Complications of biliary T-tubes after choledochotomy

Traditional management of choledocholithiasis has been supraduodenal choledochotomy, duct exploration and insertion of a T-tube. This study reviews the complications associated with T-tube use and assesses whether laparoscopic procedures are associated with an increase in complications relating to T-tube use.

Case records from two large public hospitals in New South Wales (Australia) were analysed retrospectively for a 10-year period using a standardized data collection form. Morbidity, mortality and potential factors influencing the complication rate after choledochotomy and T-tube insertion were recorded. All complications were reviewed by an experienced biliary surgeon.

T-tubes were inserted in 274 patients, with 42 patients (15.3%) experiencing a total of 60 complications relating to T-tube use. Morbidity occurring while the tube was in situ included fluid and electrolyte disturbance (five patients), sepsis (10 patients), premature dislodgement (three patients) and bile leakage (six patients). Complications resulting after planned tube removal included localized pain (13 patients), biliary peritonitis (seven patients), a prolonged biliary fistula (seven patients) and a late bile duct stricture (one patient). T-tube complications resulted in a prolonged hospital stay (19 days vs 13 days, P = 0.005), 10 additional abdominal operations and two deaths. Complications related to T-tubes were constant over the study period and were similar between laparoscopic and open cases (13.8% vs 15.5%, P = 0.81).

Although this retrospective review is likely to have underestimated the incidence of T-tube complications, it has demonstrated significant morbidity associated with T-tube use. The incidence of these complications has been constant and is unrelated to a laparoscopic approach.