponsford A, Rasheed A.
General Surgery, Royal Gwent Hospital, Newport, UK.
Department of Urology, Royal Gwent Hospital, Newport, UK.

Abstract

INTRODUCTION: Extracorporeal shockwave lithotripsy (ECSWL) for gallstones is rarely used due to high recurrence rates, but has been reported to be effective in some circumstances.
PRESENTATION OF CASE: We describe a case of a failed attempt at laparoscopic cholecystectomy due to gallbladder contraction and complete obliteration of Calot's triangle. Cholecystotomy was performed to remove all visible stones, and completed by a subtotal cholecystectomy and closure of the gallbladder remnant. The patient remained symptomatic due to a residual stone in the Hartmann's pouch. ECSWL was attempted to fragment the stone; however, follow-up imaging showed persistence of the calculus.
DISCUSSION: Literature review shows that ECSWL for multiple gallbladder stones has a low success rate. Even if a stone is successfully fragmented, a diseased gallbladder remnant seems incapable of expelling the fragments. Without completion endoscopic clearance, therefore, the treatment is considered incomplete.
CONCLUSION: Our case suggests that ECSWL is ineffective in management of residual gallbladder stones after failed cholecystectomy. 

Int J Surg Case Rep. 2017 Feb 3;32:43-46. doi: 10.1016/j.ijscr.2017.02.001. [Epub ahead of print]

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Comments 1

Hans-Göran Tiselius on Friday, 07 July 2017 07:57

This case report describes a series of attempts to remove gallstones from a shrunken and functionally destroyed gallbladder. The anatomy did not invite to neither laparoscopy nor open surgery. Following stone removal through a cholecystostomy a residual (and probably impacted) stone was treated with SWL. Very few details are given on how this procedure was carried out, but obviously the fragments did not have a chance to pass.

This is in no way surprising and it is not mentioned how (or if) the authors solved the problem. One final low-invasive option –in view of the disintegrated stone – would have been another cholecystostomy with direct chemolysis with or without endoscopic fragment clearance.

In view of the problems with this patient it had probably been better to use SWL early during the procedure in order to disintegrate the stone before stone removal via a cholecystostomy.

This case report describes a series of attempts to remove gallstones from a shrunken and functionally destroyed gallbladder. The anatomy did not invite to neither laparoscopy nor open surgery. Following stone removal through a cholecystostomy a residual (and probably impacted) stone was treated with SWL. Very few details are given on how this procedure was carried out, but obviously the fragments did not have a chance to pass. This is in no way surprising and it is not mentioned how (or if) the authors solved the problem. One final low-invasive option –in view of the disintegrated stone – would have been another cholecystostomy with direct chemolysis with or without endoscopic fragment clearance. In view of the problems with this patient it had probably been better to use SWL early during the procedure in order to disintegrate the stone before stone removal via a cholecystostomy.
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