Elsevier

Surgery

Volume 160, Issue 3, September 2016, Pages 725-730
Surgery

Pancreas
Bacterobilia may trigger the development and severity of pancreatic fistula after pancreatoduodenectomy

https://doi.org/10.1016/j.surg.2016.03.032Get rights and content

Background

Although biliary infection (bacterobilia) is considered a risk factor for infectious complications after pancreatoduodenectomy, the association between bacterobilia and postoperative pancreatic fistula has remained unclear. The aim of this study is to investigate the impact of bacterobilia on the development of postoperative pancreatic fistula following pancreatoduodenectomy.

Methods

We conducted a retrospective review of the patients who underwent pancreatoduodenectomy between November 2010 and July 2014. Intraoperative bile cultures and cultures of the peripancreatic drainage fluid on postoperative days 1 and 3 were investigated in all patients.

Results

Of 264 patients, 151 (57%) patients had a positive intraoperative bile culture. The incidence of grade B/C postoperative pancreatic fistulas (by the international definition) was greater in patients with a positive intraoperative bile culture than in those with a negative intraoperative bile culture (38% vs 25%, P = .025). A multivariate analysis revealed that a positive intraoperative bile culture (odds ratio, 2.60; P = .002) and a body mass index of ≥22 kg/m2 (odds ratio, 2.18; P = .008) were independent risk factors for grade B/C postoperative pancreatic fistulas. Among the 151 patients with a positive intraoperative bile culture, the microorganism(s) isolated from the bile was detected in the drainage fluid of 100% of the patients on postoperative day 1 and in 88% of patients on postoperative day 3.

Conclusion

Bacterobilia was found to be a risk factor for grade B/C postoperative pancreatic fistulas, and bacteria from the infected bile may be the source of the grade B/C postoperative pancreatic fistulas.

Section snippets

Patients and operative procedures

A retrospective review was conducted using a prospectively collected database of patients who underwent PD between November 2010 and July 2014 at the Shizuoka Cancer Center. This study was approved by the institutional review board of the Shizuoka Cancer Center. Our standard operation for resection of neoplasms of the head of the pancreas is a subtotal stomach-preserving pancreatoduodenectomy using the modified Child's method. Pancreaticojejunostomy was performed, consisting of approximation of

Results

A total of 264 patients (male, n = 171 [65%]; female, n = 93 [45%]) with a median age of 69 years (IQR, 62–75 years) were enrolled in this study. One hundred thirty (49%) of these patients had pancreatic cancer; 44 (17%) had bile duct cancer; 30 (11%) had ampullary cancer; 20 (8%) had an intraductal papillary mucinous neoplasm; 15 (6%) had duodenal cancer; and the remaining 25 (9%) had other diseases. One hundred forty-four (55%) of the patients underwent preoperative PBD, and the median

Discussion

Although multiple risk factors for POPF have been evaluated in previous studies,3, 4, 16, 17, 18, 19 no reports have clarified the correlation between intraoperative bile cultures and POPF. Our study showed a significant association between a positive intraoperative bile culture and development of grade B/C POPFs. In addition, the incidence of intra-abdominal hemorrhage, a critical complication related to POPF, and wound infection were also significantly greater in patients with a positive

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