Stones too large for safe extraction through a reasonably sized sphincterotomy, or retained above a narrowing of the bile duct, can often be fragmented by lithotripsy. The most frequently employed technique involves grasping the stone(s) in a robust wire basket (Fig. 4.185) through a rigid sheath against the end of which the stone is crushed (Fig. 4.186) using a special geared or ratchet handle.
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