[Mechanical destruction of common bile duct calculi]

After endoscopic papillotomy freedom from stone in the choledochal duct can be achieved in about 90% of cases. Either there is a spontaneous passage of concrements or they can be extracted with a basket. But in 10% the stones are so large or are so disproportionate to the size of the distal choledochal duct, that they cannot be removed by conventional means. Mechanical lithotripsy is an easy and simply learned alternative to electro-hydraulic lithotripsy or intraductal gall-stone dissolution for non-surgical removal of large concrements. So far the method has been successful in 18 of 20 patients. Average size of the bile-duct concrements was 27.3 mm with a mean distal choledochal diameter of 10.4 mm. In four patients the stone fragments were passed spontaneously, in 14 they were removed either with the lithotripter itself or the basket. Mechanical lithotripsy is thus an important addition to the non-surgical treatment of gall-stones.