Lithotripsy in Multimodality Treatment for Cholelithiasis in Patients at a High Surgical and Anesthesiological Risk

Abstract

Objective: to use extracorporeal shock-wave lithotripsy as an organ-saving and less traumatic treatment in patients with cholelithiasis concurrent with significant pathology. Materials and methods: the results of clinical examination and treatment in 123 somatically ill patients treated for different forms of cholelithiasis aggravated by comorbidity by extracorporeal shock-wave lithotripsy with stimulation of bile production and outflow. Results. Ninety-nine endoscopic interventions were made in all the patients, 123 patients underwent shock-wave lithotripsy. The latter could fully clear the biliary tract from stones in 79% of the patients. Enhanced biligenesis, by maintaining the adequate outflow of bile into the duodenum, resulted in the promptest evacuation of calculous parts and allowed 24 patients to get rid of stones after lithotripsy within a week. In the remaining 7% of the patients, the crushing of stones was not attained even after using more than 3000 laser impulses; so other treatments were applied to them. Conclusion. The possibility exists of treating patients with cholelithiasis and significant comorbidity without performing surgical interventions under endotracheal anesthesia. It is expedient to perform surgical treatment in somatically ill patients with cholelithiasis if medical treatments are ineffective and the clinical manifestations of the disease progress.