An experimental model for the combined medical and surgical treatment of gallstones

Summary New approaches to the treatment of gallstone disease have been introduced in recent years. In addition to bile acid dissolution, a chemical solvent (methyl tertiary-butyl ether) has been instilled directly into the gallbladder by percutaneous transhepatic techniques. Shock wave fragmentation of stones, induced by extracorporeal techniques or contact catheter probe placement, have also been successfully employed. Recurrence of gallstones, however, can be anticipated in most of these patients with an intact gallbladder and continued hepatic production of lithogenic bile. In order to explore these new procedures and to attempt to find a solution to the problem of stone recurrence, an animal model has been developed. The essential components of this model consist of an endoscopic (laparoscopic) cholecystopexy and, at a later date, percutaneous re-entry into the gallbladder by dilation of the cholecysto-cutaneous tract and the use of electrohydraulic and ultrasonic lithotripsy and methyl tertiary-butyl ether to achieve stone dissolution.