Ann Hepatobiliary Pancreat Surg.  2017 Nov;21(4):212-216. 10.14701/ahbps.2017.21.4.212.

Effect of preoperative biliary stenting on post-operative infectious complications in pancreaticoduodenectomy

• Ng ZQ
• Suthananthan AE
• Rao S

• KMID: 2397801
• DOI: http://doi.org/10.14701/ahbps.2017.21.4.212

Abstract

BACKGROUNDS/AIMS
The impact of pre-operative biliary stenting (PBS) in patients undergoing pancreaticoduodenectomy on post-operative infectious complications is unclear. Therefore, the purpose of this study is to investigate the relationship between PBS and post-operative infectious complications, to determine the effect of PBS on bile bacteriology, and to correlate the bacteriology of bile and bacteria cultured from post-operative infectious complications in our institute.
METHODS
Details of 51 patients undergoing pancreaticoduodenectomy January 2011-April 2015 were reviewed. Of 51 patients, 30 patients underwent pre-operative biliary stenting (PBS group) and 21 patients underwent pancreaticoduodenectomy without pre-operative biliary stenting. Post-operative infectious complications were compared between the two groups.
RESULTS
Overall post-operative infectious complication rate was 77% and 67% in the PBS and non-PBS groups respectively. Wound infection was the main infectious complication followed by intraabdominal abscess. The rate of wound infection doubled in the PBS group (50% vs 28%). There was slight increase in incidence of intraabdominal abscess in PBS group (53% vs 46%). 80% of PBS patients had positive intraoperative bile culture as compared to 20% in non-PBS group.
CONCLUSIONS
Preoperative biliary drainage prior to pancreaticoduodenectomy increases risk of developing post-operative wound infections and intra-abdominal collections.

Keyword

Infection; Intra-abdominal abscess; Pancreaticoduodenectomy; Stent; Wound

MeSH Terms

Abdominal Abscess
Abscess
Bacteria
Bacteriology
Bile
Drainage
Humans
Incidence
Pancreaticoduodenectomy*
Stents*
Wound Infection
Wounds and Injuries

Reference

1. Sahora K, Morales-Oyarvide V, Ferrone C, Fong ZV, Warshaw AL, Lillemoe KD, et al. Preoperative biliary drainage does not increase major complications in pancreaticoduodenectomy: a large single center experience from the Massachusetts General Hospital. J Hepatobiliary Pancreat Sci. 2016; 23:181–187.

2. Gavazzi F, Ridolfi C, Capretti G, Angiolini MR, Morelli P, Casari E, et al. Role of preoperative biliary stents, bile contamination and antibiotic prophylaxis in surgical site infections after pancreaticoduodenectomy. BMC Gastroenterol. 2016; 16:43.

3. Povoski SP, Karpeh MS Jr, Conlon KC, Blumgart LH, Brennan MF. Preoperative biliary drainage: impact on intraoperative bile cultures and infectious morbidity and mortality after pancreaticoduodenectomy. J Gastrointest Surg. 1999; 3:496–505.

4. Kawarabayashi N, Seki S, Hatsuse K, Kinoshita M, Takigawa T, Tsujimoto H, et al. Immunosuppression in the livers of mice with obstructive jaundice participates in their susceptibility to bacterial infection and tumor metastasis. Shock. 2010; 33:500–506.

5. Katz SC, Ryan K, Ahmed N, Plitas G, Chaudhry UI, Kingham TP, et al. Obstructive jaundice expands intrahepatic regulatory T cells, which impair liver T lymphocyte function but modulate liver cholestasis and fibrosis. J Immunol. 2011; 187:1150–1156.

6. Jagannath P, Dhir V, Shrikhande S, Shah RC, Mullerpatan P, Mohandas KM. Effect of preoperative biliary stenting on immediate outcome after pancreaticoduodenectomy. Br J Surg. 2005; 92:356–361.

7. van der Gaag NA, de Castro SM, Rauws EA, Bruno MJ, van Eijck CH, Kuipers EJ, et al. Preoperative biliary drainage for periampullary tumors causing obstructive jaundice; DRainage vs. (direct) OPeration (DROP-trial). BMC Surg. 2007; 7:3.

8. Ngu W, Jones M, Neal CP, Dennison AR, Metcalfe MS, Garcea G. Preoperative biliary drainage for distal biliary obstruction and post-operative infectious complications. ANZ J Surg. 2013; 83:280–286.

9. Sewnath ME, Birjmohun RS, Rauws EA, Huibregtse K, Obertop H, Gouma DJ. The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy. J Am Coll Surg. 2001; 192:726–734.

10. Iacono C, Ruzzenente A, Campagnaro T, Bortolasi L, Valdegamberi A, Guglielmi A. Role of preoperative biliary drainage in jaundiced patients who are candidates for pancreatoduodenectomy or hepatic resection: highlights and drawbacks. Ann Surg. 2013; 257:191–204.

11. Velanovich V, Kheibek T, Khan M. Relationship of postoperative complications from preoperative biliary stents after pancreaticoduodenectomy. A new cohort analysis and meta-analysis of modern studies. JOP. 2009; 10:24–29.

12. Hodul P, Creech S, Pickleman J, Aranha GV. The effect of preoperative biliary stenting on postoperative complications after pancreaticoduodenectomy. Am J Surg. 2003; 186:420–425.

13. Smith RA, Dajani K, Dodd S, Whelan P, Raraty M, Sutton R, et al. Preoperative resolution of jaundice following biliary stenting predicts more favourable early survival in resected pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2008; 15:3138–3146.

14. Pisters PW, Hudec WA, Hess KR, Lee JE, Vauthey JN, Lahoti S, et al. Effect of preoperative biliary decompression on pancreaticoduodenectomy-associated morbidity in 300 consecutive patients. Ann Surg. 2001; 234:47–55.

15. Hatfield AR, Tobias R, Terblanche J, Girdwood AH, Fataar S, Harries-Jones R, et al. Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial. Lancet. 1982; 2:896–899.

16. Sewnath ME, Karsten TM, Prins MH, Rauws EJ, Obertop H, Gouma DJ. A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann Surg. 2002; 236:17–27.

17. van der Gaag NA, Rauws EA, van Eijck CH, Bruno MJ, van der, Kubben FJ, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010; 362:129–137.

18. Glomsaker T, Hoff G, Kvaløy JT, Søreide K, Aabakken L, Søreide JA, et al. Patterns and predictive factors of complications after endoscopic retrograde cholangiopancreatography. Br J Surg. 2013; 100:373–380.

19. Martignoni ME, Wagner M, Krähenbühl L, Redaelli CA, Friess H, Büchler MW. Effect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy. Am J Surg. 2001; 181:52–59.

20. Mohammed S, Evans C, VanBuren G, Hodges SE, Silberfein E, Artinyan A, et al. Treatment of bacteriobilia decreases wound infection rates after pancreaticoduodenectomy. HPB (Oxford). 2014; 16:592–598.

21. Gerke H, White R, Byrne MF, Stiffier H, Mitchell RM, Hurwitz HI, et al. Complications of pancreaticoduodenectomy after neoadjuvant chemoradiation in patients with and without preoperative biliary drainage. Dig Liver Dis. 2004; 36:412–418.

22. Heslin MJ, Brooks AD, Hochwald SN, Harrison LE, Blumgart LH, Brennan MF. A preoperative biliary stent is associated with increased complications after pancreatoduodenectomy. Arch Surg. 1998; 133:149–154.

23. Howard TJ, Yu J, Greene RB, George V, Wairiuko GM, Moore SA, et al. Influence of bactibilia after preoperative biliary stenting on postoperative infectious complications. J Gastrointest Surg. 2006; 10:523–531.

24. Srivastava S, Sikora SS, Kumar A, Saxena R, Kapoor VK. Outcome following pancreaticoduodenectomy in patients undergoing preoperative biliary drainage. Dig Surg. 2001; 18:381–387.