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Back to 2015 Annual Meeting Program Is Preoperative Biliary Drainage Harmful in Pancreatoduodenectomy? a Large Single Center Experience. Klaus Sahora*2, 1, Zhi Ven Fong2, Cristina R. Ferrone2, Vicente Morales-Oyarvide2, Andrew L. Warshaw2, Keith D. Lillemoe2, Carlos Fernandez-Del Castillo2 1Surgery, Medical University Vienna, Vienna, Austria; 2Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA Introduction: The impact of preoperative biliary drainage (PBD) on perioperative morbidity and mortality in pancreatic surgery is still debated. The aim of this study was to investigate the outcome of stented vs. non-stented patients undergoing pancreatoduodenectomy (PD) at a tertiary care center. Methods: We retrospectively compared 500 consecutive patients who underwent preoperative biliary drainage (PBD) prior to PD with 500 patients who did not. 90-day mortality and morbidity were assessed between the two groups. In addition, microbiology data from bile, wound, abscess and blood cultures were analyzed. Results: The overall postoperative morbidity and mortality was 37% and 1.4% respectively. Major complications (Clavien ≥ III) occurred in 13.8% of patients (11% requiring interventional procedures, 0.7% re-laparotomy and 2.1% with organ failure). The overall morbidity and mortality was not significantly higher in patients who underwent PBD. However, wound infections were significantly more common in patients who underwent PBD (19% vs. 9%, p= .001). Aside from PBD, surgeon caseload (< 25 cases/year) was the only other factor significantly associated with a higher rate of wound infection on multivariate analysis. When comparing intraoperative bile cultures of stented patients with wound infection to those without, the presence of Enterobacter species (OR 2.4, 95% CI 1.5-4.1, p= .001) and Citrobacter species (OR 2.3, 95% CI 1.1 -5.2, p= .037) in the bile significantly doubled the odds of having a wound infection. Conclusion: Preoperative biliary drainage is associated with bactobilia and wound infection, but does not affect the overall morbidity and mortality of patients undergoing PD. Wound infections occur particularly in the presence of Enterobacter and Citrobacter species. Back to 2015 Annual Meeting Program |
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