Laparoscopic Common Bile Duct Exploration for Retrieval of Impacted Dormia Basket following Endoscopic Retrograde Cholangiopancreatography with Mechanical Failure: Case Report with Literature Review

Abstract

Dormia baskets are commonly used during endoscopic retrograde cholangiopancreatography (ERCP). One complication is basket retention, through impaction with a gallstone or wire fracture. We describe a case where the external handle of the basket snapped causing retained basket plus large gallstone impacted in the common bile duct (CBD). Following laparoscopic cholecystectomy, laparoscopic CBD exploration allowed direct stone fragmentation under vision with the choledochoscope. Fragments were removed using a choledochoscopic basket and Fogarty catheter, and the basket was withdrawn. Literature search identified 114 cases of retained baskets with management including shockwave lithotripsy (27%), papillary balloon dilatation (22%), open CBD exploration (11%), and one laparoscopic case.

Laparoscopic retrieval of impacted and broken dormia basket using a novel approach

“…The retained basket has been retrieved by a variety of strategies such as extracorporeal shock wave lithotripsy (ESWL), sphincterotomy and balloon dilatation, rescue mechanical lithotripter, exchange of metal wires or metal sheaths or choledochotomy – either via laparotomy or laparoscopic approach. [ 5 6 ] ESWL utilises laser lithotripsy to fragment the stones that further aid in retrieving the impacted dormia. However, this needs expertise and several sittings to achieve complete duct clearance.…”

“…Overall, endoscopic rescue has been attempted in experienced centres, but it is often difficult to catch the tip of impacted dormia basket and can be associated with risk of perforation, bleeding and need for multiple sessions. [ 6 ]…”

“…It has been reported before only thrice which makes our procedure only the fourth such in the literature. [ 6 7 8 ] Our dormia with dormia technique is novel and has not been reported before.…”

“…[ 8 ] Another surgeon who attempted laparoscopic removal of basket and stone was using balloon through choledochotomy. [ 6 ] In our case, as we could not see the basket or stone as it was impacted near ampulla, we, therefore, modified our approach. Choledochoscopy was performed, impacted dormia basket was visualised, another dormia basket was introduced through it and the tip of broken dormia was engaged in its basket, and then, it was gradually pulled out of choledochotomy site.…”

Dormia basket impacted during ERCP, resolved by laparoscopic bile duct approach: Case report

“…An unusual but possible complication is Dormia basket impaction or Traction cable breakage when removing CBD stones. An expert study reported that the complication rate associated with the use of the Dormia basket, due to a stone of hard or large consistency (> 1 cm), is a complication ranging from 0.8 to 6% of cases [ [5] , [6] , [7] ]. Therefore, it deserves an urgent resolution; however, at the moment, there is no consensus on the optimal technique or the behavior to follow for the resolution of this complication [ 2 , 8 ].…”