Physical characteristics of gallstones removed at cholecystectomy: implications for extracorporeal shock-wave lithotripsy

Abstract

The criteria by which patients are selected for new, nonsurgical forms of gallstone therapy will influence the use of these techniques. We estimated the number of patients with gallbladder stones who are potentially suitable for extracorporeal shock-wave lithotripsy according to the current Food and Drug Administration protocol for the United States trials of the Dornier gallbladder lithotriptor. Exclusion criteria include patients with (1) more than three stones, (2) stones less than 0.5 cm or more than 3.0 cm in diameter, (3) radiopaque stones, and (4) a nonfunctioning gallbladder. The gallbladder contents in 100 consecutive patients undergoing cholecystectomy were analyzed according to the number, size, and calcium content of the stones as determined by specimen radiographs. Because none of these patients underwent preoperative oral cholecystography, an estimated percentage of functioning gallbladders was taken from the literature. Preoperative symptoms were not considered in determining a patient's eligibility for gallbladder lithotripsy. On the basis of these criteria, we estimated that 85% of our surgical patients would have been excluded from extracorporeal shock-wave lithotripsy according to the current Food and Drug Administration protocol for the Dornier gallbladder lithotriptor.