Controversial role of pre-operative biliary drainage for obstructive jaundice in patients undergoing hepato-pancreato-biliary surgery

Aims Pre-operative biliary drainage (PBD) in patients undergoing hepato-pancreato-biliary surgery (HPBS) has a controversial impact on post-operative infectious complications (POICs): we report the related experience at our tertiary level centre.

Methods We retrospectively reviewed patients who underwent HPBS from 2015 to 2022 including cases with available intraoperative bile samples. We compared patients who had PBD (group A, endoscopic stenting, plus group B, percutaneous stenting) to patients directly referred to surgery (group C), evaluating bile culture (BC) results, drug-sensitivity of isolated germs and the occurrence of POICs [1] [2].

Results We included 42 patients: 24 (57%) underwent PBD, while 18 (43%) directly received surgical treatment. Group A+B and group C were comparable for age, gender and underlying pathology (table 1). Positive BC was found in 20/24 (83%) stented patients and in 2/18 (11%) directly operated patients (p<0.01). In group A+B, most frequently detected germs were Enterococci (6/20, 30%), predominantly multi-drugs sensitive (MS, 5/6, 83%), and Gram -, predominantly E. Coli (4/20, 20%); we found multi-drugs resistant (MR) Klebsiella in two patients. All 3 cases of MR germs were reported in stented population (p=0.9). POICs occurred in 8/24 (33%) cases in group A+B and in 8/18 (44%) cases in group C (p=0.53); infected fluid collections were the most represented POICs (7/8 and 6/8 cases respectively; p=0.74), which were all successfully treated with antibiotic therapy ([Table 1]).

Table 1 Outcomes following Hemospray use in the context of PB related GIB.

Conclusions In our cohort the rate of bile contamination was significantly higher in PBD group compared to directly operated patients, but we did not observe any related increase of POICs.

Conflicts of interest

C.G. De Angelis is a consultant for Boston Scientific, Olympus and Medi-Globe

• 1 Irrinki S, Kurdia K, Poudel H. et al. Impact of preoperative biliary drainage in patients undergoing pancreaticoduodenectomy – a prospective comparative study from a tertiary care centre in India. Indian J Surg Oncol 2022; 13 (03) 574-579
• 2 Sandini M, Honselmann KC, Cereda M. et al. The Relative Role of bile bacterial isolation on outcome in stent-bearing patients undergoing pancreatoduodenectomy. J Gastrointest Surg 2020; 24 (10) 2269-2276

Publication History

Article published online:
14 April 2023