Effect of preoperative biliary drainage on bacterial flora in bile of patients with periampullary cancer

Scheufele, Florian; Aichinger, Lena; Jäger, Carsten; Demir, Ihsan Ekin; Schorn, Stefan; Sargut, Mine; Erkan, Mert; Kleeff, Jörg; Frieß, Helmut; Ceyhan, Güralp O.

doi:10.1002/bjs.10450

Cited by 83 publications

(59 citation statements)

References 28 publications

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“…The present study aimed to assess the impact of preoperative bacterobilia on postoperative outcomes after PD and to examine the biliary microbiome in patients with and without PBD in order to identify potentially significant differences in the microbial colonization in each group. Patients receiving PBD had significantly higher rates of bacterobilia (94.9 vs. 25.2%) than those without PBD, results which are in line with those of previous studies and meta-analyses [7, 10, 20-22]. The 25.2% rate of bacterobilia reported in the present study is in line with the results of previous studies, which reported rates between 18.6 and 31% in patients without PBD [5, 7, 21].…”

Section: Discussionsupporting

confidence: 91%

Preoperative Bacterobilia Is an Independent Risk Factor of SSIs after Partial PD

et al. 2020

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Introduction: The impact of bacterobilia on postoperative surgical and infectious complications after partial pancreaticoduodenectomy (PD) is still a matter of debate. Methods: All patients undergoing PD with and without a preoperative biliary drainage (PBD) with complete information regarding microbial bile colonization were included. Logistic regression was applied to assess the influence of bacterobilia on postoperative outcome. Results: One hundred seventy patients were retrospectively analysed. Clinically relevant postoperative complications (Clavien-Dindo ≥ III) occurred in 40 (23.5%) patients, clinically relevant postoperative pancreatic fistulas in 29 (17.1%) patients, and surgical site infections (SSIs) in 16 (9.4%) patients. Thirty-seven of 39 (94.9%) patients with PBD and 33 of 131 (25.2%) patients without PBD had positive bile cultures (p < 0.001). A polymicrobial bile colonization was reported in 9 of 33 (27.3%) patients without PBD and 27 of 37 (73%) patients with PBD (p < 0.001). Resistance to ampicillin-sulbactam was shown in 26 of 37 (70.3%) patients with PBD and 12 of 33 (36.4%) patients without PBD (p = 0.001). PBD (OR 0.015, 95% CI 0.003-0.07, p < 0.001) and male sex (OR 3.286, 95% CI 1.441-7.492, p = 0.005) were independent predictors of bacterobilia in the multivariable analysis. Bacterobilia was the only independent predictor of SSIs in the multivariable analysis (OR 0.143, 95% CI 0.038-0.535, p = 0.004). Conclusions: Patients with a PBD show significantly higher rates of bacterobilia, polymicrobial bile colonization, and resistance to ampicillin-sulbactam. Bacterobilia is an independent predictor of SSI after PD.

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Section: Discussionsupporting

confidence: 91%

Preoperative Bacterobilia Is an Independent Risk Factor of SSIs after Partial PD

et al. 2020

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“…Second, most part of the patients received a PBD before our consultation, causing a loss of information about the possible source of colonization by MDR bacteria and the eventual antibiotic treatment administered prior to hospitalization in our Institution. 48 However, these biases should not hamper the power of this study's findings because prevention strategies to reduce the colonization by MDR bacteria or to decolonize patients prior to surgery are not available yet.…”

Section: Discussionmentioning

confidence: 98%

Preoperative surveillance rectal swab is associated with an increased risk of infectious complications in pancreaticoduodenectomy and directs antimicrobial prophylaxis: an antibiotic stewardship strategy?

Pastena¹,

Paiella²,

Azzini

et al. 2018

HPB

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“…Preoperative biliary drainage (PBD) does not have a bene cial effect on postoperative outcome; intraoperative bile samples had demonstrated that contamination of bile was signi cantly increased in patients who underwent stenting, as recently reported [38]. The increase of postoperative overall complications and wound infections urges precise indications for preoperative biliary drainage [39,40].…”

Section: Discussionmentioning

confidence: 99%

Clinically Relevant Postoperative Pancreatic Fistula rates in two methods of pancreatico-jejunal anastomosis compared: Evolution of surgical technique in a single centre over time

Zurleni

Olmetti

Marzoli

et al. 2020

Preprint

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Background:Pancreaticoduodenectomy remains the gold standard for management of patients with pancreatic head and periampullary neoplasms. Despite the low mortality, overall morbidity remains high, principally due to the development of a clinically relevant postoperative pancreatic fistula (CR-POPF).The aim of the present study is to compare rates of CR-POPF in two groups of patients treated with two different pancreaticojejunostomy techniques. Methods:Among 264 consecutive patients submitted to surgery for pancreatic neoplasm, 142 pancreaticoduodenectomies with end-to-side pancreaticojejunostomy were analysed. The first group of patients underwent a direct mucosa-to-mucosa anastomosis as described by Longmire and Traverso. In the second group, a duct-to-mucosa anastomosis with an outer seromuscolar and inner full thickness layer as described by Z’graggen, Shrikhande and Buchler was performed. Results:Mortality was 2,8% in the first group (2/71) and zero in the second. In group 1°, 48.5% of patients suffered one or more grade II-V Clavien-Dindo complications; in group 2°, complications were observed in 26,7% of patients. Clinically relevant POPF occurred in 12 patients in group 1° (17%) and in 4 patients in group 2° (5,6%). Conclusions:Changing pancreaticojejunostomy techniques may produce different outcomes. In our experience, a standardized duct-to-mucosa anastomosis, as performed in group 2, significantly reduced the rate of CR-POPF.

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Effect of preoperative biliary drainage on bacterial flora in bile of patients with periampullary cancer

Cited by 83 publications

References 28 publications

Preoperative Bacterobilia Is an Independent Risk Factor of SSIs after Partial PD

Preoperative Bacterobilia Is an Independent Risk Factor of SSIs after Partial PD

Preoperative surveillance rectal swab is associated with an increased risk of infectious complications in pancreaticoduodenectomy and directs antimicrobial prophylaxis: an antibiotic stewardship strategy?

Clinically Relevant Postoperative Pancreatic Fistula rates in two methods of pancreatico-jejunal anastomosis compared: Evolution of surgical technique in a single centre over time

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