PRESENTED BY

DR. SALEH AHMED HAMIDI

(DIPTO)

INTERN DOCTOR

HOLY FAMILY RED CRESCENT MEDICAL

COLLEGE HOSPITAL, DHAKA

T-TUBE

MANAGEMENT

WHAT IS T TUBE ?

A tubular device in the shape of a T,

inserted through the skin into a cavity or

a wound and used for drainage.

ARE SILICONE RUBBER T-TUBES BETTER THAN LATEX

RUBBER TUBES IN THE COMMON BILE DUCT?

A retrospective comparison of latex and

silicone rubber T-tubes draining the

common bile duct in the Rhesus monkey

shows that both tubes excite an adequate

local tissue reaction. [BJS , vol 61 , page 201-06]

However, latex rubber degenerated more

rapidly than silicone rubber, the interval

between insertion of the tube and onset of

complications being significantly shorter.

CONTD

It is suggested that silicone rubber T-

tubes have a place in human biliary

surgery, especially when long-term

drainage of the biliary tract is

requirred.

VARIOUS USE OF T-TUBE

T-tube Necessary after Laparoscopic /open Choledochotomy

Use of T-tube for Patients with Persistent Duodenal Fistula

Hepaticojejunostomies in the setting of liver transplantation

Pancreaticoduodenectomy

CONTD

Use of a T-tube stent to treat a patient

with tracheal stenosis.

Use of the Montgomery T tube in

ventilator-dependent patients

PURPOSE OF T TUBE

Handling of the common bile duct in the

form of dissection, dilatation or

choledochotomy invariably leads to

slowing of motility in the common bile

duct as well as can lead to spasm of the

sphincter of Oddi.

T-tube can cause back pressure and give

way of sutures used to suture the

choledochotomy incision leading to a

surgical calamity.

CONTD

The morbidity and mortality

associated with biliary peritonitis is

extremely high. Placement of a T

tube prevents all these

complications.

CONTD

T tube should be placed in both open as

well as laparoscopic CBD explorations.

COMPLICATION OF T-TUBE

Complications that have been reported

may occur with the T-tube in situ. These

include

Fluid and electrolyte imbalance,

Early dislodgment,

Tube dislocation,

Tube retention,

And bacteremia

CONTD

Those associated with removal of the T-

tube include

Bile leaks,

Biliary peritonitis,

Sepsis

POST OPERATIVE MANAGEMENT OF T-TUBE

Drainage of bile through T-tube up to 7th POD

Position of the T-tube should maintainted

Progressive clamping of the T-tube from 8th POD

Observation of the patient during clamping for –a.Pain in abdomen b. Fever c. jaundice

Daily observation of bile flow-Quantitty of bile, color of bile , Any leakage

CONTD

WHAT IS T TUBE CHOLANGIOGRAM ?

A T-tube cholangiogram is an x-ray of the biliary duct system.

These ducts transport bile between liver, gallbladder, and small intestine are not seen on radiographs without the use of contrast materials.

This contrast is injected via a T-tube, which is normally put in place during surgical procedures ranging from liver transplantation to cholcystectomy.

T-TUBE

WHY IS A T-TUBE CHOLANGIOGRAM PERFORMED?

Reveal any choleliths (stones) not

previously detected.

Demonstrate any small lesions, strictures,

or dilatations in biliary ducts.

To investigate the biliary tract.

CONTD

This exam can show blockages within

common bile duct or hepatic ducts.

The most common reason for this exam is

to look for remaining stones or stone

fragments in the ducts after having the

gallbladder removed