Management of T tubes for common bile duct stones: a new technique

The optimal treatment of common bile duct (CBD) stones is controversial, and depends on local expertise, the patient's medical condition and the time of diagnosis. Current practice entails a wide variation in the duration of leaving T tubes in place, anywhere from 7 to 30 days, and in the time to postoperative cholangiogram. Here we present a new technique for T-tube placement and management of secondary or retained CBD calculi that reduces T-tube duration to

After CBD exploration and clearance, we place a 10- to 18-French T tube through a 22- to 34-French straight rubber catheter with side holes acting as a sheath. The two tubes are exteriorized together, with the sheath protruding 1-2 cm. We place a colostomy bag for collecting possible abdominal drainage over the site and run the T tube through the colostomy bag into a bile bag.

Our method allows early removal of the T tube in patients with cleared ducts and early radiologic instrumentation of the CBD through the sheath to extract retained calculi. This obviates the need for postoperative endoscopic retrograde cholangiopancreaticography.

This method reduces the length of hospital stay, the number of outpatient office visits and postoperative studies, and the duration of T-tube drainage, potentially decreasing the incidence of complications of T tubes, improving patient satisfaction.