Wrapping of the omental pedicle flap around the T-tube for the early postoperative biliary endoscopic intervention
Keywords:Omental pedicle, CBD stone, Artificial T-tube tract, Biliary endoscopy
Background:The placement of t-tube and postoperative biliary endoscopic intervention through T-tube tract is not an uncommon practice in the management of residual choledocholithiasis. In this study, we have evaluated the safety and feasibility of artificial T-tube tract for the early postoperative biliary endoscopy and early intervention through it, which was made by wrapping of the omental pedicle flap around the T-tube.
Methods:A total of 230 cases of choledocholithiasis who underwent open common bile duct exploration and t-tube insertion according to new surgical technique in our hospital from January 2009 to January 2014 were analyzed retrospectively. T-tube imaging was taken after 2 weeks and for normal imaging T-tube was removed and biliary endoscopy was performed at 2-3 weeks.
Results:Of 230 patients, 78 (33.9%) were male and 152 (66.1%) were female; 68 (29%) patients were with comorbidity. All groups underwent early postoperative endoscopy and early intervention at 2-3 weeks (an average of 17.9 ± 2.2 days). The result was statistically significant at (P <0.05). The residual stone were found in 27 patients (11.7%) and also noticed firmed, matured t-tube tract without any incidence of bile leakage.
Conclusions:Wrapping of the omental pedicle flap around the T-tube is a simple, practical and safe procedure to make strong artificial T-tube tract for the early biliary endoscopic intervention, It has shortened the time of postoperative biliary endoscopy from 4-6 to 2-3 weeks without any incidence of intraperitoneal bile leakage.
Sunthorn Treesaranuwattana, Choosak Khemtai, Darunee Pimkow. Bile leakage after T-tube removal: report of 3 cases. Thai J Surg. 2003;24:109-14.
Gillatt DA, May RE, Kennedy R, Longstaff AJ. Complications of T-tube drainage of the common bile duct. Ann Royal Coll Surg Engl. 1985;67(6):370-1.
Irfan Ahemd, Charita Pradhan, Ian J. Beckingham, Ian J. Beckingham, Adam J. Brooks, Braian J. Rowlands. Is a T-tube necessary after common bile duct exploration? World J Surg. 2008;32(7):1485-8.
Marko Nikolic, Alan Karthikesalingam, Senthil Nachimuthu, Tjun Y. Tang, Adrian M. Harrish. Biliary peritonitis caused by a leaking T-tube fistula disconnected at the point of contact with the anterior abdominal wall: a case report. J Med Case Rep. 2008;2:302.
Ahmed T, Alam MT, Ahmed SU, Jahan M. Role of intraoperative flexible choledochoscopy in calculous biliary tract disease. Mymensingh Med J. 2012;(3):462-8.
Muhammad Rizwan Khan, Sameera Naureen, Dildar Hussain, Rizwan Azami. Management outcome of residual common bile duct stones at Aga Khan University Hospital. J Ayub Med Coll Abbottabad. 2005;17(3)7-10.
Nadia Saeed, Muhammad Tauqeer Nasir, Muhammad Iqbal Khan, Ghulam Asghar Channa. Choledochorraphy (primary repair) versus T-tube drainage after open choledochotomy. J Ayub Med Coll Abbottabad. 2012;24(1)18-20.
Rajan KV, Kate V, Ananthakrishnan N. Role of operative flexible choledochoscopy in calculous biliary tract disease. Trop Gastroenterol. 2000;21(2):80-3.
Daldoul S, Moussi A, Zaouche A. T-tube drainage of the common bile duct choleperitoneum: etiology and management. J Visc Surg. 2012;149(3):172-8.
Maghsoudi H, Garadaghi A, Jafary GA. Biliary peritonitis requiring reoperation after removal of T-tubes from the common bile duct. Am J Surg. 2005;190(3):430-3.
Gharaibeh KI, Heiss HA. Biliary leakage following T-tube removal. Int Surg. 2000;85(1):57-63.