From the Research
T-Tube Cholangiogram Procedure
To perform a T-tube cholangiogram on a post Common Bile Duct (CBD) surgery patient, the following steps can be taken:
- A T-tube is inserted following CBD exploration to facilitate removal or flushing of stones into the duodenum 1.
- A tube cholangiogram is performed on the 1st postoperative day to check for any retained stones 1.
- If retained stones are encountered, 1 mg glucagon can be administered intravenously and saline irrigation through the tube can be done under fluoroscopic control to help the stone pass into the duodenum 1.
- The cholangiogram can be repeated 10-14 days later, before removing the tube, to ensure that there are no remaining stones or complications 1, 2.
Considerations and Complications
Some considerations and potential complications to be aware of when performing a T-tube cholangiogram include:
- The risk of retained stones, which can be mitigated by using glucagon and irrigation 1.
- The risk of biliary leakage, which can occur after T-tube removal and may require treatment with antibiotics, parenteral fluids, and analgesia, or even open drainage 3.
- The potential for technical difficulties or complications during the procedure, such as impacted stones or bile duct injury, which may require conversion to open cholecystectomy or other interventions 2, 4.
- The importance of proper technique and experience in performing the procedure, as well as careful monitoring and follow-up to minimize the risk of complications 4, 5.
Alternative Techniques
Alternative techniques for managing CBD stones and performing cholangiography include:
- Laparoscopic choledocholithotomy with transductal T-tube insertion, which can be a safe and feasible option for large-sized impacted CBD stones 2.
- Laparoscopic common bile duct exploration (LCBDE) with T-tube placement, which can be a safe and effective alternative for managing CBD stones, especially in cases with multiple or large stones 4.
- Antegrade CBD stenting with primary closure, which may be a preferred technique for choledochotomy closure in some cases, although further assessment in clinical trials is needed 5.