Laparoscopic cholecystectomy after unsuccessful shock-wave therapy.

Extracorporeal shock-wave therapy of gallstones was begun at the Surgical Department of the University of Freiburg, Germany, in March 1988; 85 patients were treated up to September 1991. The stone-free rate differed with the gallstone group. Patients with solitary stones less than 20 mm in diameter showed a significantly higher rate after 18 months of lithotripsy and dissolution therapy than patients with multiple stones (p < 0.01), that is, 83% and 49%, respectively. Open cholecystectomy was necessary for seven patients with complications following fragmentation. After starting laparoscopic cholecystectomy, eight patients decided in favor of this procedure because of constant biliary symptoms. These patients had a mean duration of dissolution therapy of 19 months. The minimal invasive procedure is an alternative for patients with unsuccessful lithotripsy and lysis who initially demanded conservative treatment. Indication for shock-wave therapy is limited to only a small group of patients with solitary cholesterol gallstones less than 20 mm who reject laparoscopic surgery.