Background
Although previously examined, the potential relationship between preoperative biliary
drainage (PBD), intraoperative bile culture (IBC), and postoperative morbidity and
mortality rate for pancreatic surgery remains unclear.
Methods
Two hundred twenty patients underwent operation for either benign pancreatic disease
or malignant periampullary and pancreatic neoplasms, consisting of pylorus-preserving
proximal pancreatoduodenectomy (n = 180), biliary bypass (n = 31), and total pancreatectomy
(n = 9). An intraoperative bile specimen was prospectively collected immediately after
division of the bile duct and sent for bacteriologic evaluation for both aerobic and
anaerobic microorganisms. Morbidity and mortality rates were evaluated.
Results
Of 220 patients evaluated, 113 patients (51.4%) had a positive IBC. Factors associated
with a positive IBC were age >70 years (odds ratio [OR], 5.9;95% confidence interval,
[CI]: 1.6-22.1; P = .007), history of coronary artery disease (OR, 0.08; 95% CI, 0.01-0.5; P = .007), diagnosis of neoplasia (OR, 0.3; 95% CI, 0.1-0.9; P =. 03), and PBD (OR, 0.1; 95% CI, 0.06-0.2; P = .0001). Infectious complications (OR, 1.8; 95% CI, 1-3; P = .03), and wound infection (OR, 2.8; 95% CI,1.4-5.3; P = .002) were greater in patients with positive IBC.
Conclusions
PBD predisposes to a positive IBC. Patients with a positive IBC have a clinically
important increased risk of developing both infectious complications and wound infection
after pancreatic surgery.
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Article info
Publication history
Accepted:
April 15,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
