Effect of preoperative biliary drainage for obstructive jaundice on postoperative course after pancreaticoduodenectomy

Abstract

s / Pancreatolog S108 Aims: Definition of an alternative prophylaxis targeted on bile cultures in pancreatic surgery and validation of SSIs incidence. Patients & methods: Between Jan-2010 and Oct-2013 we performed 222 consecutive pancreatic resections with bile contamination (203 pancreaticoduodenectomies, 19 total pancreatectomies). We routinely performed culture on intra-operative bile samples and prospectively recorded SSIs. Analyzing antimicrobial susceptibility of detected germs, we introduced from Mar-2013 ampicillin-sulbactam as alternative to cefazolin for perioperative prophylaxis; we therefore realized a comparison between patients receiving standard (n1⁄4170) and new (n1⁄452) schedule. Results: Analyzing the standard group, 56% of patients had positive bile cultures; 49% of microbes belonged to Enterococcus Spp. 47% of patients had a preoperative biliary stent: it was strongly associated with bile infection (100% vs 17%, p<0,001); bile infection was associated with higher morbidity in patients with (72% vs 56%, p1⁄40,037) or without stent (87% vs 56%, p1⁄40,026), as well as with higher SSIs (63% vs 37%, p1⁄40,113). 49,5% of infected bile samples harbored cefazolin-resistant microbes: in these patients postoperative global SSIs were higher (71% vs 30%, p1⁄40,023) as well as superficial, deep and organ/space-SSIs. Since we administered ampicillin-sulbactam perioperative prophylaxis, we observed a significant decrease of superficial (20,6% vs 3,8%, p1⁄40,005) and deep (8,8% vs 0, p1⁄40.025) SSIs; we noted no difference in organ/space-SSIs. Conclusion: Bile infection leads to a significant increase of postoperative morbidity in pancreatic surgery. Bile-culture targeted prophylaxis seems effective in reducing SSIs.