Bacteribilia After Preoperative Bile Duct Stenting A Prospective Study

Study Design: 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.Goals: The goals of the presented Study were to investigate the effects of preoperative bile duct stenting oil 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.Study: 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 air 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 riot elevated. A critical evaluation of benefits from preoperative biliary drainage for each patient is necessary.