Lithotripsy in the Laparoscopic Era

OBJECTIVES The overall prevalence of gallstones in the United States is between 10% and 15%. Eighty-five percent of common bile duct (CBD) stones can be removed by endoscopic sphincterotomy with basket or balloon extraction, or both. The introduction of mechanical lithotripsy improved the results up to 90%. We present one case of retained CBD stone after 2 failed endoscopic sphincterotomies and balloon/basket extraction treated by electrohydraulic lithotripsy (EHL). METHODS A fifty-year-old man underwent ERCP for suppurative cholangitis. Because of the failure of stone extraction, he was taken to the operating room for an open cholecystectomy and CBD exploration. The intraoperative cholangiogram showed contrast flowing into the duodenum. Seven weeks later, the patient presented with mild pancreatitis, and a T-tube cholangiogram revealed a stone impacted in the distal CBD. Percutaneous balloon extraction was again unsuccessful. RESULTS The patient underwent a single 2.5-hour session of EHL via the T-tube tract. Mild pulmonary edema occurred intraoperatively. Complete clearance of the CBD was obtained without the need for additional ERCP. CONCLUSIONS EHL is a valid and effective option for difficult retained common bile duct stones after failed ERCP.