BACKGROUND: Several risk factors for complications after pancreaticoduodenectomy have been reported. However, the impact of intraoperative bacterial contamination on surgical outcome after pancreaticoduodenectomy has not been examined in depth. METHODS: This retrospective study included patients who underwent pancreaticoduodenectomy and peritoneal lavage using 7000 ml saline between July 2012 and May 2014. The lavage fluid was subjected to bacterial culture examination. The influence of a positive bacterial culture on surgical-site infection (SSI) and postoperative course was evaluated. Risk factors for positive bacterial cultures were also evaluated. RESULTS: Forty-six (21.1 per cent) of 218 enrolled patients had a positive bacterial culture of the lavage fluid. Incisional SSI developed in 26 (57 per cent) of these 46 patients and in 13 (7.6 per cent) of 172 patients with a negative lavage culture (P < 0.001). Organ/space SSI developed in 32 patients with a positive lavage culture (70 per cent) and in 43 of those with a negative culture (25.0 per cent) (P < 0.001). Grade B/C pancreatic fistula was observed in 22 (48 per cent) and 48 (27.9 per cent) respectively of patients with positive and negative lavage cultures (P = 0.010). Postoperative hospital stay was longer in patients with a positive lavage culture (28 days versus 21 days in patients with a negative culture; P = 0.028). Multivariable analysis revealed that internal biliary drainage, combined colectomy and a longer duration of surgery were significant risk factors for positive bacterial culture of the lavage fluid. CONCLUSION: Intraoperative bacterial contamination has an adverse impact on the development of SSI and grade B/C pancreatic fistula following pancreaticoduodenectomy.
BACKGROUND: Several risk factors for complications after pancreaticoduodenectomy have been reported. However, the impact of intraoperative bacterial contamination on surgical outcome after pancreaticoduodenectomy has not been examined in depth. METHODS: This retrospective study included patients who underwent pancreaticoduodenectomy and peritoneal lavage using 7000 ml saline between July 2012 and May 2014. The lavage fluid was subjected to bacterial culture examination. The influence of a positive bacterial culture on surgical-site infection (SSI) and postoperative course was evaluated. Risk factors for positive bacterial cultures were also evaluated. RESULTS: Forty-six (21.1 per cent) of 218 enrolled patients had a positive bacterial culture of the lavage fluid. Incisional SSI developed in 26 (57 per cent) of these 46 patients and in 13 (7.6 per cent) of 172 patients with a negative lavage culture (P < 0.001). Organ/space SSI developed in 32 patients with a positive lavage culture (70 per cent) and in 43 of those with a negative culture (25.0 per cent) (P < 0.001). Grade B/C pancreatic fistula was observed in 22 (48 per cent) and 48 (27.9 per cent) respectively of patients with positive and negative lavage cultures (P = 0.010). Postoperative hospital stay was longer in patients with a positive lavage culture (28 days versus 21 days in patients with a negative culture; P = 0.028). Multivariable analysis revealed that internal biliary drainage, combined colectomy and a longer duration of surgery were significant risk factors for positive bacterial culture of the lavage fluid. CONCLUSION: Intraoperative bacterial contamination has an adverse impact on the development of SSI and grade B/C pancreatic fistula following pancreaticoduodenectomy.
Authors: Ayòtúndé B Fadayomi; Gyulnara G Kasumova; Omidreza Tabatabaie; Susanna W L de Geus; Tara S Kent; Sing Chau Ng; A James Moser; Mark P Callery; Stanley W Ashley; Jennifer F Tseng Journal: HPB (Oxford) Date: 2018-03-09 Impact factor: 3.647
Authors: Massimo Sartelli; Alain Chichom-Mefire; Francesco M Labricciosa; Timothy Hardcastle; Fikri M Abu-Zidan; Abdulrashid K Adesunkanmi; Luca Ansaloni; Miklosh Bala; Zsolt J Balogh; Marcelo A Beltrán; Offir Ben-Ishay; Walter L Biffl; Arianna Birindelli; Miguel A Cainzos; Gianbattista Catalini; Marco Ceresoli; Asri Che Jusoh; Osvaldo Chiara; Federico Coccolini; Raul Coimbra; Francesco Cortese; Zaza Demetrashvili; Salomone Di Saverio; Jose J Diaz; Valery N Egiev; Paula Ferrada; Gustavo P Fraga; Wagih M Ghnnam; Jae Gil Lee; Carlos A Gomes; Andreas Hecker; Torsten Herzog; Jae Il Kim; Kenji Inaba; Arda Isik; Aleksandar Karamarkovic; Jeffry Kashuk; Vladimir Khokha; Andrew W Kirkpatrick; Yoram Kluger; Kaoru Koike; Victor Y Kong; Ari Leppaniemi; Gustavo M Machain; Ronald V Maier; Sanjay Marwah; Michael E McFarlane; Giulia Montori; Ernest E Moore; Ionut Negoi; Iyiade Olaoye; Abdelkarim H Omari; Carlos A Ordonez; Bruno M Pereira; Gerson A Pereira Júnior; Guntars Pupelis; Tarcisio Reis; Boris Sakakhushev; Norio Sato; Helmut A Segovia Lohse; Vishal G Shelat; Kjetil Søreide; Waldemar Uhl; Jan Ulrych; Harry Van Goor; George C Velmahos; Kuo-Ching Yuan; Imtiaz Wani; Dieter G Weber; Sanoop K Zachariah; Fausto Catena Journal: World J Emerg Surg Date: 2017-07-10 Impact factor: 5.469