Spoletini G, Bianco G, Franco A, Frongillo F, Nure E, Giovinazzo F, Galiandro F, Tringali A, Perri V, Costamagna G, Avolio AW, Agnes S. Pediatric T-tube in adult liver transplantation: Technical refinements of insertion and removal. World J Gastrointest Surg 2021; 13(12): 1628-1637 [PMID: 35070068 DOI: 10.4240/wjgs.v13.i12.1628]
Corresponding Author of This Article
Gabriele Spoletini, FEBS, MD, PhD, Doctor, General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy. gabriele.spoletini@policlinicogemelli.it
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Dec 27, 2021; 13(12): 1628-1637 Published online Dec 27, 2021. doi: 10.4240/wjgs.v13.i12.1628
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
Gabriele Spoletini, Giuseppe Bianco, Antonio Franco, Francesco Frongillo, Erida Nure, Francesco Giovinazzo, Federica Galiandro, Alfonso Wolfango Avolio, Salvatore Agnes, General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Andrea Tringali, Vincenzo Perri, Guido Costamagna, Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Author contributions: Spoletini G and Bianco G were responsible for the conception, design, data analysis and drafting the article; Franco A and Tringali A were responsible for the acquisition of data and provided important intellectual content of the manuscript; Frongillo F, Nure E, Giovinazzo F, Galiandro F, Perri V, Costamagna G, Avolio AW and Agnes S provided substantial contributions to analysis and interpretation of data and made critical revisions of the manuscript; all authors approved the final version submitted.
Institutional review board statement: The Institutional Review Board of Fondazione Policlinico Universitario A Gemelli IRCCS provided approval for this study (IRB No. 3796).
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gabriele Spoletini, FEBS, MD, PhD, Doctor, General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy. gabriele.spoletini@policlinicogemelli.it
Received: March 17, 2021 Peer-review started: March 17, 2021 First decision: May 4, 2021 Revised: May 17, 2021 Accepted: November 24, 2021 Article in press: November 24, 2021 Published online: December 27, 2021 Processing time: 281 Days and 11.1 Hours
Abstract
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.
Core Tip: The use of small caliber T-tubes and a peculiar insertion technique minimize the size of the choledochotomy and reduce the chance of T-tube related adverse events; a careful T-tube removal procedure with the insertion of a temporary Nelaton drain mitigates the risk of uncontrolled biliary fistula and the need for emergency procedures.
