Despite multiple but useless attempts even via Soehendra lithotripter, Dormia basket
rested trapped in an "hallow" of the distal CBD.
The Dormia basket
is positioned in the lumen of necrotic collection (a, b).
In all these 121 patients we proceed to IOC, which helped in detecting 10 cases (2%) of ductal stones: clearance of the CBD was achieved using a Dormia basket
in this subgroup.
The retained baskets were retrieved by a variety of strategies: extracorporeal shockwave lithotripsy (22), balloon dilatation (18), open surgery (9), a second Dormia basket
(10), rescue mechanical lithotripter (5), exchange of metal wires (5), conservative management (2), exchange of metal sheaths (2), extension of sphincterotomy (2), laparoscopic surgery (2), laser lithotripsy (2), rat tooth forceps (2), goose neck snare (1), and papillotome to the stone (1).
Endoscopic removal of common bile duct stones has been regarded as an excellent modality for retained or recurrent CBD stones in patients after cholecystectomy; it has also been considered an acceptable treatment in patients with a gallbladder in situ.8 In experienced hands, the risks associated with endoscopic treatment are lower than those with surgical exploration of the common bile duct.9 The standard technique of CBD stone extraction comprise of endoscopic billiary sphinterotomy which widens the billiary orifice using electro-coagulation current, followed by removal of stones with balloon-tip catheters and /or Dormia basket
Although the difference of conversion rate is not statistically significant in our study (3.1% in group 1 versus 13.8% in group 2), there was only 1 failed case in group 1 which was in consistence with the fact that we found it easier to manipulate the Dormia basket
catheter than guide wire to advance through cystic duct and duodenal papilla.
One patient had repair of an iatrogenic endoscopic duodenal perforation, and the other required an open CBD exploration and removal of an impacted Dormia basket
Finally, a urology 'Dormia basket
' was passed through the hole in the foreign body under direct vision.
(11) Retrieval is usually done by interventional radiology using gooseneck snares, endovascular retrieval forceps or Dormia baskets
; surgical removal is also reported.