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The effect of biliary stents implanted before pancreaticoduodenectomy in periampullary tumors on postoperative results: a retrospective analysis of 106 consecutive cases at a single medical center. Surg Today 2022; 53:499-506. [PMID: 36115929 DOI: 10.1007/s00595-022-02589-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/27/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The present study evaluated the potential effects of biliary drainage before pancreaticoduodenectomy on postoperative outcomes and presented the details of a surgeon's 6 years of experience. METHODS All consecutive pancreatoduodenectomies performed from 2015 to 2021 were retrospectively analyzed. The study population was divided into two groups: the stented group (Group I) and the nonstented group (Group II). Patient demographic data and clinical characteristics were compared between the two groups. RESULTS This study comprised 106 individuals who underwent pancreaticoduodenectomy for periampullary tumors. The median age of the patients was 64.41 ± 11.67 years, and 65 (61.3%) were males. Sixty-seven patients (63.2%) received biliary drains (stented group), and 39 (36.8%) patients did not (nonstented group). Total bilirubin values (6.39 mg/dl) were higher in the nonstented patient group than in the stented group. The rate of total complications was significantly higher in the stented group than in the nonstented group [please check this carefully] (p < 0.05). The length of stay, operation time and pancreatic fistula were found to be higher in the stented group than in the nonstented group. CONCLUSIONS Although the total bilirubin value was higher in the nonstented patient group than in the stented group, preoperative biliary drainage increased postoperative complication rates, operation time, and hospital stay. An advanced age and the presence of stents were independent risk factors influencing morbidity development according to the multivariate analysis.
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Pamecha V, Sadashiv Patil N, Kumar S, Rajendran V, Gupta S, Vasantrao Sasturkar S, Kumar Sinha P, Arora A, Agarwal N, Baghmar S. Upfront pancreaticoduodenectomy in severely jaundiced patients: is it safe? JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 26:524-533. [DOI: 10.1002/jhbp.671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Viniyendra Pamecha
- Department of Liver Transplant and Hepato Pancreato Biliary Surgery Institute of Liver and Biliary Sciences D‐1, Acharya Shree Tulsi Marg, Vasant Kunj New Delhi 110070India
| | - Nilesh Sadashiv Patil
- Department of Liver Transplant and Hepato Pancreato Biliary Surgery Institute of Liver and Biliary Sciences D‐1, Acharya Shree Tulsi Marg, Vasant Kunj New Delhi 110070India
| | - Senthil Kumar
- Department of Liver Transplant and Hepato Pancreato Biliary Surgery Institute of Liver and Biliary Sciences D‐1, Acharya Shree Tulsi Marg, Vasant Kunj New Delhi 110070India
| | - Vivek Rajendran
- Department of Liver Transplant and Hepato Pancreato Biliary Surgery Institute of Liver and Biliary Sciences D‐1, Acharya Shree Tulsi Marg, Vasant Kunj New Delhi 110070India
| | - Sahil Gupta
- Department of Liver Transplant and Hepato Pancreato Biliary Surgery Institute of Liver and Biliary Sciences D‐1, Acharya Shree Tulsi Marg, Vasant Kunj New Delhi 110070India
| | - Shridhar Vasantrao Sasturkar
- Department of Liver Transplant and Hepato Pancreato Biliary Surgery Institute of Liver and Biliary Sciences D‐1, Acharya Shree Tulsi Marg, Vasant Kunj New Delhi 110070India
| | - Piyush Kumar Sinha
- Department of Liver Transplant and Hepato Pancreato Biliary Surgery Institute of Liver and Biliary Sciences D‐1, Acharya Shree Tulsi Marg, Vasant Kunj New Delhi 110070India
| | - Asit Arora
- Department of Liver Transplant and Hepato Pancreato Biliary Surgery Institute of Liver and Biliary Sciences D‐1, Acharya Shree Tulsi Marg, Vasant Kunj New Delhi 110070India
| | - Nikhil Agarwal
- Department of Liver Transplant and Hepato Pancreato Biliary Surgery Institute of Liver and Biliary Sciences D‐1, Acharya Shree Tulsi Marg, Vasant Kunj New Delhi 110070India
| | - Saphalta Baghmar
- Department of Medical Oncology Institute of Liver and Biliary Sciences New Delhi India
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Rystedt J, Tingstedt B, Ansorge C, Nilsson J, Andersson B. Major intraoperative bleeding during pancreatoduodenectomy - preoperative biliary drainage is the only modifiable risk factor. HPB (Oxford) 2019; 21:268-274. [PMID: 30170978 DOI: 10.1016/j.hpb.2018.07.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/16/2018] [Accepted: 07/22/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pancreatoduodenectomy is associated with a high risk of complications. The aim was to identify preoperative risk factors for major intraoperative bleeding. METHODS Patients registered for pancreatoduodenectomy in the Swedish National Pancreatic and Periampullary Cancer Registry, 2011 to 2016, were included. Major intraoperative bleeding was defined as ≥1000 ml. Univariable and multivariable analysis of preoperative parameters were performed. RESULTS In total, 1864 patients were included. The median blood loss was 600 ml, and 502 patients (27%) had registered bleeding of ≥1000 ml. Preoperative independent risk factors associated with major bleeding were male sex (p < 0.001), body mass index (BMI) ≥25 kg/m2 (p < 0.001), preoperative biliary drainage (PBD) (p < 0.001), C-reactive protein (CRP) ≥12 mg/L (p = 0.006) and neo-adjuvant chemotherapy treatment (NAT) (p = 0.002). Postoperative intensive care (p < 0.001), reoperation (p = 0.035), surgical infections (p = 0.036), and bile leakage (p = 0.045) were more common in the group with major bleeding, and the 30-day mortality was higher (4.9% vs 1.6%; p < 0.001). CONCLUSION Most predictive parameters for major intraoperative bleeding are not modifiable. PBD is an independent predictor for major intraoperative bleeding and to reduce the risk, patients with resectable periampullary tumors should, if possible, be subject to surgery without preoperative biliary drainage.
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Affiliation(s)
- Jenny Rystedt
- Department of Surgery, Skåne University Hospital; Clinical Sciences, Lund University, Lund, Sweden.
| | - Bobby Tingstedt
- Department of Surgery, Skåne University Hospital; Clinical Sciences, Lund University, Lund, Sweden
| | - Christoph Ansorge
- Division of Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Nilsson
- Cardiothoracic Surgery, Skåne University Hospital; Clinical Sciences, Lund University, Lund, Sweden
| | - Bodil Andersson
- Department of Surgery, Skåne University Hospital; Clinical Sciences, Lund University, Lund, Sweden
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Houghton E. Complex percutaneous biliary procedures: Review and contributions of a high volume team. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii180036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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De Pastena M, Marchegiani G, Paiella S, Malleo G, Ciprani D, Gasparini C, Secchettin E, Salvia R, Gabbrielli A, Bassi C. Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: An analysis of 1500 consecutive cases. Dig Endosc 2018; 30:777-784. [PMID: 29943483 DOI: 10.1111/den.13221] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/22/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Implications of preoperative biliary drain on morbidity and mortality after pancreatoduodenectomy are still controversial. The present study aims to assess the impact of preoperative biliary drain on postoperative outcome and to define optimal serum bilirubin cut-off to recommend biliary drainage in patients undergoing pancreatoduodenectomy. METHODS All consecutive pancreatoduodenectomies carried out at Verona Hospital from 2005 to 2016 were retrospectively analyzed. The study population was divided into three groups: preoperative biliary drained (Stented Group), preoperative jaundice without drainage (Jaundiced Group) and the control group of non-jaundiced, non-stented patients (Control Group). RESULTS A total of 1500 patients were included. Seven hundred and fourteen patients (47.6%) received biliary drain (stented group), 258 (17.2%) patients did not (jaundiced group) and 528 (35.2%) patients represented the (control group). Major complications and mortality rates did not differ between groups. Conversely, the risk of developing surgical site infections doubled in the stented group (18.1%) (OR = 2.1, 95% CI = 1.5-2.8). In jaundiced patients, a preoperative bilirubin value greater than 7.5 mg/dL (128 μmol/L) accurately predicted the likelihood of postoperative complications. CONCLUSION Preoperative biliary drain does not increase major complications and mortality rates after pancreatoduodenectomy, but it is associated with higher surgical site infection rates. In jaundiced patients, a bilirubin value greater than 7.5 mg/dL (128 μmol/L) should indicate biliary drainage.
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Affiliation(s)
- Matteo De Pastena
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Marchegiani
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Salvatore Paiella
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Debora Ciprani
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Clizia Gasparini
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Erica Secchettin
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
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Tol JAMG, van Hooft JE, Timmer R, Kubben FJGM, van der Harst E, de Hingh IHJT, Vleggaar FP, Molenaar IQ, Keulemans YCA, Boerma D, Bruno MJ, Schoon EJ, van der Gaag NA, Besselink MGH, Fockens P, van Gulik TM, Rauws EAJ, Busch ORC, Gouma DJ. Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. Gut 2016; 65:1981-1987. [PMID: 26306760 DOI: 10.1136/gutjnl-2014-308762] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In pancreatic cancer, preoperative biliary drainage (PBD) increases complications compared with surgery without PBD, demonstrated by a recent randomised controlled trial (RCT). This outcome might be related to the plastic endoprosthesis used. Metal stents may reduce the PBD-related complications risk. METHODS A prospective multicentre cohort study was performed including patients with obstructive jaundice due to pancreatic cancer, scheduled to undergo PBD before surgery. This cohort was added to the earlier RCT (ISRCTN31939699). The RCT protocol was adhered to, except PBD was performed with a fully covered self-expandable metal stent (FCSEMS). This FCSEMS cohort was compared with the RCT's plastic stent cohort. PBD-related complications were the primary outcome. Three-group comparison of overall complications including early surgery patients was performed. RESULTS 53 patients underwent PBD with FCSEMS compared with 102 patients treated with plastic stents. Patients' characteristics did not differ. PBD-related complication rates were 24% in the FCSEMS group vs 46% in the plastic stent group (relative risk of plastic stent use 1.9, 95% CI 1.1 to 3.2, p=0.011). Stent-related complications (occlusion and exchange) were 6% vs 31%. Surgical complications did not differ, 40% vs 47%. Overall complication rates for the FCSEMS, plastic stent and early surgery groups were 51% vs 74% vs 39%. CONCLUSIONS For PBD in pancreatic cancer, FCSEMS yield a better outcome compared with plastic stents. Although early surgery without PBD remains the treatment of choice, FCSEMS should be preferred over plastic stents whenever PBD is indicated. TRIAL REGISTRATION NUMBER Dutch Trial Registry (NTR3142).
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Affiliation(s)
- J A M G Tol
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - J E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - R Timmer
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - F J G M Kubben
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - E van der Harst
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - F P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Q Molenaar
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y C A Keulemans
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - D Boerma
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - M J Bruno
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - N A van der Gaag
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - M G H Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - P Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - T M van Gulik
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - E A J Rauws
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - O R C Busch
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - D J Gouma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Extended Perioperative Antibiotic Coverage in Conjunction with Intraoperative Bile Cultures Decreases Infectious Complications after Pancreaticoduodenectomy. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2016; 2016:3031749. [PMID: 27147813 PMCID: PMC4842379 DOI: 10.1155/2016/3031749] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/14/2016] [Accepted: 03/20/2016] [Indexed: 11/18/2022]
Abstract
Background. Bile contamination from the digestive tract is a well-known risk factor for postoperative complications. Despite the literature concerning prevalence of bacterobilia and fungobilia in patients with biliary pathologies, there are no specific recommendations for perioperative antimicrobial coverage for biliary/pancreatic procedures. We evaluated the effect of at least 72 hours of perioperative broad spectrum antibiotic coverage on outcomes of pancreaticoduodenectomy (PD). Materials and Methods. A retrospective review of all patients at Case Medical Center of Case Western Reserve University undergoing PD procedure, from 2006 to 2011, was performed (n = 122). Perioperative data including demographics, comorbidities, biliary instrumentation, antibiotic coverage, culture results, and postoperative outcomes were analyzed. Propensity score matching method was used to match the patients according to duration of antibiotic coverage into two groups: 72 hours (A72) and 24 hours (A24). Results. Longer broad spectrum antibiotic coverage in group A72 resulted in significantly less surgical site infections after PD, compared to routine 24 hours of perioperative antibiotics in group A24. This study did not reveal a statistically significant decrease in postoperative fungal infections in patients receiving preoperative antifungals. Conclusion. Prolonged perioperative antibiotic therapy in conjunction with intraoperative bile cultures decreases the short-term infectious complications of PD, with no significant increase in Clostridium difficile colitis incidence.
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Agalianos C, Paraskeva K, Gouvas N, Davides D, Dervenis C. Impact of biliary stenting on surgical outcome in patients undergoing pancreatectomy. A retrospective study in a single institution. Langenbecks Arch Surg 2015; 401:55-61. [DOI: 10.1007/s00423-015-1360-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/11/2015] [Indexed: 12/18/2022]
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Arkadopoulos N, Kyriazi MA, Papanikolaou IS, Vasiliou P, Theodoraki K, Lappas C, Oikonomopoulos N, Smyrniotis V. Preoperative biliary drainage of severely jaundiced patients increases morbidity of pancreaticoduodenectomy: results of a case-control study. World J Surg 2015; 38:2967-72. [PMID: 24952079 DOI: 10.1007/s00268-014-2669-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recent studies have indicated that preoperative biliary drainage (PBD) should not be routinely performed in patients suffering from obstructive jaundice before surgery. The severity of jaundice that mandates PBD has yet to be defined. Our aim was to investigate whether PBD is truly justified in severely jaundiced patients before pancreaticoduodenectomy. The parameters evaluated were overall morbidity, length of hospital stay, and total in-hospital mortality. METHODS From January 2000 to December 2012, a total of 240 patients underwent pancreaticoduodenectomy for periampullary tumors. Group A comprised 76 patients with preoperative serum bilirubin ≥15 mg/dl who did not undergo PBD before surgery. Group B comprised another 76 patients, matched for age and tumor localization (papillary vs. pancreatic head) who underwent PBD 2-4 weeks before pancreaticoduodenectomy and were identified from the same database. RESULTS Less operative time was required in the 'no PBD' group compared with the 'PBD' group (210 vs. 240 min). Total intraoperative blood loss and blood transfusions were also significantly less in the 'no PBD' group. There was no difference detected in the rate of pancreatic fistula or biliary fistula formation. Group A patients demonstrated significantly lower morbidity than group B (24 vs. 36 %, respectively) and therefore required briefer hospitalization (11 vs. 16 days). Mild infectious complications appear to be the main factor that enhanced morbidity in the PBD group. However, total in-hospital mortality was not significantly different between the two groups. CONCLUSIONS Even severe jaundice should not be considered as an indication for PBD before pancreaticoduodenectomy, as PBD increases infections and postoperative morbidity, therefore delaying definite treatment.
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Affiliation(s)
- Nikolaos Arkadopoulos
- 4th Department of Surgery, University of Athens Medical School, Attikon Hospital, 1 Rimini Str, Chaidari, 12462, Athens, Greece
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Kyriazi MA, Arkadopoulos N, Smyrniotis V. Preoperative biliary drainage of severely jaundiced patients increases morbidity of pancreaticoduodenectomy: reply. World J Surg 2014; 39:804-5. [PMID: 25476760 DOI: 10.1007/s00268-014-2898-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Maria A Kyriazi
- 4th Department of Surgery, Attikon Hospital, University of Athens Medical School, 1 Rimini str, 12462, Chaidari, Greece,
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Yang H, Chen Y. The role of preoperative biliary drainage in severely jaundiced patients. World J Surg 2014; 39:802-3. [PMID: 25270347 DOI: 10.1007/s00268-014-2814-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hui Yang
- Hepatobiliary Surgery Department of Qilu Hospital, Shandong University, No. 44 WenhuaXi Road, Jinan, 250012, China
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Mantas D, Charalampoudis P. Preoperative biliary drainage in patients with distal obstruction due to pancreatic head cancer. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2014. [DOI: 10.2217/ije.13.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A total of 77% of pancreatic head cancers manifest with obstructive jaundice. Hyperbilirubinemia impairs immunity and nutrition and is responsible for systemic toxicity. Several studies have attempted to investigate the impact of biliary drainage prior to duodenopancreatectomy (preoperative biliary drainage [PBD]) on jaundice resolution, morbidity, mortality and infectious complications, conferring high controversy. One large randomized controlled trial concluded that PBD should not be recommended in patients with distal obstructive jaundice owing to high infection rates. However, this work has been extensively criticized due to the exclusion of severely jaundiced patients, lack of information regarding antimicrobial agents used and employment of plastic instead of metal stents. However, proponents of PBD favor its application in selected cases. This work aims to review the literature on PBD for jaundice due to pancreatic head malignancy, to outline the controversy pertaining to this modality and to identify the indications of PBD in selected patients with malignant distal obstruction.
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Affiliation(s)
- Dimitrios Mantas
- Second Department of Propedeutic Surgery, Laiko General Hospital, Athens University Medical School, 17 Agiou Thoma Street 11527, Athens, Greece
| | - Petros Charalampoudis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Athens University Medical School, 17 Agiou Thoma Street 11527, Athens, Greece
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Mohammed S, Evans C, VanBuren G, Hodges SE, Silberfein E, Artinyan A, Mo Q, Issazadeh M, McElhany AL, Fisher WE. Treatment of bacteriobilia decreases wound infection rates after pancreaticoduodenectomy. HPB (Oxford) 2014; 16:592-8. [PMID: 23992045 PMCID: PMC4048081 DOI: 10.1111/hpb.12170] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 06/25/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although mortality following pancreaticoduodenectomy is decreasing, postoperative morbidity remains high. It was hypothesized that culture-directed treatment of bacteriobilia would decrease the incidence of infectious complications following pancreaticoduodenectomy. METHODS In a retrospective study of 197 pancreaticoduodenectomy patients, those in the control group (n = 128, 2005-2009) were given perioperative prophylactic antibiotics, whereas those in the treatment group (n = 69, 2009-2011) were continued on antibiotics until intraoperative bile culture results became available. Patients with bacteriobilia received 10 days of antibiotic treatment, which was otherwise discontinued in patients without bacteriobilia. Various complication rates were compared using Fisher's exact test for categorical variables, Wilcoxon rank sum test for ordinal variables, and a two-sample t-test for continuous variables. RESULTS Demographics, comorbidities, baseline clinical characteristics, and intraoperative and postoperative variables were similar between the two groups. There were higher incidences of elevated creatinine (19% versus 4%; P = 0.004) and preoperative hyperglycaemia (18% versus 7%; P = 0.053) in the control group. Fewer patients in the control group underwent preoperative biliary stenting (48% versus 67%; P = 0.017) and intraperitoneal drains were placed at the time of resection more frequently in the control group (85% versus 38%; P < 0.001). Bacteriobilia was found in 59% of patients. Treatment of bacteriobilia was associated with a decrease in the rate of postoperative wound infections (12% in the control group versus 3% in the treatment group; P = 0.036) and overall complication severity score (1 in the control group versus 0 in the treatment group; P = 0.027). CONCLUSIONS Prolonged antibiotic therapy for bacteriobilia may decrease postoperative wound infection rates after pancreaticoduodenectomy. A randomized prospective trial is warranted to provide evidence to further support this practice.
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Affiliation(s)
- Somala Mohammed
- Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Role of preoperative biliary drainage in jaundiced patients who are candidates for pancreatoduodenectomy or hepatic resection. Ann Surg 2013; 259:e74-5. [PMID: 24263318 DOI: 10.1097/sla.0000000000000401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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