Effect of preoperative biliary stenting on post-operative infectious complications in pancreaticoduodenectomy

Abstract

Backgrounds/AimsThe impact of pre-operative biliary stenting (PBS) in patients undergoing pancreaticoduodenectomy on post-operative infectious complications is unclear. Therefore, the purpose of this study is to investigate the relationship between PBS and post-operative infectious complications, to determine the effect of PBS on bile bacteriology, and to correlate the bacteriology of bile and bacteria cultured from post-operative infectious complications in our institute.MethodsDetails of 51 patients undergoing pancreaticoduodenectomy January 2011-April 2015 were reviewed. Of 51 patients, 30 patients underwent pre-operative biliary stenting (PBS group) and 21 patients underwent pancreaticoduodenectomy without pre-operative biliary stenting. Post-operative infectious complications were compared between the two groups.ResultsOverall post-operative infectious complication rate was 77% and 67% in the PBS and non-PBS groups respectively. Wound infection was the main infectious complication followed by intraabdominal abscess. The rate of wound infection doubled in the PBS group (50% vs 28%). There was slight increase in incidence of intraabdominal abscess in PBS group (53% vs 46%). 80% of PBS patients had positive intraoperative bile culture as compared to 20% in non-PBS group.ConclusionsPreoperative biliary drainage prior to pancreaticoduodenectomy increases risk of developing post-operative wound infections and intra-abdominal collections.

Significance of bile culture surveillance for postoperative management of pancreatoduodenectomy

“…We acknowledge limitations of this non-randomized study, including relatively small sample size. Many studies reported that bile is contaminated in patients undergoing PD after biliary drainage [6–10, 20, 21]. Our study agrees with the importance of surveillance bile culture for management of patients with PD.…”

Impact of Preoperative Endoscopic Biliary Drainage on Postoperative Outcome after Pancreaticoduodenectomy

“…Also, Ng et al, reported a high incidence of overall infectious complications in the group of PBD than the other group without drainage (77% versus 67%, respectively). Wound infection was the highest complication (41%) of the infectious ones, followed by IAA (29%) (16), as observed in our study. But we had a lower incidence of infectious complications than the former study.…”

“…Many studies observed polymicrobial organisms in bile cultures withdrawn during the surgery in patients with biliary stenting. E-coli and Klebsiellapneumoniae were the most common bacterial infection (16,26) as reported in our study. Other large volume studies are needed for the justification of the optimal time of PD needed before surgery to have a better outcome.…”

“…Many retrospective and prospective literature studies discussed this issue with different conclusions (13)(14)(15). Experimental studies had shown that reduction of serum bilirubin level can improve the liver and immune system function with correction of the coagulation profiles (15,16). Liu et al, showed that serum bilirubin did not significantly affect postoperative complications after PD (17) as reported in our study.…”

Clinical implications of bile cultures obtained during pancreatoduodenectomy: a cohort study and meta-analysis

“…5,6 Previous studies showed an association between preoperative biliary drainage, contamination of intraoperative bile cultures (IOBCs) and the occurrence of postoperative infectious complications, particularly SSIs. 1,[7][8][9][10] Although biliary drainage is not routinely recommended, the number of patients requiring this preoperative procedure is expected to rise due to the increasing use of neoadjuvant chemotherapy in pancreatic cancer. 11,12 Patients with a biliary stent appear to have different IOBC contamination patterns.…”