Prevention of Biliary Leakage after Removal of T-tube in Immunocompromised Patients

Soltani, Ehsan; Bahar, Ali Mehrabi; Dehghanian, Paria; Aghaei, Monavar Afzal; Mozaffari, Samira

doi:10.1007/s12262-013-0958-5

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…In immunocompromised patients, such as those on corticosteroids, the incidence of peritonitis after tube removal is reported to be as high as 50%. (15) In another study comprising 139 patients the reported incidence of complications after tube removal was 4.3%. (16) Corbett CRR et al in a study done in south east Thames region however reported the incidence of peritonitis after tube removal to be as low as 1 out of every 119 exploration.…”

Section: Discussionmentioning

confidence: 95%

“…They also reported that no additional benefits were found by keeping the T-tube for as long as 6 to 12 weeks studies have also concluded that the fibrous tract between the bile duct and skin may get disrupted leading to extravasation of bile to the surrounding tissue. (16) Ehson Sultan et al (15) Suggested that prior to removal of the tube a tractogram should be performed by injecting 5 to 10 cm 3 of Urografin by a 24 G cather pushed between the skin and the tube. Infected bile is thought to be another cause of complication following T-tube removal.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors of Biliary Peritonitis following T-Tube RemovalThe Unsolved Problem

Barua¹,

Hazarika²,

Hussain³

2019

jemds

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BACKGROUND Gall stone disease remains one of the most common problems leading to surgical intervention. About 15% of all gall stone disease patients have stones in the common bile duct (choledocholithiasis). Open choledocholithotomy is still widely performed, particularly in centres without ERCP facilities. Though primary repair of the common bile duct is possible, most surgeons prefer to drain the common bile duct with T-tube. This avoids pressure build up in the CBD in case of oedema around the ampulla of Vater in the immediate post-operative period. Normally, the T-tube is left for 14-20 days in order to allow a fibrous tract to form around it. In absences of any distal obstruction, the T-tube is removed by gentle traction in the horizontal limb. In majority of the cases no complications occur after tube removal. However, in some patients, biliary peritonitis occurs with varying severity. The aim of this study is to find out if there are yet unrecognized factors that increases the risk of biliary peritonitis post T-tube removal. METHODS A case control study was done in our rural based tertiary hospital with patients undergoing cholecystectomy and choledocholithotomy in between July 2017 and June 2018 in all surgical wards. 18 cases who had complications following T-tube removal were taken as cases (Group B). All these cases were females in the age group 20 to 45 years. None of these patients had other risk factors like diabetes, jaundice or any cause for immunosuppression. 36 cases comparable with regard to age, sex and pre-operative health status and who did not have any complications after tube removal were taken as control (group A). Data from these two groups was recorded under two headings-1) patient related. 2) technique related. Data was entered in excel sheet and analysis was done to see if there are any significant differences between the two groups either in patient related or technique related factors. RESULTS Patient related factors like duration of disease, Hb%, liver function test etc, were compared between group A and group B but no statistically significant difference was found. Of the technique related factors, no significant difference was noted between the two groups as far as removal of T-tube time was concerned. However statistically significant difference was noted when suture material used to repair the CBD was considered, with 55.55% of cases in group B showing the use of Vicryl (Polyglactin) as compared to 22.22% in group A. CONCLUSIONS It was observed that a significantly higher number of patients had complication following T-tube removal when the CBD was repaired with Vicryl suture as compared to patients where Catgut suture was used.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Risk Factors of Biliary Peritonitis following T-Tube RemovalThe Unsolved Problem

Barua¹,

Hazarika²,

Hussain³

2019

jemds

View full text Add to dashboard Cite

show abstract

“…Seldinger's method, which involves using a wire to guide the removal of the T-tube, shows a significant reduction of biliary leakage especially in cases of immunocompromised patients and cases of liver transplantation [ 13 ]. However, recent studies suggest that performing a fistulography to identify maturation of tract prior to the removal of T-tube especially in immunocompromised state has been effective in reducing the procedure related complications [ 14 ].…”

Section: Clinical Discussionmentioning

confidence: 99%