Extracorporeal shock wave lithotripsy of biliary and pancreatic stones

The aim of the study was to answer the following questions: Is extracorporeal shock wave lithotripsy for gallbladder stones a safe and effective therapy? (Chapter 2) Is simultaneous treatment with extracorporeal shock wave lithotripsy and the solvent methyl te.rt-butyl ether feasible, safe. and more effective than either treatment alone? (Chapter 3) Is ultrasonography reliable for the evaluation of ESWL-results? (Chapter 4) What proportion of patients, with symptomatic gallbladder stones, is suitable for the current operative and non-operative treatment modalities? (Chapter 5) Is stone recurrence inevitable after gallbladder saving therapies? (Chapter 6) Is extracorporeal shock wave lithotripsy a safe and effective therapy for common bile duct stones? (Chapter 7) Is extracorporeal shock wave lithotripsy a safe and effective therapy for pancreatic duct stones? (Chapter 8

Liver fibrosis after extracorporeal shock-wave lithotripsy of gallbladder stones - A case report

We encountered significant liver fibrosis in a healthy young patient undergoing laparoscopic cholecystectomy for symptomatic gallstone disease. Twelve months prior to cholecystectomy the patient underwent multiple extracorporeal shock-wave lithotripsy (ESWL) sessions with adjuvant oral bile-acid therapy. Since the site of fibrosis corresponded clearly to the shock-wave transmission path, which was in accordance with animal studies, it was concluded that this liver fibrosis was a side effect of biliary ESWL. Based on these findings and the literature, we conclude that further assessment of the long-term safety of ESWL is still warranted, especially in patients undergoing multiple ESWL sessions

High tie versus low tie in rectal surgery: comparison of anastomotic perfusion

Both "high tie" (HT) and "low tie" (LT) are well-known strategies in rectal surgery. The aim of this study was to compare colonic perfusion after HT to colonic perfusion after LT. Patients undergoing rectal resection for malignancy were included. Colonic perfusion was measured with laser Doppler flowmetry, immediately after laparotomy on the antimesenterial side of the colon segment that was to become the afferent loop (measurement A). This measurement was repeated after rectal resection (measurement B). The blood flow ratios (B/A) were compared between the HT group and the LT group. Blood flow was measured in 33 patients, 16 undergoing HT and 17 undergoing LT. Colonic blood flow slightly decreased in the HT group whereas the flow increased in the LT group. The blood flow ratio was significantly higher in the LT group (1.48 vs. 0.91; p = 0.04), independent of the blood pressure. This study shows the blood flow ratio to be higher in the LT group. This suggests that anastomoses may benefit from better perfusion when LT is performed