Bacteribilia after preoperative bile duct stenting: a prospective study.
METHODS
A prospective analysis of intraoperative bile duct cultures in patients undergoing surgery for both, malignant or benign periampullary diseases at the Department of Surgery, St Josef Hospital, Bochum, Germany, during a period of 18 months, between January 2004 and June 2005.


OBJECTIVE
The goals of the presented study were to investigate the effects of preoperative bile duct stenting on intraoperative bile duct cultures and postoperative outcome in patients undergoing pancreatic surgery.


BACKGROUND
In pancreatic surgery, bile duct stenting is often aimed at improving postoperative outcome. As implantation of xenograft material in the main bile duct facilitates bacterial contamination and cholangitis, a critical evaluation of stenting is mandatory.


METHODS
In all patients with a hepaticojejunostomy (n=80), a bile duct culture was collected during the operation. All patients received antibiotic prophylaxis perioperatively and a retrograde flushing of bile ducts with warm saline after bile duct resection. Fifty-one percent (41/80) patients had biliary drainage before surgery, whereas 49% (39/80) were operated without preoperative draining procedures.


RESULTS
After bile duct stenting, 98% of patients had a positive bile culture, whereas only 21% of infected bile was seen in patients without drainage (P<0.001). Despite infected bile, only 2% stented patients developed acute cholangitis postoperatively, versus 13% patients in the group without stent (P=0.231). After stenting, major complications occurred in 12%, versus 8% in patients without stent (P=0.817).


CONCLUSIONS
Preoperative biliary drainage leads to an almost 100% bacterial contamination of bile ducts. With hospital-adjusted antibiotic prophylaxis and retrograde flushing of bile ducts, the postoperative rate of acute cholangitis and morbidity is not elevated. A critical evaluation of benefits from preoperative biliary drainage for each patient is necessary.
Herzog
Torsten
T
Department of Surgery, St Josef Hospital, Ruhr-University Bochum, School of Medicine, Bochum, Germany.
Belyaev
Orlin
O
Muller
Christophe A
CA
Mittelkotter
Ulrich
U
Seelig
Matthias H
MH
Weyhe
Dirk
D
Felderbauer
Peter
P
Schlottmann
Renate
R
Schrader
Henning
H
Schmidt
Wolfgang E
WE
Uhl
Waldemar
W
D000208:Acute Disease; D000368:Aged; D019072:Antibiotic Prophylaxis; D001646:Bile / Q000382:microbiology*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation*; D002761:Cholangitis / Q000382:microbiology / Q000517:prevention & control*; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D004066:Digestive System Diseases / Q000150:complications / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome