Biliary stone removal may be performed by the interventional radiologist via a T-tube (drainage tube) previously placed by a surgeon during removal of the gallbladder. In this circumstance, the patient retains surgically inaccessible stone(s) in the common bile duct.
Biliary stone removal is generally performed five to six weeks following surgical placement of a T-tube to allow for bile duct drainage and maturation of the drainage tract. Once the tract is matured, a guide wire is inserted into the bile duct and the T-tube is removed. A sheath is then passed over the guide wire and the guide wire is removed. A basket or snare device may be inserted through the sheath to retrieve the ductal stones. Depending on the size of the stone, other techniques for stone retrieval through a T-tube tract may be employed, to include passing the stone into the small intestine or fragmentation of the stone to enable basket retrieval.