Nizar SF, Shelat VG. T-tubes: Past, present, and future. World J Gastrointest Surg 2026; 18(6): 120160 [DOI: 10.4240/wjgs.120160]
Corresponding Author of This Article
Vishal G Shelat, Adjunct Associate Professor, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. vgshelat@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
review-article
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World J Gastrointest Surg. Jun 27, 2026; 18(6): 120160 Published online Jun 27, 2026. doi: 10.4240/wjgs.120160
T-tubes: Past, present, and future
Sukayna Fathima Nizar, Vishal G Shelat
Sukayna Fathima Nizar, Department of General Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Vishal G Shelat, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Author contributions: Shelat VG conceptualized and designed the study, supervised, and made critical revisions; Nizar SF and Shelat VG conducted the literature review, consolidated the data, drafted the manuscript, and made critical revisions; all authors contributed to preparation of the draft and approved the submitted version.
Conflict-of-interest statement: Both authors have no conflicts to declare.
Corresponding author: Vishal G Shelat, Adjunct Associate Professor, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. vgshelat@gmail.com
Received: February 24, 2026 Revised: March 7, 2026 Accepted: April 7, 2026 Published online: June 27, 2026 Processing time: 125 Days and 5.8 Hours
Abstract
T-tubes were once central to bile duct surgery because they provided decompression, postoperative cholangiographic access, and a route for further intervention. With advances in choledochoscopy, endoscopy, imaging, and minimally invasive surgery, their routine use has declined in favor of primary closure and internal stenting when duct clearance is secure, and rescue pathways are available. This opinion review revisits the T-tube across a past-present-future framework. Historically, it functioned not only as a drain but also as a tool for verification and intraductal access. Contemporary evidence supports a selective rather than routine role, particularly in high-risk biliary-enteric reconstruction, small-caliber ducts, difficult tissue conditions, or settings where temporary externalized control may reduce the consequences of leak or stricture. At the same time, T-tubes carry important burdens, including fluid and electrolyte loss, cholangiography-related complications, removal-related bile leak, and substantial outpatient care demands. Their modern value therefore lies less in routine drainage than in calibrated use within a structured stewardship pathway. Future directions should aim to preserve temporary duct support while reducing the morbidity of externalization through improved imaging, choledochoscopy, and bioresorbable technologies.
Core Tip: The T-tube should no longer be viewed as a routine postoperative drain in biliary surgery. Its contemporary role is selective: A temporary interface for decompression, access, and control in high-risk biliary situations, especially vulnerable biliary-enteric reconstructions. Any benefit, however, depends on disciplined postoperative stewardship, including tube care, monitoring, imaging, and safe removal. The future is not a return to routine T-tube use, but refinement of its indications and replacement of externalized drainage where newer technologies can provide safer temporary support.
