Published online Dec 21, 2019. doi: 10.3748/wjg.v25.i47.6847
Peer-review started: September 29, 2019
First decision: November 27, 2019
Revised: December 7, 2019
Accepted: December 13, 2019
Article in press: December 13, 2019
Published online: December 21, 2019
Preoperative endoscopic biliary procedures are widespread in the management of periampullary tumours. The influence of bile contamination on the infectious complications of patients undergoing pancreaticoduodenectomy (PD) has not been thoroughly evaluated.
The large data of clinical features and outcomes after PD in patients with infected bile will help improve future clinical outcome.
This study aimed to identify the clinical features and outcomes after PD in patients with infected bile based on data from the Japanese Society of Pancreatic Surgery for future management of perioperative infectious complications.
We retrospectively reviewed the database of 4101 patients who underwent PD. Preoperative biliary drainage was performed in 1964 patients (47.9%), and bile contamination was confirmed in 606 patients (14.8%).
The incidence of postoperative infectious complications was 37.9% in patients with preoperative biliary drainage and 42.4% in patients with biliary contamination, respectively. Patients with extrahepatic bile duct carcinoma, ampulla of Vater carcinoma, and pancreatic carcinoma had a high frequency of preoperative biliary drainage (82.9%, 54.6%, and 50.8%) and bile contamination (34.3%, 26.2%, and 20.2%). Bile contamination was associated with postoperative pancreatic fistula (POPF) Grade B/C, wound infection, and catheter infection. A multivariate logistic regression analysis revealed that biliary contamination (odds ratio 1.33, P = 0.027) was the independent risk factor for POPF Grade B/C. The three most commonly cultured microorganisms from bile (Enterococcus, Klebsiella, and Enterobacter) were identical to those isolated from organ spaces.
In patients undergoing PD, bile contamination is related to postoperative infectious complication including POPF Grade B/C.
The management of biliary contamination should be standardised for patients who require preoperative biliary drainage for PD, as the main microorganisms are identical in both organ spaces and bile.