Gennaro Clemente1, Agostino M De Rose2, Rita Murri3, Francesco Ardito2, Gennaro Nuzzo2, Felice Giuliante2. 1. Hepatobiliary Unit, Department of Surgical Sciences, A. Gemelli Medical School, Largo Gemelli, 800168, Rome, Italy. gclemente@rm.unicatt.it. 2. Hepatobiliary Unit, Department of Surgical Sciences, A. Gemelli Medical School, Largo Gemelli, 800168, Rome, Italy. 3. Department of Infectious Diseases, Catholic University of Sacred Heart, A. Gemelli Medical School, Rome, Italy.
Abstract
BACKGROUND: Primary intrahepatic lithiasis is defined by the presence of gallstones at the level of cystic dilatations of the intrahepatic biliary tree. Liver resection is considered the treatment of choice, with the purpose of removing stones and atrophic parenchyma, also reducing the risk of cholangiocarcinoma. However, in consequence of the considerable incidence of infectious complications, postoperative morbidity remains high. The current study was designed to evaluate the impact of preoperative bacterial colonization of the bile ducts on postoperative outcome. METHODS: The clinical records of 73 patients treated with liver resection were reviewed and clinical data, operative procedures, results of bile cultures, and postoperative outcomes were examined. RESULTS: Left hepatectomy (38 patients) and left lateral sectionectomy (19 patients) were the most frequently performed procedures. Overall morbidity was 38.3 %. A total of 133 microorganisms were isolated from bile. Multivariate analysis identified previous endoscopic or percutaneous cholangiography (p = 0.043) and preoperative cholangitis (p = 0.003) as the only two independent risk factors for postoperative infectious complications. CONCLUSIONS: Postoperative morbidity was strictly related to the preoperative biliary infection. An effective control of infections should be always pursued before liver resection for intrahepatic stones and an aggressive treatment of early signs of sepsis should be strongly emphasized.
BACKGROUND:Primary intrahepatic lithiasis is defined by the presence of gallstones at the level of cystic dilatations of the intrahepatic biliary tree. Liver resection is considered the treatment of choice, with the purpose of removing stones and atrophic parenchyma, also reducing the risk of cholangiocarcinoma. However, in consequence of the considerable incidence of infectious complications, postoperative morbidity remains high. The current study was designed to evaluate the impact of preoperative bacterial colonization of the bile ducts on postoperative outcome. METHODS: The clinical records of 73 patients treated with liver resection were reviewed and clinical data, operative procedures, results of bile cultures, and postoperative outcomes were examined. RESULTS: Left hepatectomy (38 patients) and left lateral sectionectomy (19 patients) were the most frequently performed procedures. Overall morbidity was 38.3 %. A total of 133 microorganisms were isolated from bile. Multivariate analysis identified previous endoscopic or percutaneous cholangiography (p = 0.043) and preoperative cholangitis (p = 0.003) as the only two independent risk factors for postoperative infectious complications. CONCLUSIONS: Postoperative morbidity was strictly related to the preoperative biliary infection. An effective control of infections should be always pursued before liver resection for intrahepatic stones and an aggressive treatment of early signs of sepsis should be strongly emphasized.
Authors: Jean-Yves Mabrut; Christian Partensky; Daniel Jaeck; Elie Oussoultzoglou; Jacques Baulieux; Olivier Boillot; Jan Lerut; Jean de Ville de Goyet; Catherine Hubert; Jean-Bernard Otte; Maxime Audet; Christian Ducerf; Jean-François Gigot Journal: Ann Surg Date: 2007-08 Impact factor: 12.969