Management of T Tubes for Common Bile Duct Stones: A New Technique

Abstract

Background: The optimal treatment of common bile duct (CBD) stones is controversial, and depends on local expertise, the patient’s medical condition and the time of diagnosis. Current practice entails a wide variation in the duration of leaving T tubes in place, anywhere from 7 to 30 days, and in the time to postoperative cholangiogram. Here we present a new technique for T-tube placement and management of secondary or retained CBD calculi that reduces T-tube duration to ≤ 5 days. Materials and Methods: After CBD exploration and clearance, we place a 10- to 18-French T tube through a 22- to 34-French straight rubber catheter with side holes acting as a sheath. The two tubes are exteriorized together, with the sheath protruding 1–2 cm. We place a colostomy bag for collecting possible abdominal drainage over the site and run the T tube through the colostomy bag into a bile bag. Results: Our method allows early removal of the T tube in patients with cleared ducts and early radiologic instrumentation of the CBD through the sheath to extract retained calculi. This obviates the need for postoperative endoscopic retrograde cholangiopancreaticography. Conclusion: This method reduces the length of hospital stay, the number of outpatient office visits and postoperative studies, and the duration of T-tube drainage, potentially decreasing the incidence of complications of T tubes, improving patient satisfaction.

Intraoperative endoscopic retrograde cholangiopancreatography (ERCP) to remove common bile duct stones during routine laparoscopic cholecystectomy does not prolong hospitalization: a 2-year experience

“…In patients with a high operative risk, some surgeons prefer to place a T-tube to try to extract the CBDS postoperatively [16,27], which converts the method of treatment into a two-step procedure. In our series, a sphincterotomy was performed during the IO-ERCP in all cases with CBDS.…”