Simplified T-tube replacement with two-piece retrievable catheters

A new two-piece T tube has been developed for easy reinsertion over a guide wire, usually without the need for tract dilation. It is introduced as a single unit over a removable introducer cannula and is formed in situ within the common bile duct by manipulation of guiding sutures. The self-retaining T configuration is maintained by a suture-locking device. The T tube can be easily retrieved, repositioned, or exchanged. It can be modified distally with either a long limb or a "T loop" to provide internal biliary drainage via the T-tube tract. These low-profile catheters improve the safety of tube replacement through immature tracts (n = 6) and have also been introduced through transhepatic tracts (n = 6). Thirty-three catheters have been placed in 21 patients without significant complications.