T-tube removal after liver transplantation: a new technique that reduces biliary complications

This article discusses a new simple, fast, and easily performed technique that allows reduction of morbidity and hospital stay after T-tube removal. A retrospective analysis was conducted of 145 recipients who underwent T-tube removal 3 months after orthotopic liver transplantation. Patients were divided in two groups: group 1 (n=93) underwent T-tube removal and contemporary placement under fluoroscopic guidance of a counter-drain. Group 2 (n=52) T-tubes were removed from the bile duct under fluoroscopy but were left in place as a counter-drain. Overall, there were 33 (22.7%) complications related to T-tube removal. Treatment was always conservative and no deaths were related to T-tube. In group 1, 29 (31.2%) complications occurred; and the mean hospital stay was 9.4+/-9.3 days. In group 2, four complications (7.7%) occurred (P=0.002); and the mean hospital stay was 5.8+/-5.5 days (P=0.012). The adoption of this new technique-under fluoroscopic guidance, using the T-tube itself as a counter-drain-for T-tube removal allowed us to significantly reduce biliary complications and hospital stay.