Pediatric T-tube in adult liver transplantation: Technical refinements of insertion and removal

Gabriele Spoletini, Giuseppe Bianco, Antonio Franco, Francesco Frongillo, Erida Nure, Francesco Giovinazzo, Federica Galiandro, Andrea Tringali, Vincenzo Perri, Guido Costamagna, Alfonso Wolfango Avolio, Salvatore Agnes

Risultato della ricerca: Contributo in rivistaArticolo in rivista


Background: With the increasing use of extended-criteria donor organs, the interest around T-tubes in liver transplantation (LT) was restored whilst concerns regarding T-tube-related complications persist. Aim: To describe insertion and removal protocols implemented at our institution to safely use pediatric rubber 5-French T-tubes and subsequent outcomes in a consecutive series of adult patients. Methods: Data of consecutive adult LT patients from brain-dead donors, treated from March 2017 to December 2019, were collected (i.e., biliary complications, adverse events, treatment after T-Tube removal). Patients with upfront hepatico-jejunostomy, endoscopically removed T-tubes, those who died or received retransplantation before T-tube removal were excluded. Results: Seventy-two patients were included in this study; T-tubes were removed 158 d (median; IQR 128-206 d) after LT. In four (5.6%) patients accidental T-tube removal occurred requiring monitoring only; in 68 (94.4%) patients Nelaton drain insertion was performed according to our protocol, resulting in 18 (25%) patients with a biliary output, subsequently removed after 2 d (median; IQR 1-4 d). Three (4%) patients required endoscopic retrograde cholangiopancreatography (ERCP) due to persistent Nelaton drain output. Three (4%) patients developed suspected biliary peritonitis, requiring ERCP with sphincterotomy and nasobiliary drain insertion (only one revealing contrast extravasation); no patient required percutaneous drainage or emergency surgery. Conclusion: The use of pediatric rubber 5-French T-tubes in LT proved safe in our series after insertion and removal procedure refinements.
Lingua originaleEnglish
pagine (da-a)1628-1637-1637
Stato di pubblicazionePubblicato - 2021


  • Biliary drainage
  • Biliary fistula
  • Endoscopic retrograde cholangio-pancreatography
  • Kehr
  • Liver transplantation
  • T-tube


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