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Acute Presentation (Boerhaave’s Syndrome)
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
An alternative, given the high leak rate, is to form a controlled esophagocutaneous fistula with a T-tube [5]. A large-diameter (6–10 mm) T-tube is placed through the tear with the limbs lying beyond the boundaries of the perforation and the esophageal wall closed loosely around the tube with interrupted, absorbable sutures. The tube is externalized and secured at the skin, a further drain is placed down to the repair, and apical and basal intercostal chest drains are sited. Healing is monitored by serial radiology. The T-tube is left until a defined tract is established, with the majority removed around six weeks.
Liver and biliary system, pancreas and spleen
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
T-tube cholangiography is a post-operative contrast examination of the biliary ducts. A T-tube is placed in the CBD at the time of open surgery and a cholangiogram is performed 7–10 days later. The T-tube also acts as post-operative bile drainage. If excessive bile drains through the T-tube it can be indicative of a lack of free drainage into the duodenum.
Basic surgical skills and anastomoses
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Common bile duct T-tubes should remain in for 10 days. However, once the T-tube cholangiogram has shown that there is free flow of bile into the duodenum and that there are no retained stones, some surgeons like to clamp the T-tube prior to removal. The 10-day period is required to minimise the risk of biliary peritonitis after removal. T-tubes are traditionally and intentionally made of latex to stimulate fibrosis, which results in the formation of a tract to allow the drainage of bile if required. It is important to use an alternative to latex if the patient is allergic, bearing in mind the decreased potential for fibrosis of silicone-based T-tubes. The increase in less invasive means of intervention for bile duct pathology has resulted in fewer T-tubes being used.
Developments in the Diagnosis and Management of Cholecystoenteric Fistula
Published in Journal of Investigative Surgery, 2022
Ying-Yu Liu, Shi-Yuan Bi, Quan-Run He, Ying Fan, Shuo-Dong Wu
At present, the surgical treatment of CEF should be case-specific. We conducted 11 literature reviews on surgical treatment of CEF in the last five years, excluding patients diagnosed with gallstone ileus. A total of 58 cases of CEF (37 cases of CDF, 13 cases of CCF, 7 cases of CGF, and 1 case of CDF with CCF) were reported [31–41]. Patients underwent surgery laparoscopically in 53 cases, although 16 (30.1%) of those were converted to open surgery. Most cases underwent cholecystectomy with gastrointestinal tract repair, with or without T tube drainage. Duodenal repair mostly utilized a Graham patch. In patients with serious inflammation and adhesion of the gallbladder, subtotal cholecystectomy can be implemented. Fistulas that have been diagnosed preoperatively can be sutured using an endoscopic stapling device. Routine pathological examination or intraoperative frozen pathological examination should be carried out to detect premalignant or malignant lesions.
Comparison of Patient Outcomes and Safety between Overlapping and Nonoverlapping Surgeries in Patients Undergoing Laparoscopic Common Bile Duct Exploration
Published in Journal of Investigative Surgery, 2022
Xue Zhang, Jinhui Wang, Fubao Liu, Yong Zhao
The T-tube was clamped intermittently for 3 to 5 days after the surgery. If the patients did not report any discomfort, the T-tube was completely clamped gradually, and patients were discharged with the T-tube. At 1 month after surgery, cholangiography was performed through the T-tube, which was later withdrawn on the following day at the outpatient department. In the case of any stained stone, the choledochoscope was used for complete removal of the stone through the T-tube before the tube was removed. Residual stones were also treated by postoperative ERCP and extraction in patients who underwent LCBDE via the transcystic approach. Ultrasonography and liver function tests were performed at 2 weeks postoperatively, and were re-examined at the intervals of 3 or 6 months after patient discharge in the outpatient clinic. Further, the information on the long-term postoperative complications, including residual stones, stone recurrence, and bile duct stricture, was extracted through telephone or outpatient records. In the case of any persistent abnormality, imaging studies, such as computed tomography or magnetic resonance cholangiopancreatography were performed for further investigation. Postoperative ERCP and extraction were also performed for patients with residual stones or stone recurrence.
Perihilar Hepatectomy for Hepatolithiasis with Compressed Hilar Bile Duct Induced by Perihilar Hyperplasia of Liver
Published in Journal of Investigative Surgery, 2020
Guangyu Chen, Feng Tian, Xin Zhao, Yan Chen, Tao Peng, Jingchi Cui, Dajiang Li, Yu He, Shuguang Wang
Each patient underwent intraoperative cholangioscopy through the common bile duct or the biliary-enteric anastomosis to confirm no inflammatory stenosis in the hilar bile duct and no residual bile duct stenosis in the intrahepatic bile duct after hepatectomy. All biliary stones were removed with forceps. Indications of hepaticojejunostomy include Oddis sphincter laxity, manifested by possible passage of urinary catheter (internal diameter >14 Fr) through the Oddis sphincter, which appeared “dead fish mouth” and cannot be closed in the cholangioscopy; and Oddis sphincter stenosis, manifested by inability of the urinary catheter (internal diameter >10 Fr) to pass through the Oddis sphincter [11]. The procedure of hepaticojejunostomy was an end-to-side, mucosa-to-mucosa anastomosis of the extra-hepatic duct with a Roux-en-Y jejunal loop measuring 60 cm long. The anastomosis was interruptedly sutured with absorbable material (Vircyl, 5-0, Johnson Ltd, USA) [12]. A T-tube measuring 3.5–5 mm in diameter was inserted through the biliary-enteric anastomosis or the common bile duct in all patients after performing bile duct exploration for biliary decompression and postoperative cholangiography or cholangioscopic manipulation if necessary.