Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2019; 25(47): 6847-6856
Published online Dec 21, 2019. doi: 10.3748/wjg.v25.i47.6847
Influence of bile contamination for patients who undergo pancreaticoduodenectomy after biliary drainage
Keiichi Okano, Yasuyuki Suzuki
Keiichi Okano, Yasuyuki Suzuki, Departments of Gastroenterological Surgery, Kagawa University, Kita-gun, Kagawa 761-0793, Japan
Author contributions: Okano K and Suzuki Y designed and performed the research and wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Kagawa University Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Keiichi Okano, FACS, MD, PhD, Associate Professor, Department of Gastroenterological Surgery, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
Received: September 29, 2019
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
Research background

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.

Research motivation

The large data of clinical features and outcomes after PD in patients with infected bile will help improve future clinical outcome.

Research objectives

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.

Research methods

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%).

Research results

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.

Research conclusions

In patients undergoing PD, bile contamination is related to postoperative infectious complication including POPF Grade B/C.

Research perspectives

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.