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.