Use of safety catheter after removal of Kehr's tube in liver transplant patients

The authors report on the use of a safety catheter when removing the T-tube in the patients with choledocho-choledochal biliary reconstruction after liver transplantation. After T-tube removal, bile may leak into the peritoneal cavity through the catheter insertion site in the biliary wall. Biliary peritonitis, bilomas, subhepatic collections may develop, which are difficult to treat in immunodepressed patients. The safety catheter is used to allow the external drainage of the biliary outflow, if present, and to prevent the complications due to bile collecting in the peritoneal cavity. Moreover, the catheter allows cholangiography and interventional procedures to be performed when necessary. A soft guidewire is inserted into the distal bile duct through the T-tube and pushed into the duodenum. After removing the T-tube, an 8.3-F all-purpose catheter (APD) is placed on the guidewire with the tip just outside the biliary wall. The APD is then connected to a drainage bag allowing the amount of bile eliminated daily to be checked. This maneuver was performed in 24 transplant recipients and the safety catheter correctly positioned in 22 of them (91.6%). The APD was removed 48 hours after insertion in 15 patients with no biliary leakage. In the remaining 7 patients the catheter was left in situ up to 8 days, since biliary leakage was observed (range: 50-400 ml/day). No early or late complications related to this technique were observed.