The effect of bactibilia on the course and outcome of laparoscopic cholecystectomy

Abstract

Although bactibilia is an important condition of acute cholecystitis, its effect on the course and outcome of the infectious gallbladder disease has rarely been studied, particularly in relation to the laparoscopic procedure. The current study attempts to learn more about the inter-relationship between bactibilia and laparoscopic cholecystectomy during acute cholecystitis. Demographic, preoperative, operative, and postoperative data were prospectively collected in every patient with acute cholecystitis treated in the department of surgery at the Bnai Zion Medical Center, Israel. Intraoperative biliary samples were collected under aseptic conditions at the time of operation for bacteriologic examination and were routinely cultured in aerobic and anaerobic media for 3 days. The study population was divided into culture-positive and culture-negative groups, and the collected parameters were compared between the groups. Age over 60 years, a palpable gallbladder, temperature over 37.5 degrees C, a white blood cell (WBC) count of more than 12,000/cc(3), and serum alkaline phosphatase higher than 100 U/dL were all found to be factors capable of predicting bactibilia. Bactibilia was a significant factor associated with total, as well as infectious, operative complications. Bactibilia is considered to indicate an advanced stage of acute cholecystitis. In cases of laparoscopic cholecystectomy for infectious gallbladder disease, bactibilia is strongly associated with total, as well as local, infectious complications. Preoperative conditions such as older age, elevated temperature, a palpable gallbladder, elevated WBC count, and elevated serum levels of alkaline phosphatase can serve as predictors of bactibilia and its consequent complications. Although the sensitivity and specificity of the predictive factors for bactibilia are limited to 63% and 67%, respectively, in their presence during acute cholecystitis, conservative wide-spectrum antibiotics as the first-line therapy is appropriate, and, upon regimen failure, laparoscopic surgery by an experienced surgeon is indicated as the adjusted therapy.

Incidence of Bactobilia Increases over Time after Endoscopic Sphincterotomy

“…This is consistent with other studies and is thought to be caused by age-dependent physiological changes (decreased biliary motility and clearance, increasing duodenal motor disorders and anatomical/functional alterations, diabetes mellitus) [9,11,12,13]. …”

“…Nor did patients with bactobilia have more infectious complications. This is in contrast with two other studies on the effect of bile cultures on the outcome of LC [11,12]. In the study by Morris-Stiff et al [12] more infectious complications occurred in the group with positive bile cultures (p < 0.05).…”

“…In the study by Morris-Stiff et al [12] more infectious complications occurred in the group with positive bile cultures (p < 0.05). Also in a study by Galili et al [11] not only did infectious complications occur more often, but overall complications were significantly higher in the group with infected bile. These findings were not reproduced in our study, possibly due to the limited number of patients included.…”

Bactobilia Among Patients with Uncomplicated Cholelithiasis Undergoing Laparoscopic Cholecystectomy: The Risk Factors and Effects on Postoperative Infectious Complications

“…In some studies, bactobilia has been shown to be a risk factor predisposing to postoperative infectious complications, which are one of the most important concerns of surgeons, especially in laparoscopic surgery (4,5). The rate of post-operative wound infection after elective cholecystectomy in uncomplicated symptomatic gallstone ranges from 2.3% to 20% (6)(7)(8)(9).…”

“…Obtaining bile culture during biliary surgery is mainly advised only in patients with some predisposing factors that could increase the risk of such infections. These risk factors include pyrexia, previous biliary instrumentation, previous biliary sepsis, bilioenteric anastomosis, immune suppression status, a palpable gallbladder, elevated WBC count, and elevated serum levels of alkaline phosphatase and old age (2,5,8,10,11). However, reports are still conflicting over the use of bile culture at biliary surgery (6,12).…”