Wrapping of the omental pedicle flap around the T-tube for the early postoperative biliary endoscopic intervention

Abstract

Background: The placement of t-tube and postoperative biliary endoscopic intervention through T-tube tract is not an uncommon practice in the management of residual choledocholithiasis. In this study, we have evaluated the safety and feasibility of artificial T-tube tract for the early postoperative biliary endoscopy and early intervention through it, which was made by wrapping of the omental pedicle flap around the T-tube. Methods: A total of 230 cases of choledocholithiasis who underwent open common bile duct exploration and t-tube insertion according to new surgical technique in our hospital from January 2009 to January 2014 were analyzed retrospectively. T-tube imaging was taken after 2 weeks and for normal imaging T-tube was removed and biliary endoscopy was performed at 2-3 weeks. Results: Of 230 patients, 78 (33.9%) were male and 152 (66.1%) were female; 68 (29%) patients were with comorbidity. All groups underwent early postoperative endoscopy and early intervention at 2-3 weeks (an average of 17.9 ± 2.2 days). The result was statistically significant at (P <0.05). The residual stone were found in 27 patients (11.7%) and also noticed firmed, matured t-tube tract without any incidence of bile leakage. Conclusions: Wrapping of the omental pedicle flap around the T-tube is a simple, practical and safe procedure to make strong artificial T-tube tract for the early biliary endoscopic intervention, It has shortened the time of postoperative biliary endoscopy from 4-6 to 2-3 weeks without any incidence of intraperitoneal bile leakage.