...the percentage of patients who are stone free after lithotripsy is 47% to 77% after 6 months and 68% to 84% after 12 months. [32] [34] [40] [41] [42] [43] [44] Side effects of lithotripsy include petechiae at the site of shock-wave delivery (8%), hematuria (4%), and liver hematoma (<1%).[34] No long-term liver biochemical abnormalities have been noted. Biliary pain develops in approximately one third of patients, and cystic duct obstruction occurs in 5%; fewer than 2% experience a complication of stone passage, such as biliary pancreatitis.[34]
Lithotripsy has been shown to be more cost-effective in the elderly than in the young and less cost-effective in patients with multiple stones than in those with a single stone. When combined with ursodeoxycholic acid treatment, lithotripsy is at least as cost-effective as open cholecystectomy for patients with small stones but less cost-effective for those with large stones. [45] [46] It should be emphasized that these studies of cost-effectiveness were performed in the era of open cholecystectomy. Data comparing the cost-effectiveness of lithotripsy with that of laparoscopic cholecystectomy are not available.
The rate of gallstone recurrence after lithotripsy is 6% to 7% after the first year and 31% to 44% after 5 years. [7] [8] Recurrence is most often related to the presence of lithogenic bile and gallbladder dysmotility rather than to patient variables such as gender, age, and weight. Recurrent stones are usually small and multiple and cause recurrent biliary pain. Maintenance therapy with ursodeoxycholic acid is neither cost-effective nor effective. [9] [47]
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