Bile leak following T-tube removal

• Published in: Al-Azhar Assiut medical Journal : AAMJ Vol. 19; no. 3; pp. 469 - 476
• Main Authors: Shemy, Gamal, Hassan, Ahmed, Elias, Abd
• Format: Journal Article
• Language: English
• Published: Wolters Kluwer - Medknow Publications 01.07.2021; Medknow Publications and Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Bile ducts; biliary leakage; Care and treatment; choledocholithiasis; Common bile duct; Complications and side effects; Drainage, Surgical; Medical examination; Methods; Ostomy; peritonitis; t-tube choledochostomy; Egypt; choledocholithiasis; peritonitis; T-tube choledochostomy; biliary leakage
• ISSN: 1687-1693; 2536-9652
• DOI: 10.4103/azmj.azmj_50_21

Background and aim and objectives T-tube choledochostomy is performed following open or laparoscopic common bile duct exploration. There is increased concern regarding safety and efficiency of choledochostomy. The present paper evaluates the short-lived effectiveness and safety of T-tube bile leak after its removal. Patients and methods A total of 86 cases of choledocholithiasis were admitted to Al-Azhar University Hospital, Assiut. They underwent cholecystectomy (open), choledochotomy, and T-tube choledochostomy. T-tube choledochography was performed 10 days after surgery, and removal of the tube was done after 12 days. Results Morbidities, mainly bile leak and peritonitis, were estimated. A total of 10 patients had evidence of radiological leak. Marked biliary reactions were noticed in six cases promptly following T-tube removal. Five of these cases had clinical peritonitis, treated conservatively. Only one patient had biliary peritonitis and required reoperation. Conclusion The operative use of T-tube choledochostomy has been in dramatical decline in the past 20 years (owing to the development and adoption of removal lesser invasive maneuvers of choledocholithiasis removal). Manipulation of T-tube (situation and extraction) is technically exigent. Intricacy and morbidity are critical; thus, it is recommended not to be performed as a routine maneuver. Easier options must be taken into account initially.