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.

Spoletini, G., Bianco, G., Franco, A., Frongillo, F., Nure, E., Giovinazzo, F., Galiandro, F., Tringali, A., Perri, V., Costamagna, G., Avolio, A. W., Agnes, S., Pediatric T-tube in adult liver transplantation: Technical refinements of insertion and removal, <<WORLD JOURNAL OF GASTROINTESTINAL SURGERY>>, 2021; 13 (12): 1628-1637-1637. [doi:10.4240/wjgs.v13.i12.1628] [http://hdl.handle.net/10807/194295]

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

Spoletini, Gabriele;Bianco, Giuseppe;Frongillo, Francesco;Nure, Erida;Tringali, Andrea;Perri, Vincenzo;Costamagna, Guido;Avolio, Alfonso Wolfango;Agnes, Salvatore
2021

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.
Inglese
Spoletini, G., Bianco, G., Franco, A., Frongillo, F., Nure, E., Giovinazzo, F., Galiandro, F., Tringali, A., Perri, V., Costamagna, G., Avolio, A. W., Agnes, S., Pediatric T-tube in adult liver transplantation: Technical refinements of insertion and removal, <<WORLD JOURNAL OF GASTROINTESTINAL SURGERY>>, 2021; 13 (12): 1628-1637-1637. [doi:10.4240/wjgs.v13.i12.1628] [http://hdl.handle.net/10807/194295]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/194295
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