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To the Editor.—
When a surgeon has placed a T tube in the common duct and finds a stone in one of the branches of the common duct above the T tube, he has several options.If the discovery takes place during the operation, he will usually remove the T tube and irrigate through catheters, or reverse a catheter and make suction, or use Fogarty catheters. The first two methods often fail. (We don't know the failure rate for Fogarty catheters.) The point of our discourse is that the simplest way to bring down the stone to the "working" level in the common duct is to keep the T tube in place, introduce enough saline to fill the system, and then make suction. In this hydraulic system, there is no collapse of the ducts with suction, and therefore the pull is effective in drawing the stone down to the common
Cassebaum WH. T Tube and Stone. JAMA. 1974;229(4):391. doi:10.1001/jama.1974.03230420013004