T-Tube

Excerpt

Cholelithiasis, or stones formed within the gall bladder, might obstruct the biliary flow into the small bowel. Eventually, cholelithiasis might migrate into the choledochal, and the patient would clinically present with jaundice. Several surgical options have been introduced to manage the choledocholithiasis, including step-wise management with endoscopic retrograde cholangiopancreatography (ERCP) and consequent or synchronized open or laparoscopic cholecystectomy or laparoscopic choledocotomy and open or laparoscopic approach for cholecystectomy. The former option with ERCP and either open or laparoscopic cholecystectomy is more commonly used. In contrast, the latter option of laparoscopic choledochal exploration is limited to well-equipped tertiary referral centers.

Following the removal of choledocholithiasis, the gap within the CBD would be repaired with absorbable sutures. To prevent the long-term consequences of the ductal stricture and divert the short-term biliary build-up following suture repairing the CBD and keep a patent duct, surgeons would provocatively place a T-tube in the duct. The T-tube is latex, silicone, or red rubber shaped, similar to the English letter T. The long handle of the T would pass through the abdominal wall and be connected to a draining bag. Later in the process of choledochal healing, the patency of the duct and the presence of any retained choledocholithiasis would be examined by instilling a contrast media and consequently obtaining an x-ray.

T Tube is a draining tube placed in the common bile duct after common bile duct (CBD) exploration with supra-duodenal choledochotomy. It provides external drainage of bile into a controlled route while the healing process of choledochotomy is maturing and the original pathology is resolving. T tub is named to reflect the shape of the tube used for the CBD drainage. It is not be confused with the Tracheal tube or Tympanoplasty tube.

Other options of managing CBD exploration are stenting, or primary closure in selected patients have been used. The idea and procedure were introduced and used for decades by surgeons around the world. It was the standard of care for CBD exploration until a couple of decades ago. In several centers worldwide, applying a postoperative percutaneous choledochoscopy with a T tube sinus tract is usually used to address the retained intrahepatic stones.