Diagnostic value of T-tube cholangiography and choledochoscopy in residual calculi after biliary surgery, Is T-tube cholangiography necessary before T-tube removal？

Abstract Background T-tube cholangiography and choledochoscopy are commonly employed techniques for assessing residual bile duct stones following biliary surgery. Further investigation is warranted to determine the utility of routine cholangiography prior to T-tube removal. It is imperative to explore the diagnostic efficacy of various examination methods for detecting residual calculi post-biliary surgery. Methods The clinical data of 287 patients who underwent T-tube angiography and choledochoscopy following choledochotomy and subsequent T-tube drainage at the Department of General Surgery, Xuanwu Hospital, Capital Medical University from 2017 to 2022 were retrospectively analyzed. All patients underwent both cholangiography and choledochoscopy six to eight weeks after laparoscopic cholecystectomy combined with common bile duct exploration and T-tube drainage surgery. The results of T-tube cholangiography and choledochoscopy for each patient were recorded, followed by analysis and comparison. Results Among the cohort of 287 patients, T-tube cholangiography revealed 38 cases of residual stones, which were subsequently confirmed by choledochoscopy in 29 cases. Conversely, among the remaining 249 patients who exhibited no evidence of residual stones on T-tube angiography, a single patient was later verified to have retained stones through choledochoscopy. The results of T-tube cholangiography and choledochoscopy showed no significant difference (P = 0.82), indicating a high level of agreement between the two methods (Kappa value: 0.70). Conclusion The simultaneous performance of T-tube cholangiography and choledochoscopy after biliary surgery is recommended to enhance the diagnostic accuracy of residual stones and reduce the incidence of bile duct stone remnants.