Effect of preoperative biliary drainage on intraoperative biliary cultures and surgical outcomes after pancreatic resection

MM Bernon; S Steenkamp; S Dlamini; M Miller; S Sobnach; N Leech; UK Kotze; JEJ Krige; EG Jonas

Authors

MM Bernon University of Cape Town https://orcid.org/0000-0002-7967-8548
S Steenkamp University of Cape Town
S Dlamini University of Cape Town
M Miller University of Cape Town https://orcid.org/0000-0001-6137-7723
S Sobnach University of Cape Town https://orcid.org/0000-0001-6137-7723
N Leech University of Cape Town https://orcid.org/0009-0002-6973-8241
UK Kotze University of Cape Town https://orcid.org/0000-0003-1405-474X
JEJ Krige University of Cape Town https://orcid.org/0000-0002-7057-9156
EG Jonas University of Cape Town https://orcid.org/0000-0003-0123-256X

Keywords:

pancreaticoduodenectomy, preoperative biliary drainage, surgical site infection, complications, pancreatic cancer, obstructive jaundice

Abstract

Background: Prolonged obstructive jaundice (OJ), associated with resectable pancreatic pathology, has many deleterious effects that are potentially rectifiable by preoperative biliary drainage (POBD) at the cost of increased postoperative infective complications. The aim of this study is to assess the impact of POBD on intraoperative biliary cultures (IBCs) and surgical outcomes in patients undergoing pancreatic resection.

Methods: Data from patients at Groote Schuur Hospital, Cape Town, between October 2008 and May 2019 were analysed. Demographic, clinical, and outcome variables were evaluated, including perioperative morbidity, mortality, and 5-year survival.

Results: Among 128 patients, 69.5% underwent POBD. The overall perioperative mortality in this study was 8.8%. The POBD group had a significantly lower perioperative mortality rate compared to the non-drainage group (5.6% vs. 25.6%). POBD patients had a higher incidence of surgical site infections (55.1% vs. 23.1%), polymicrobial growth from IBCs and were more likely to culture resistant organisms. Five-year survival was similar in the two groups.

Conclusion: POBD was associated with a high incidence of resistant organisms on the IBCs, a high incidence of surgical site infections and a high correlation between cultures from the surgical site infection and the IBCs.