MANAGEMENT OF TRACTION WIRE FRACTURE COMPLICATING MECHANICAL BASKET LITHOTRIPSY

Background and Study Aims: The application of basket catheters has bec ome the main method of removing calculi from the biliary and pancreati c duct. However, larger or impacted stones have to be crushed and frag mented by mechanical lithotriptors before removal is possible. Sometim es, fracture of the traction wire occurrs as a severe and fraught comp lication. We describe a precautionary measure which helps to manage th is complication. Patients and Methods: In a series of 569 consecutive patients suffering from bile or pancreatic duct stones we found 60 (10 .5%) who required mechanical lithotripsy for oversized or impacted cal culi. Mechanical lithotripsy was always performed initally with a long metal sheath (80 cm) in combination with a standard traction wire. If the traction wire fractured we replaced the long metal sheath stepwis e by shorter ones (70 cm, 60 cm and 50 cm, respectively), allowing imm ediate continuation of the lithotriptic procedure using the same tract ion wire. Results: During the lithotriptic procedure three of our pati ents (5%) were afflicted by traction wire fracture. Two patients could be relieved directly by changing the initial metal sheath to shorter ones. Because of the exceptional hardness of a pancreatic duct stone t he third patient needed stone fragmention by extracorporeal shock wave lithrotripsy (ESWL) before complete mechanical clearance of the duct could be accomplished. Conclusion: We advocate the inital use of a lon g metal sheath (80 cm) to perform mechanical lithotripsy. In case of t raction wire fracture the use of a shorter metal sheath allows immedia te successful continuation of the procedure, thereby frequently avoidi ng procedures such as ESWL or surgery.