Complications after Pancreatic Head Resection: Impact of Preoperative Biliary Drainage and Intraoperative Bile Cultures
Abstracts
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Background: Despite a low mortality morbidity is still high after pancreatic head resection. The influence of preoperative biliary drainage (BD) on postoperative complications has been published with controversial results. The aim of our study was to determine the impact of BD on intraoperative bile culture (IOBC) and morbidity following pancreatic head resection. Methods: From July 1994 to February 2001 305 pancreatic head resections (Whipple 18%, pylorus preserving pancreatoduodenectomy 60%, duodenum preserving head resection 21%, pancreatectomy 1%) were performed. Most data were collected in a prospective database, microbiological data were gained retrospectively. Indications for surgery were chronic pancreatitis (58%), malignancy (38%) or others (4%). Preoperatively, 38% of the patients had a BD performed for bile duct obstruction. IOBC was obtained in 74% of the patients. The influence of 16 pre- and intraoperative parameters on morbidity was determined by uni- and multivariate analysis. Further analysis using microbiological data was performed in patients who had IOBC. Results: In all 305 patients (in 226 patients with IOBC) morbidity was 40% (41%), surgical complication rate 28% (28%), infectious abdominal complication rate (abscess, wound infection) 14% (14%) and mortality 2.9% (2.2%). When analyzing all 305 operations BD was associated with less overall complications by uni- (p<0.05) or multivariate (p<0.03) analysis and fewer surgical complications (p=0.08 univariate/p<0.02 multivariate). Infectious abdominal complications, pneumonia and death rate were not significantly decreased by BD. In patients with IOBC 56% had positive cultures (51% polymicrobial). BD was significantly associated with positive IOBC (89% vs 36% without BD; p<0.001). Forty-one percent of infectious abdominal complications occurred in patients with sterile IOBC. In infectious abdominal complications with positive IOBC there was a 94%-correlation between microorganisms found. Positive IOBC did not influence the rates of the different types of complication in univariate analysis. When added as parameter to multivariate analysis the result of IOBC did not influence complication or death rates. Conclusions: Although increasing the risk of positive IOBC preoperative biliary drainage can be used safely in patients with extrahepatic biliary obstruction before pancreatic head resection without concern for increased postoperative complication rates. |
