Use of Fogarty Balloon Catheter for CBD Stone Removal
Yes, Fogarty balloon catheters are effectively used for CBD stone removal, particularly in percutaneous transhepatic approaches where stones are pushed into the duodenum after papillary dilation, achieving success rates of 95.7%. 1
Primary Technique and Success Rates
The Fogarty balloon is most commonly employed in percutaneous CBD stone extraction following transhepatic access. 1 The standard approach involves:
- Establishing percutaneous transhepatic biliary access
- Performing balloon dilation of the papilla of Vater
- Using the Fogarty balloon to push stones in an antegrade fashion into the duodenum 1
In a large series of 261 symptomatic patients, this technique achieved a 95.7% success rate for stone clearance. 1 For stones larger than 15 mm, basket lithotripsy must be performed prior to balloon dilation and Fogarty catheter use. 1
Role in Laparoscopic CBD Exploration
Fogarty catheters can also be used during laparoscopic CBD exploration (LBDE) for stone fragment removal after lithotripsy. 2 During LBDE, the Fogarty catheter serves as an adjunct tool alongside choledochoscopic baskets to retrieve stone fragments after direct fragmentation under vision. 2
Complication Profile
Major complications occur in 6.8% of cases using the percutaneous Fogarty technique. 1 Reported complications include:
- Cholangitis
- Biloma and hematoma
- Abscess formation
- CBD and duodenal perforation
- Bile peritonitis
- Gastroduodenal artery pseudoaneurysm
- Right hepatic artery transection 1
Critical Safety Consideration
A unique complication risk exists when using vascular Fogarty embolectomy catheters for CBD stone removal: balloon separation and retention. 3 A case report documented a Fogarty balloon separating from the catheter during laparoscopic CBD instrumentation, causing subsequent CBD obstruction requiring endoscopic removal. 3 Surgeons must verify the balloon remains attached after catheter removal, and consideration should be given to using more rigid biliary-specific balloons rather than vascular embolectomy catheters. 3
Clinical Context and Alternatives
Percutaneous stone extraction with Fogarty balloons should be reserved for patients who fail or cannot undergo ERCP and laparoscopic duct exploration. 1 The 2017 Gut guidelines recommend that ERCP (supplemented by mechanical lithotripsy, EPBD with prior sphincterotomy, or cholangioscopy) and LBDE remain first-line approaches, with percutaneous techniques reserved for refractory cases. 1
For endoscopic approaches, balloon catheters demonstrate superior complete clearance rates (92.3%) compared to basket catheters (80.0%) for stones ≤10 mm. 4