Diagnostic value of T-tube cholangiography and choledochoscopy in residual calculi after biliary surgery | BMC Gastroenterology | Full Text

BMC Gastroenterology volume 24, Article number: 383 (2024) Cite this article

115 Accesses

Metrics details

T-tube cholangiography and choledochoscopy are commonly used techniques for detecting residual bile duct stones after biliary surgery. However, the utility of routine cholangiography before T-tube removal needs further investigation. This study aims to evaluate the diagnostic efficacy of various methods for detecting residual calculi following biliary surgery.

We retrospectively analyzed the clinical data of 287 adult patients who underwent common bile duct exploration with T-tube drainage, followed by T-tube cholangiography and choledochoscopy, at the Department of General Surgery, Xuanwu Hospital, Capital Medical University, between 2017 and 2022. Exclusion criteria were patients with bile duct tumors, incomplete medical records or loss to follow-up, and patients with contraindications to T-tube or choledochoscopy. McNemanr test and Kappa test were used to compare the results and consistency between choledochoscopy and T-tube cholangiography. All patients underwent both cholangiography and choledochoscopy six to eight weeks after laparoscopic cholecystectomy combined with common bile duct exploration and T-tube drainage. The results of T-tube cholangiography and choledochoscopy for each patient were recorded, analyzed, and compared.

Among the 287 patients, T-tube cholangiography detected residual stones in 38 cases, which were confirmed by choledochoscopy in 29 cases. Conversely, of the 249 patients without evidence of residual stones on T-tube angiography, 11 patient was later found to have retained stones through choledochoscopy. There was no significant difference between the results of T-tube cholangiography and choledochoscopy (P = 0.82), indicating a high level of agreement between the two methods (Kappa value: 0.70) (95% CI, 0.65–0.76).

There is no significant difference in the diagnostic accuracy between T-tube cholangiography and choledochoscopy for detecting residual bile duct stones after surgery (P = 0.82). The two methods demonstrated a high level of consistency (Kappa value: 0.70) (95% CI, 0.65–0.76). The choice of diagnostic method for postoperative residual bile duct stones should be based on the specific condition of the patient.

Peer Review reports

The prevalence of cholelithiasis, encompassing gallbladder stone, extrahepatic bile duct stone, and intrahepatic bile duct stone, is estimated to affect approximately 10%∽20% of the overall population [1,2,3]. Among patients with cholelithiasis, those presenting with common bile duct stones account for approximately 10%~15% [4]. ERCP has become a preferred treatment for choledocholithiasis [5, 6]. However, ERCP carries the risk of complications, including bleeding, perforation, infection, ductal injury, and pancreatitis, some of which may be life-threatening [7, 8]. Open or laparoscopic common bile duct exploration and T-tube drainage are indispensable treatment methods for cholecystolithiasis combined with choledocholithiasis [9]. However, due to the extensive and occult distribution of stones and the technical demands associated with choledochoscopy, residual stones in the bile duct still occur occasionally postoperatively, with a prevalence rate ranging from 2 to 5% [10].T-tube cholangiography and choledochoscopy are reliable techniques for assessing residual bile duct stones, effectively reducing the incidence of postoperative stone retention. T-tube cholangiography is a straightforward, cost-effective method to visualize the biliary system after surgery and ascertain the presence of any remaining stones in the biliary tract [11]. In our hospital, T-tube drainage is employed in cases where patients present with numerous small or silt-like stones within the common bile duct, particularly when there is significant acute inflammation and marked edema of the common bile duct. Moreover, it serves as a crucial determinant in clinical decision-making regarding T-tube removal. The application and development of choledochoscopy enables direct observation of the presence of residual stones, tumors, strictures, inflammation or bleeding in both intrahepatic and extrahepatic bile ducts. Additionally, simultaneous treatment can be performed during the procedure. Further investigation is warranted to determine the necessity of routinely performing cholangiography prior to T-tube removal.

Therefore, this study is to compare the diagnostic efficacy of T-tube cholangiography and choledochoscopy in assessing residual stones following biliary tract surgery, and to investigate whether routine performance of conventional T-tube cholangiography prior to T-tube removal is necessary for improved clinical guidance or not.

The clinical data of 287 adult patients who underwent common bile duct exploration with T-tube drainage, followed by T-tube cholangiography and choledochoscopy, at the Department of General Surgery, Xuanwu Hospital, Capital Medical University, between 2017 and 2022 were retrospectively analyzed. Exclusion criteria were patients with bile duct tumors, incomplete medical records or loss to follow-up, and patients with contraindications to T-tube or choledochoscopy. Among them, there were 158 males and 129 females, with ages ranging from 18 to 68 years (mean age: 63.30 ± 4.58 years). Of the 287 patients, 25 had previously undergone laparoscopic cholecystectomy and underwent only laparoscopic common bile duct exploration. The remaining 262 patients underwent combined laparoscopic cholecystectomy and common bile duct exploration, even in the absence of gallstones in some cases. This approach was taken to ensure thorough exploration and treatment of potential residual stones. We will clarify this aspect in the methods section. All patients underwent subsequent common bile duct incision and T-tube drainage.

Patients were discharged from the hospital with T-tube cloesd after bile duct surgery and readmitted within 6 to 8 weeks for T-tube cholangiography and choledochoscopy, we reopen T-tube when the patient is readadmitted. If residual stones were detected in the bile duct, a stone basket was used to remove the residual stones during choledochoscopy. The detailed surgical procedures were as followed.

Patients undergoing T-tube cholangiography were positioned supine, closed the T-tube and a slow instillation of 20–50 ml of 20% ioversol (contrast agent) was performed through the T-tube. The patient’s position was adjusted to ensure even dispersion of contrast agent throughout the biliary tract, followed by multi-angle radiography for precise visualization. Subsequently, the T-tube was opened and connected to a drainage bag. Surgeons and radiologists interpreted the results of T-tube cholangiography to ascertain the presence of residual stones.

The patient was positioned supine, and the T-tube was gradually extracted. Choledochoscopy was performed through the sinus tract for access. Sequential examination included the biliary tract, common bile duct, opening of the lower end of the common bile duct, common hepatic duct, as well as left and right hepatic ducts along with their respective branches at all levels. Residual stones identified during choledochoscopy can be retrieved using a stone retrieval basket. In cases where stones are large or incarcerated, holmium laser lithotripsy may be employed for removal. If stone extraction proves challenging, repeat removal can be attempted after 1–2 weeks. Following extraction, a 16 F silicone tube was placed and connected to a drainage bag; this silicone tube was removed on postoperative day two.

All data of patients were included in SPSS 26.0 software for summary and processing. McNemanr test and Kappa test were used to compare the results and consistency between choledochoscopy and T-tube cholangiography. Evaluation criteria: Kappa value < 0, poor consistency; Kappa value 0.00-0.20, very low consistency; Kappa value was 0.21–0.40, with general consistency; Kappa value was 0.41–0.60, with moderate consistency; Kappa value was 0.61–0.80, highly consistent; Kappa value > 0.81, almost completely consistent. All statistical tests above were two sided, with significance set at P < 0.05. In this study, we focused on evaluating the diagnostic concordance between T-tube cholangiography and choledochoscopy using McNemar’s test and the Kappa statistic. Since our primary aim was to compare the agreement between the two methods, rather than assess their performance against an independent gold standard, analyses of sensitivity, specificity, and ROC curves were not included. This approach allows us to directly examine the consistency between the two diagnostic techniques.

The patient characteristics, including sex, age, and common bile duct (CBD) diameter, did not exhibit any significant differences between the residual stone and non-residual stone groups (Table 1). Among the 287 patients included in this study, choledochoscopy confirmed the presence of residual stones in 40 cases, resulting in an incidence rate of 13.9%. T-tube cholangiography identified residual stones in 38 cases. However, choledochoscopy subsequently confirmed that 9 of these cases did not have any residual stones, indicating a false positive rate of 3.6%, and it is positive only for diagnosis of residual stones. Conversely, T-tube cholangiography results were negative in 11 cases, but choledochoscopy reexamination revealed residual stones, resulting in a false negative rate of 4.4%. (Table 2). There was no significant difference between T-tube cholangiography and choledochoscopy in the evaluation of residual stones (Mcnemanr Test, P = 0.82), and the two methods were highly consistent (Kappa value: 0.70) (95% CI, 0.65–0.76).

In addition, residual stones were found in 3 of 9 cases with T-tube cholangiography results indicating bubbles, and Hem-o-lock clamp was found in the common bile duct in 2 cases with choledochoscopy. Furthermore, there are 3 cases of intestinal biliary metaplasia, 1 case of inflammatory hyperplasia, 1 case of mass and foreign body at the lower end of the biliary tract, 4 cases of biliary edema, stenosis and atresia, and 1 case of cholesterol crystallization in the biliary tract that were also diagnosed by choledochoscopy. Incomplete sinus tract was formed in 5 cases.

Choledocholithiasis is a common disease around the world [12]. The most frequent abnormality affecting the pancreatobiliary system is bile duct stones, and the amount of these patients is increasing, especially in the elderly Asian population [13]. Common bile duct exploration with T-tube drainage is a fundamental, secure, and dependable surgical approach for stone remova. Currently, the clinical methods employed to examine residual stones encompass B-ultrasound, T-tube cholangiography, choledochoscopy, and magnetic resonance cholangiopancreatography (MRCP) [14]. T-tube cholangiography and choledochoscopy are employed for the purpose of identifying residual stones post-operation, driven by and technical considerations. Although B-ultrasound examination is cost-effective and provides information on the location and quantity of residual stones, it may be susceptible to interference from gas and stone structure, leading to potential missed diagnoses of residual stones. Due to its high cost and limitations such as contraindications for patients with metal implants or other factors, MRCP examination is not routinely performed prior to T-tube removal. Despite the visualization of stone removal during choledochoscopy in laparoscopic common bile duct exploration (LCBDE), a residual rate of 6.8% for choledocholithiasis still persists [15]. In this study, the prevalence of residual calculi following biliary duct operation over the past five years in a cohort of 287 cases was found to be 13.2%. We hypothesize that the elevated missed stone rate observed in our study may be attributed to the higher average age of our patient cohort. Older patients tend to present with a greater number of stones or smaller stones, particularly silt-like stones, which are inherently more challenging to completely clear during surgery. Additionally, our hospital manages a substantial volume of emergency cases involving common bile duct stones, where acute inflammation or significant edema may impede the accurate detection and thorough removal of stones.

Through analyzing the research findings and consulting relevant literature, several factors contributing to missed diagnosis and misdiagnosis of biliary residual stones were identified: (1) Previous studies have reported an 8.33% false negative rate when using a contrast agent concentration of 30%. The high concentration of contrast agent on X-ray images can obscure residual stones, leading to missed diagnoses (2). Contraction of the Oddi sphincter during T-tube cholangiography may result in filling defects in the lower part of the common bile duct, which can be mistaken for stones. Maintaining a temperature range of 30–40 degrees Celsius for the contrast agent can prevent stimulation and spasm of the sphincter (3). Bubbles detected during cholangiography are an important factor affecting diagnostic accuracy. In 3 of 9 cases with detected bubbles, bile duct residual stones were found. If bubbles enter the bile duct during contrast agent injection, they can create small shadows on images that are easily confused with stone images (4). The expertise of radiologists and clinicians also influences image interpretation accuracy; attention should be given to anatomical variations in the bile ducts (5). Prolonged wearing of T-tubes can cause changes in their position, which affects imaging results.

To improve the accuracy of diagnosing residual biliary stones and mitigate the factors contributing to missed or misdiagnosed cases, according to our clinical experience several key preventive measures can be implemented: (1) Adjusting Contrast Agent Concentration: Reducing the contrast agent concentration below 30% can enhance stone visualization and minimize the likelihood of obscured residual stones on X-ray (2). Preventing Oddi Sphincter Contraction: Maintaining the contrast agent temperature between 30 and 40 °C can reduce sphincter spasms and avoid filling defects that mimic stones (3). Avoiding Bubble Formation: Proper injection techniques, including the use of degassed contrast medium and slow injection, can help prevent bubbles, which may be mistaken for stones. In cases of suspected bubbles, repeating the cholangiogram after bubble clearance is recommended (4). Enhancing Diagnostic Expertise: Regular training for radiologists and clinicians on interpreting cholangiography images, especially regarding anatomical variations, is essential to improve diagnostic accuracy (5). Monitoring T-tube Position: Regular assessment of T-tube placement during prolonged use ensures accurate imaging results, as shifts in tube position can distort cholangiography findings.

T-tube cholangiography is a routine examination method for detecting residual bile duct stones before the T-tube removal. It is a simple and dynamic procedure that can be performed within 6–8 weeks post-surgery. During the process, contrast agent is injected through the common bile duct via the T-tube and discharged into the intestinal cavity (Fig. 1). This imaging technique offers several advantages: (1) it confirms T-tube position before removal, ensuring it has not dislodged from the common bile duct; (2) preoperative T-tube cholangiography detects bile duct stenosis, space-occupying lesions, and assesses sinus tract maturity; (3) it evaluates Oddi sphincter function, particularly in patients with dysfunction after endoscopic sphincterotomy (EST), and reveals anatomical variations in the bile ducts(Fig. 2).

T-tube cholangiography for examining intestinal cavity and branch bile ducts. a: CR before cholangiography; b: The contrast agent flows into the biliary tract along the T-tube and develops; c: The contrast agent begins to drain from the common bile duct into the duodenal cavity;d: A large amount of contrast media was discharged into the duodenal enteric cavity and into the intrahepatic bile duct

T-tube cholangiography. a: T-tube and biliary tract were normal; b: Cholangiography showed tension of T-tube; c: Cholangiography showed a bubble at the lower end of the common bile duct (no residual calculi were found by choledochoscopy later); d: Cholangiography showed a bubble at the lower end of the common bile duct (choledochoscopy revealed residual calculus and ectopic Hem-o-lock clamp later)

Cholangiography, as an indirect imaging technique, is susceptible to various factors including the positioning of the photograph, presence of gas in the biliary tract, concentration and injection speed of contrast agent, number and size of stones as well. However, relying solely on negative results from T-tube cholangiography for removal of the T-tube may lead to missed diagnosis of residual stones in the biliary tract. This can increase the risk of postoperative abdominal pain and obstructive cholangitis while also contributing to recurrence of choledocholithiasis and subsequent reoperation. The false negative rate for residual stone diagnosis using T-tube cholangiography was found to be 4.4% in this study.

Choledochoscopy, a minimally invasive technique widely adopted in the past two decades, offers several advantages, including ease of use, reduced complications, and accurate diagnosis following sinus tract maturation and T-tube removal [16,17,18,19]. It is particularly effective in diagnosing and treating residual and recurrent stones, assessing bile status, identifying biliary tumors [20], foreign bodies, and stenosis—capabilities (Fig. 3) that cholangiography or other imaging methods cannot match. Direct visualization allows precise evaluation of stone size, number, composition, and bile duct mucosal conditions, and facilitates biopsy. Studies report a residual stone removal rate exceeding 90% with choledochoscopy, making it a highly effective and safe technique [21, 22]. However, its invasive nature poses risks of complications such as biliary infection, leakage, bleeding, or pancreatitis [22].

Choledochoscopy via T-tube sinus tract. a: Choledochoscopy shows residual stones; b: The stone retrieval basket was taken under choledochoscopy; c: Open the basket to remove the stone; d: Ectopic Hem-o-lock clamp in common bile duct; e: The stone and clamp; f: Choledochal mass lesion

In this study, in addition to the confirmed 40 cases of residual stones, we also diagnosed and treated 3 cases of intestinal biliary metaplasia, 2 cases of Hem-o-lock clamp displacement, 1 case of inflammatory hyperplasia, 1 case of mass and foreign body at the lower end of the biliary tract, 4 cases of biliary edema, stenosis and atresia, 1 case of cholesterol crystallization in the biliary tract, and 1 case of non-formation of the sinus tract by choledochoscopy. Simultaneously, we observed mild bile turbidity with a small amount of pus moss in 73 cases and bile containing a large amount of floccule in19 cases (Figs. 2 and 3).

In our opinion, T-tube cholangiography holds significant importance in choledochoscopy. The presence of various confluence modes in the bile duct, such as pancreaticobiliary maljunction or duodenal diverticula, can lead to persistent upper abdominal discomfort post-surgery. Surgeons often have difficulty in identifying biliary tract variations prior to the operation, and choledochoscopy is limited by its restricted field of vision and operating angle, making it difficult to investigate the biliary duct at all levels thoroughly. However, T-tube cholangiography can make up these limitations by exploring areas that cannot be reached through choledochoscopy alone, thus preventing missed diagnoses. If cholangiography shows a discontinuous sinus tract or contrast agent leakage into the abdominal cavity, it indicates incomplete sinus formation. Following laparoscopic surgery, it takes a minimum of 6∽8 weeks for the T-tube sinus tract to mature [16]. Elderly individuals with complicated conditions like diabetes, compromised immune systems, and malnutrition may require three to six months for T-tube sinus maturation [22]. Kong J et al. recommended performing the choledochoscopy through the T-tube sinus tract opening after 8 weeks of T-tube indwelling [21].

We should proceed cautiously and prioritize the preservation of sinus tract integrity during choledochoscopy. With the increasing prevalence of minimally invasive laparoscopic surgery, particularly among patients with compromised systemic conditions such as cirrhosis, hypoproteinemia, diabetes, and immunosuppressive drug use due to several reasons, it is advisable to extend the duration of T-tube placement until a robust sinus tract has formed.

Recently, during choledochoscopy, our department observed a slight increase in the incidence of incomplete sinus tracts compared to previous cases. Latex rubber tubes are typically favored over alternative materials [23]. Considering the advancements in silicone tube production technology, the surface of the silicone tube has become smoother compared to previous versions. The incompleteness of sinus tract formation was observed when the choledochoscopy entered abdominal cavity. For cases involving residual stones and foreign bodies in the biliary tract, they can be extracted using a stone retrieval basket. In cases of localized lesions, pathological tissue can be obtained for definitive diagnosis using forceps. If an incomplete sinus tract is detected during the operation and choledochoscopy mistakenly enters the abdominal cavity, it is imperative to promptly stop the procedure. Following this, a drainage tube of similar diameter to the original T-tube should be inserted into the common bile duct or abdominal cavity for external fixation and drainage, thereby promoting the formation of a complete sinus tract. After the tube is placed, attention should be given to confirming that bile is draining through the tube and to closely observing postoperative abdominal signs to prevent potential complications such as bile leakage.The process of T-tube cholangiography should be standardized, in order to reduce the false negative rate and false positive rate of T-tube cholangiography, as well as minimize the occurrence of residual stone and the rate of reoperation. Before performing cholangiography, the contrast agent concentration should be approximately 20%, and there should be a vertical distance of more than 60 cm between the suspension position of the contrast agent and the body plane height to ensure an adequate gravitational potential energy. Hanging the contrast agent too high may result in bile reflux, leading to infection. It is crucial to eliminate any bubbles prior to the administration of the contrast agent. During cholangiography, it is recommended that the patient assumes a position with lowered head and elevated feet in order to optimize visualization of the intrahepatic bile ducts. Subsequently, transitioning to a supine position facilitates imaging of the lower segment of the bile ducts. Following completion of the examination, drainage should be initiated to facilitate excretion of the contrast agent.

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Common bile duct

Magnetic resonance cholangiopancreatography

Laparoscopic common bile duct exploration

Endoscopic sphincterotomy

Ko CW, Lee SP. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc. 2002;56(6 Suppl):S165–169.

Article PubMed Google Scholar

Costi R, Gnocchi A, Di Mario F, Sarli L. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol. 2014;20(37):13382–401.

Article PubMed PubMed Central Google Scholar

Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology. 1999;117(3):632–9.

Article PubMed CAS Google Scholar

Su Z, Gong Y, Liang Z. Prevalence of gallstone in Mainland China: a meta-analysis of cross-sectional studies. Clin Res Hepatol Gastroenterol. 2020;44(4):e69–71.

Article PubMed Google Scholar

Wu Y, Xu CJ, Xu SF. Advances in risk factors for recurrence of common bile Duct stones. Int J Med Sci. 2021;18(4):1067–74.

Article PubMed PubMed Central CAS Google Scholar

Cianci P, Restini E. Management of cholelithiasis with choledocholithiasis: endoscopic and surgical approaches. World J Gastroenterol. 2021;27(28):4536–54.

Article PubMed PubMed Central Google Scholar

Chon HK, Kim TH. Endoclip therapy of post-sphincterotomy bleeding using a transparent cap-fitted forward-viewing gastroscope. Surg Endosc. 2017;31(7):2783–8.

Article PubMed Google Scholar

Akshintala VS, Kanthasamy K, Bhullar FA, Sperna Weiland CJ, Kamal A, Kochar B, et al. Incidence, severity, and mortality of post-ERCP pancreatitis: an updated systematic review and meta-analysis of 145 randomized controlled trials. Gastrointest Endosc. 2023;98(1):1–e612.

Article PubMed Google Scholar

Marks B, Al Samaraee A. Laparoscopic exploration of the common bile Duct: a systematic review of the published evidence over the last 10 years. Am Surg. 2021;87(3):404–18.

Article PubMed Google Scholar

Sagami R, Hayasaka K, Ujihara T, Iwaki T, Katsuyama Y, Harada H, et al. Accurate evaluation of residual common bile Duct stones by Endoscopic Ultrasound: a two-step check method for residual Stone Clearance. Digestion. 2022;103(3):224–31.

Article PubMed CAS Google Scholar

Zhang JF, Du ZQ, Lu Q, Liu XM, Lv Y, Zhang XF. Risk factors Associated with residual stones in common bile Duct Via T Tube Cholangiography after common bile Duct Exploration. Med (Baltim). 2015;94(26):e1043.

Article Google Scholar

Ferkingstad E, Oddsson A, Gretarsdottir S, Benonisdottir S, Thorleifsson G, Deaton AM, et al. Genome-wide association meta-analysis yields 20 loci associated with gallstone disease. Nat Commun. 2018;9(1):5101.

Article PubMed PubMed Central Google Scholar

Tsunoda K, Shirai Y, Hatakeyama K. Prevalence of cholesterol gallstones positively correlates with per capita daily calorie intake. Hepatogastroenterology. 2004;51(59):1271–4.

PubMed Google Scholar

Shamiyeh A, Lindner E, Danis J, Schwarzenlander K, Wayand W. Short- versus long-sequence MRI cholangiography for the preoperative imaging of the common bile duct in patients with cholecystolithiasis. Surg Endosc. 2005;19(8):1130–4.

Article PubMed CAS Google Scholar

Mattila A, Luhtala J, Mrena J, Kautiainen H, Kellokumpu I. An audit of short- and long-term outcomes after laparoscopic removal of common bile duct stones in Finland. Surg Endosc. 2014;28(12):3451–7.

Article PubMed Google Scholar

Jiang C, Zhao X, Cheng S. T-Tube use after laparoscopic common bile Duct Exploration. JSLS. 2019;23(1):e2018.

Article PubMed Central Google Scholar

Yin Y, He K, Xia X. Comparison of primary suture and T-Tube drainage after laparoscopic common bile Duct Exploration Combined with Intraoperative Choledochoscopy in the treatment of secondary common bile Duct stones: a single-Center Retrospective Analysis. J Laparoendosc Adv Surg Tech A. 2022;32(6):612–9.

Article PubMed PubMed Central Google Scholar

Qiu W, Sun XD, Wang GY, Zhang P, Du XH, Lv GY. The clinical efficacy of laparoscopy combined with choledochoscopy for cholelithiasis and choledocholithiasis. Eur Rev Med Pharmacol Sci. 2015;19(19):3649–54.

PubMed CAS Google Scholar

Campagnacci R, Baldoni A, Baldarelli M, Rimini M, De Sanctis A, Di Emiddio M, et al. Is laparoscopic fiberoptic choledochoscopy for common bile duct stones a fine option or a mandatory step? Surg Endosc. 2010;24(3):547–53.

Article PubMed CAS Google Scholar

Chen PH, Lo HW, Wang CS, Tsai KR, Chen YC, Lin KY, et al. Cholangiocarcinoma in hepatolithiasis. J Clin Gastroenterol. 1984;6(6):539–47.

Article PubMed CAS Google Scholar

Kong J, Wu SD, Xian GZ, Yang S. Complications analysis with postoperative choledochoscopy for residual bile duct stones. World J Surg. 2010;34(3):574–80.

Article PubMed Google Scholar

Zhang L, Li L, Yao J, Chu F, Zhang Y, Wu H. Residual choledocholithiasis after choledocholithotomy T-tube drainage: what is the best intervention strategy? BMC Gastroenterol. 2022;22(1):509.

Article PubMed PubMed Central CAS Google Scholar

Corbett CR, Fyfe NC, Nicholls RJ, Jackson BT. Bile peritonitis after removal of T-tubes from the common bile duct. Br J Surg. 1986;73(8):641–3.

Article PubMed CAS Google Scholar

Download references

Not applicable.

This work is supported by the Beijing Natural Science Foundation (7182063), and the Beijing Health System High Level Health Technical Personnel (2014-3-058).

Department of General Surgery, Xuan Wu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China

Saixin Li, Zheng Wang, Zheng Li, Kenan Wang, Minghao Sui, Dongbin Liu, Yamin Zheng & Kuo Liang

You can also search for this author in PubMed Google Scholar

WZ and LS concepted and designed the study. WK and SM performed the statistical data collection. LZ and WZ participated in the analysis, interpretation and drafting of the data in the manuscript. LS and WZ writed the manuscript. ZY and LK revised the manuscript for important intellectual content. LD prepared all the figures and table. All authors read and approved the final manuscript.

Correspondence to Yamin Zheng or Kuo Liang.

All experimental protocols were approved by Ethics Committee of Xuanwu Hospital, Capital Medical University. Prior to the procedure, all patients provided informed consent in accordance with the ethical guidelines set forth by the hospital’s ethics committee, which adhered to medical ethics regulations.

Not applicable.

The authors declare no competing interests.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

Li, S., Wang, Z., Li, Z. et al. Diagnostic value of T-tube cholangiography and choledochoscopy in residual calculi after biliary surgery. BMC Gastroenterol 24, 383 (2024). https://doi.org/10.1186/s12876-024-03474-7

Download citation

Received: 13 February 2024

Accepted: 22 October 2024

Published: 28 October 2024

DOI: https://doi.org/10.1186/s12876-024-03474-7

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative