The role of biliary T-tubes in contemporary hepatobiliary and emergency surgery: Has their time passed?

Abstract

Background: Biliary T-tubes were once considered an essential operative tool that mandated surgeon familiarity. Given advances in both interventional gastroenterology and radiology, coupled with minimal T-tube experience amongst graduating surgical residents, the contemporary role of Ttubes is unclear. The primary goal was to systematically evaluate the modern utility of T-tubes. The secondary goal was to describe potential T-tube technical pitfalls. Methods: A systematic review (Medline, PubMed, EMBASE, Web of Science, Cochrane) was completed (PRISMA methods) to evaluate the role of T-tubes. This was combined with a retrospective audit of technical complications as a direct result of T-tube management. Results: Among 194 citations, no randomized trials or prospective studies of reasonable methodologic quality were noted. The current literature is limited in its insight into the role of biliary T-tubes. Most descriptions occur within textbooks, dated retrospective audits and invited reviews. Ttube related complication themes include: (1) poor T-tube sizing, (2) poor T-tube preparation, (3) common bile duct injury during T-tube insertion, (4) early T-tube dislodgement and (5) sepsis from T-tube obstruction. Conclusion:The current role of T-tubes has been dramatically reduced secondary to advances in multidisciplinary techniques and lack of familiarity amongst graduating trainees.Complications in technique are not uncommon.