title: Etiology of bile infection and its association with postoperative complications following pancreatoduodenectomy.
abstract: Currently controversy exists whether bile infection following preoperative biliary drainage has an impact on postoperative complications and mortality rate. The objective of the study was to determine etiology of preoperative bile infection and to evaluate its influence on postoperative complications and mortality after pancreatoduodenectomy.
  
  
  METHODS
  Data on 64 patients, undergoing pancreatoduodenectomy at Kaunas University of Medicine Hospital between 2002 and 2004 were collected prospectively. We evaluated etiology and the impact of bile infection on development of post-operative complications. Patients were divided into groups according to results of intraoperative bile culture.
  
  
  RESULTS
  In 31 patients (48.4%) intraoperative bile cultures were negative, while in remaining 33 patients (51.6%) infected bile was documented. Both patient groups were homogenous according to demographic data, preoperative and intraoperative variables. Pancreaticoduodenectomy was performed in 21 patients after preoperative biliary drainage (endoscopic stenting, bilidigestive anastomosis or percutaneous bile drainage), others (n=43) had primary operation. Infected bile was found more often in patients who underwent biliary drainage (p<0.0001). Among 43 patients with primary pancreaticoduodenectomy 22 patients underwent endoscopic retrograde cholangiopancreatography without stenting, while remaining 21 had no preoperative endoscopic manipulation. Infected bile was present in 9 patients after endoscopic retrograde cholangiopancreatography (40.9%) and in 4 without preoperative endoscopy (19%). Enterococcus and Escherichia coli dominated in bile cultures of patients with primary pancreaticoduodenectomy, while multiple species (3 and more microorganisms) dominated following drainage procedures. Septic postoperative complications were identified in 26.6% of cases. Infected bile did not influence both overall and septic postoperative complications. Bacteria causing abdominal cavity and wound infections matched bile cultures in 7.7% of cases only.
  
  
  CONCLUSIONS
  Our data show that infected bile is found more often after preoperative biliary drainage procedures. However, bile infection did not increase statistically significantly the number of postoperative septic complication.
authors.affiliation: Clinic of Surgery, Kaunas University of Medicine Hospital, Eiveniu 2, 50009 Kaunas, Lithuania. saulius_grizas@yahoo.co.uk
authors.forename: Saulius
authors.initials: S
authors.lastname: Grizas
authors.forename: Migle
authors.initials: M
authors.lastname: Stakyte
authors.forename: Marius
authors.initials: M
authors.lastname: Kincius
authors.forename: Giedrius
authors.initials: G
authors.lastname: Barauskas
authors.forename: Juozas
authors.initials: J
authors.lastname: Pundzius
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000209:etiology*; D001646:Bile / Q000382:microbiology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000150:complications; D003627:Data Interpretation, Statistical; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D011446:Prospective Studies; D015607:Stents; D013530:Surgical Wound Infection / Q000209:etiology