Mechanical lithotripsy of bile duct stones in 209 patients--effect of technical advances.

Between 1982 and 1987, mechanical lithotripsy of common bile duct (CBD) stones was performed in 209 patients (mean age +/- SD: 72 +/- 10 years), using self-constructed lithotripters and baskets with breaking strengths of approximately 50 and 100 kg between 1982 and 1986, and stronger and bigger baskets with breaking strengths of approximately 125 kg since 1987. Patients with single (49.3%) and multiple stones (50.7%) were distributed about equally. Stone size ranged between 4 and 80 mm (mean longitudinal diameter 18 +/- 9 mm, mean transversal diameter 13 +/- 3 mm), with a majority of the patients (61.2%) having stones of between 10 and 19 mm, and about one-third (32.1%) of the patients with stones greater than or equal to 20 (20-80) mm. The overall success rate of mechanical lithotripsy in all 209 patients treated between 1982 and 1987 was 87.6% including 79.1% for CBD stones greater than or equal to 20 mm and 67.6% for stones greater than or equal to 25 mm. The introduction of baskets with breaking strengths of approximately 125 kg in 1987 considerably increased the success rate of mechanical lithotripsy, especially for "large and giant" CBD stones, to 92.3% (greater than or equal to 20 mm) and 85.7% (greater than or equal to 25 mm), respectively.