INTRODUCTIONPancreaticoduodenectomy (Whipple procedure) is the standard treatment for operable carcinomas of the head of the pancreas, periampullary tumors and in some cases of chronic pancreatitis. Advances in surgical skills and postoperative care have resulted in mortality rates of less than 5%.1 Despite significant improvements in the safety and efficacy of pancreatic surgery, morbidity still remains high in the range of 30% to 65%.2 Delayed gastric emptying (DGE) and Postoperative Pancreatic fistula (POPF) remains the major causes of morbidity.The exact cause of DGE following pancreaticoduodenectomy is not known. It appears to be multifactorial. [3][4][5] Technical factors in the construction of gastroenterostomy have been implicated in the development of DGE. Significant edema or kinking at this anastomosis may be a factor in the development of DGE. 6 ABSTRACT Background: Morbidity following Pancreaticoduodenectomy still remains high. Few studies have shown decrease in morbidity with the addition of Braun Enteroenterostomy (BEE). Aim of the present study was to determine any possible benefit with addition of BE to the standard reconstruction after pancreaticoduodenectomy. Methods: In this prospective randomized controlled study, all patients who underwent Pancreaticoduodenectomy from June 2012 to July 2016 were included. They were randomized to undergo either standard reconstruction (Group A) or with addition of Braun Enteroenterostomy to standard reconstruction (Group B). Outcomes were compared between 2 groups and the results were analyzed. P value of <0.05 was considered significant. Results: 104 patients were included in the study. Group A included 56 patients who underwent standard reconstruction and Group B had 48 patients who had addition of BEE to standard reconstruction. The demographic profile, tumour characteristics, and biochemical profile were similar in 2 groups. Mean operating time and Intra operative blood loss were similar. The incidence of pancreatic fistula (POPF) did not differ significantly in 2 groups (14/56, 25% in group A versus 8/48, 16.6% in group B; p = 0.42). The incidence of Delayed Gastric Emptying (DGE) was not statistically different in 2 groups (20/56, 35.7% in group A versus 12/48, 25% in group B; p=0.77). Infection rates were similar in two groups. Mean hospital stay was similar in both groups (11.2 days versus 10.7 days; p=0.68). Conclusions:The outcomes of patients after pancreaticoduodenectomy were not altered by addition of Braun Enteroenterostomy to standard reconstruction.
INTRODUCTIONRoutine intra-operative bile culture during biliary tract surgeries is a common practice among hepatobiliary surgeons. This is based on reports that bactibilia is a predictor of septic complications following these surgeries. 1,2Most of these studies have focused on impact of pre-operative biliary drainage on the biliary microflora and its resulting infectious complications. Bile-contaminated operations are reported to have a higher incidence of septic complications than non-bilecontaminated operations. 3There is high correlation of bile culture results with those from post-operative septic foci with concordance rates as high as 80-89%.4-6 Intra operative bile culture result was thus purported to guide early institution of appropriate in patients at risk of developing infectious complications and guide selection of appropriate antibiotic prophylaxis. This study was aimed at studying the microbiological profile of routine intraoperative bile cultures and correlate with the isolates from septic foci in those undergoing biliary tract surgeries. ABSTRACTBackground: Routine intra-operative bile culture during biliary tract surgeries is a common practice among hepatobiliary surgeons. This is based on reports that bactibilia is a predictor of septic complications following these surgeries. This study was aimed at studying the microbiological profile of routine intraoperative bile cultures and correlate with the isolates from septic foci in those undergoing biliary tract surgeries. Methods: A prospective database of all patients who underwent biliary tract surgeries between July2014 to June 2016 was taken up for analysis. Charts were reviewed with special focus on microbiological culture data yielded from both routine bile culture and those from septic complications were recorded and analyzed. Strain typing screening was done by comparing the antibiotic susceptibility profiles of various isolates in each patient. Results: Of the total one hundred and forty four patients undergoing biliary tract surgery, 46 patients (32%) had a positive bile culture. Of these cultures were positive in 30 out of 32 patients (94%) who had preoperative CBD stent in situ. Bile culture positivity rate was highest with CBD exploration cases and incidence of surgical site infections (SSI) was highest with pancreatoduodenectomy cases. There was no significant association between a positive bile culture and development of surgical site infection (p = 0.09). Conclusions: There is no significant association of a positive bile culture with risk of surgical site infections in patients undergoing biliary tract surgery. Even in patients with positive bile culture who develop surgical site infections, two third of them are caused by different strains.
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