title: Effect of bile contamination on immediate outcomes after pancreaticoduodenectomy for tumor.
abstract: BACKGROUND
  The influence of preoperative biliary drainage on the postoperative course of patients undergoing pancreaticoduodenectomy (PD) remains controversial. Among drawbacks of biliary drainage, bile contamination and its consequences are incompletely evaluated. This study aimed to compare outcomes after PD in patients with sterile and those with infected bile.
  
  
  METHODS
  Seventy-nine consecutive patients underwent PD for periampullary tumor with routine bile culture and antibiotic prophylaxis with cefazolin. The postoperative course of 35 patients with infected bile (group B+) was compared with that of 44 patients with sterile bile (group B-).
  
  
  RESULTS
  The distribution of tumors was comparable except for ampullary carcinoma, which was more frequent in group B+ patients (p = 0.001). Interventional biliary endoscopy was performed preoperatively in 80% of patients in group B+ versus 14% in group B- (p < 0.001), including 9 isolated sphincterotomies (20% versus 5%, p < 0.03) and 20 endoprosthesis insertions (57% versus 0%, p < 0.0001). More patients in group B+ were classified as American Society of Anesthesiologists (ASA) 2 (p = 0.04). Operative time and blood loss were similar in both groups. One patient died postoperatively (group B+). Overall morbidity was increased in group B+ (77% versus 59%, p = 0.05). Postoperative infectious complications, all demonstrated bacteriologically, were more frequent in group B+: (65% versus 37%, p = 0.003). In group B+, bile was polybacterial in 54% of patients and isolated microorganisms were resistant to cefazolin in 97%. In patients with infectious complications, the same germ was isolated in bile and another sample in 49%.
  
  
  CONCLUSIONS
  In patients undergoing PD, bile infection is related to previous interventional biliary endoscopy in 80% of patients and is associated with an increased rate of postoperative infections. During PD for ampullary carcinoma or after interventional biliary endoscopy, a specific antibioprophylaxis should be evaluated.
authors.affiliation: Department of Surgery, Hospital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Cortes
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
authors.forename: Frederic
authors.initials: F
authors.lastname: Bert
authors.forename: Sylvie
authors.initials: S
authors.lastname: Janny
authors.forename: Philippe
authors.initials: P
authors.lastname: Sockeel
authors.forename: Reza
authors.initials: R
authors.lastname: Kianmanesh
authors.forename: Philippe
authors.initials: P
authors.lastname: Ponsot
authors.forename: Philippe
authors.initials: P
authors.lastname: Ruszniewski
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D001646:Bile / Q000382:microbiology*; D016022:Case-Control Studies; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D016896:Treatment Outcome