1, T-tube drainage is the most commonly used means and methods in biliary surgery. Usually T-tube is placed after bile duct exploration to drain the bile duct, prevent bile leakage and play a transitional role, and then removed after the formation of T-tube sinus tract. However, even after the regular time of extraction, some cases of sinus tract rupture still occur, leading to bile leak and biliary peritonitis. Once bile leakage occurs, it must be treated actively. 2. Bile leak caused by sinus tract rupture of T duct is mainly due to the presence of many systemic and local pathological factors affecting the formation of T duct sinus tract. It is generally accepted that the following factors affect sinus tract formation and need to be noted: time is the main factor, followed by old age and frailty, malnutrition, cirrhosis, ascites, diabetes, anemia, hypoproteinemia, jaundice, long-term application of hormones, large omental defects, etc. 3, T-tube sinus rupture prevention: because the patient’s systemic and local pathology is limited, then we can do as much as possible is, first of all, clever and correct placement of T-tube, preferred latex tube, it is better than silicone tube can stimulate the surrounding tissue proliferation and early formation of sinus tract. The principle of “thick, short and straight” is followed and the T-tube is surrounded by a large omentum. Secondly, the patient’s unfavorable factors should be actively corrected and the extubation time should be extended appropriately, which can be 1 to 2 months after extubation. But even so there are very few cases of bile leak after 60 days of extubation, and even six months of sinus tract has not yet formed. 4, T-tube sinus tract rupture caused by biliary peritonitis treatment: T-tube sinus tract rupture caused by biliary peritonitis regardless of the severity of the disease must be treated immediately, otherwise the mortality rate of bile leakage up to 28.6%. Both surgical and non-surgical treatment methods have been reported. (1) Immediate surgical treatment; however, surgery is not acceptable to patients because of the high degree of injury and pain. (2) Endoscopic treatment with ERCP/ENBD to drain the bile ducts; the treatment time is short and effective for those with a small amount of bile leakage. For those with large bile leakage, the treatment time is long and even ineffective. There is no report of bile leakage due to T-tube extraction with minimally invasive treatment via T-tube sinusoidal choledochoscopy. In my practice, I have performed endoscopic placement of trans-T-tubular sinusoidal fibrinobiliary choledochoscopy in the endoscopy room immediately after detection of bile leaks, and the efficacy of the procedure has been confirmed. In case of incomplete sinus tract dissection, the proximal end of the dissection can be clearly seen under direct visualization and placed for smooth drainage with definite results. If the sinus tract is completely broken, the proximal end is completely free in the abdominal cavity, and the choledochoscope can only enter the abdominal cavity to repeatedly flush and aspirate the overflowing bile. As long as the proximal end is found and the tube is placed successfully, the outcome is good. In conclusion, in case of bile leakage due to sinus rupture of T-tube, it is best to prefer trans-T-tube sinus tract fibrous bile duct placement, supplemented by ERCP/ENBD drainage if necessary, and then consider surgery only if both methods are ineffective.