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July 1989

The Surgeon and Biliary Lithotripsy

Author Affiliations

Chicago, Ill

Arch Surg. 1989;124(7):769-770. doi:10.1001/archsurg.1989.01410070019003

Surgeons have been receiving the news of lithotripsy for gallstones with anxiety and some disdain. The initial pieces of the story have seemed to be a rewrite of the advent of endoscopy, biliary stenting for pancreatic cancer, endoscopic polypectomy, and percutaneous drainage of abdominal abscesses. The possibility that an operation done by surgeons since 1882 may be replaced by a procedure not involving an incision, and that this procedure may not be done by surgeons, is disconcerting, to say the least.

While some surgeons have reacted by predicting that lithotripsy will cause gallbladder perforations, obstructed common ducts, and recurrent stones, a reaction that might be interpreted as a sophisticated form of denial, others have preferred to watch and wait, suffering silently, and a few have planned joint ventures, limited partnerships, and other schemes to invest in machines, for motives seemingly transparent, but truly known only to themselves. Hospital administrators, presumably

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