Abstract
Background
The aim of this meta-analysis and systematic review was to evaluate the association
between intraoperative bile cultures and postoperative complications of patients undergoing
pancreaticoduodenectomy.
Methods
A detailed literature search was performed from January 2015 to July 2022 in PubMed,
Web of Science, Google Scholar, and EMBASE for related research publications. The
data were extracted, screened, and graded independently. An analysis of pooled data
was performed, and a risk ratio with corresponding confidence intervals was calculated
and summarized.
Results
A total of 8 articles were included with 1,778 pancreaticoduodenectomy patients who
had an intraoperative bile culture performed. A systematic review demonstrated that
some of the most common organisms isolated in a positive intraoperative bile culture
were Enterococcus species, Klebsiella species, and E. coli. Four studies also showed that specific microorganisms were associated with specific
postoperative complications (surgical site infection and intra-abdominal abscess).
The postoperative complications that were evaluated for an association with a positive
intraoperative bile culture were surgical site infections (risk ratio = 2.33, 95%
confidence interval [1.47–3.69], P < .01), delayed gastric emptying (risk ratio = 1.23, 95% confidence interval [0.63–2.38],
P = n.s.), 90-day mortality (risk ratio = 0.68, 95% confidence interval [0.01–52.76],
P = n.s.), postoperative pancreatic hemorrhage (risk ratio = 1.70, 95% confidence interval
[0.33–8.74], P = n.s.), intra-abdominal abscess (risk ratio = 1.70, 95% confidence interval [0.38–7.56],
P = n.s.), and postoperative pancreatic fistula (risk ratio = 0.97, 95% confidence
interval [0.72–1.32], P = n.s.).
Conclusion
The cumulative data suggest that a positive intraoperative bile culture has no association
with predicting the postoperative complications of delayed gastric emptying, 90-day
mortality, postoperative pancreatic hemorrhage, intra-abdominal abscess, or postoperative
pancreatic fistula. However, the data also suggest that a positive intraoperative
bile culture was associated with a patient developing a surgical site infection.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Bile cultures: a guide to infectious complications after pancreaticoduodenectomy.J Surg Oncol. 2010; 102: 478-481
- Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer.Ann Surg. 2014; 260: 372-377
- Bacterobilia may trigger the development and severity of pancreatic fistula after pancreatoduodenectomy.Surgery. 2016; 160: 725-730
- Biliary bacteria: significance and alterations after antibiotic therapy.Arch Surg. 1982; 117: 445-449
- Specific intraoperative antibiotic therapy abrogates the negative effect of biliary contamination on the Comprehensive Complication Index after pancreatic head resection.Surgery. 2022; 171: 1642-1651
- Specific bile microorganisms caused by intra-abdominal abscess on pancreaticoduodenectomy patients: a retrospective cohort study.Curr Oncol. 2021; 29: 111-121
- Association of intra-operative bile culture with post-operative complications after pancreaticoduodenectomy.Surg Infect (Larchmt). 2022; 23: 351-356
- Practicing Chiropractors’ Committee on Radiology Protocols (PCCRP) for biomechanical assessment of spinal subluxation in chiropractic clinical practice.http://www.guideline.gov/content.aspx?id=14576Date accessed: July 8, 2022
- High incidence of postoperative infections after pancreaticoduodenectomy: a need for perioperative anti-infectious strategies.Infect Dis Now. 2021; 51: 456-463
- Does the microbiology of bactibilia drive postoperative complications after pancreatoduodenectomy?.J Gastrointest Surg. 2020; 24: 2544-2550
- The association between bacterobilia and the risk of postoperative complications following pancreaticoduodenectomy.HPB (Oxford). 2022; 24: 277-285
- Effect of preoperative biliary drainage on bacterial flora in bile of patients with periampullary cancer.Br J Surg. 2017; 104: e182-e188
- Postoperative pancreatic fistula: an international study group (ISGPF) definition.Surgery. 2005; 138: 8-13
- The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after.Surgery. 2017; 161: 584-591
- Comparing surgical infections in National Surgical Quality Improvement Project and an Institutional Database.J Surg Res. 2015; 196: 416-420
- Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume.Ann Surg. 2000; 232: 786-795
- Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality.Ann Surg. 2002; 236 (discussion 66–68): 355-366
- Surgical experience with pancreatic and peripancreatic neuroendocrine tumors: review of 125 patients.J Gastrointest Surg. 1998; 2: 473-482
- Preoperative endoscopic stent placement before pancreaticoduodenectomy: a meta-analysis of the effect on morbidity and mortality.Gastrointest Endosc. 2002; 56: 529-534
- A preoperative biliary stent is associated with increased complications after pancreatoduodenectomy.Arch Surg. 1998; 133: 149-154
- Preoperative biliary drainage for cancer of the head of the pancreas.N Engl J Med. 2010; 362: 129-137
- Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy.Ann Surg. 1999; 230: 131-142
- Prognostic impact of bacterobilia on morbidity and postoperative management after pancreatoduodenectomy: a systematic review and meta-analysis.World J Surg. 2018; 42: 2951-2962
- Correlation between preoperative biliary drainage, bile duct contamination, and postoperative outcomes for pancreatic surgery.Surgery. 2007; 142: 313-318
- Effect of bile contamination on immediate outcomes after pancreaticoduodenectomy for tumor.J Am Coll Surg. 2006; 202: 93-99
Article info
Publication history
Published online: January 25, 2023
Accepted:
December 13,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
