Colonization of Bile Ducts and Postoperative Infectious Complications of Pancreaticoduodenectomies
Keywords
Abstract
Description
Pancreaticoduodenectomy is part of the curative treatment of periampullary neoplasms. Postoperative mortality for this procedure is between 1 and 5 %, and morbidity ranging from 30 to 50%. Infectious complications, with pancreatic fistula and gastric delayed empting, are an important part of this morbidity, affecting nearly 35% of patients.
One of the risk factors of infectious complications is the presence of a preoperative obstructive jaundice, due to obstruction of bile ducts by the tumor. In this case, it is proposed to perform a preoperative drainage of the bile ducts, preferably by endoscopic procedure (ERCP), associated with the placement of a endoprosthesis. However, this procedure is controversial, this one increasing postoperative morbidity, and in particular the rate of infectious complications. One explanation of these events is the bacteriological contamination of the bile ducts during the endoscopic procedure. In addition, it has been observed for the patients who have benefited from preoperative drainage, the biliary flora is predominantly polymicrobial and may contain multiresistant nosocomial germs, unlike patients who have not benefited from this procedure, whose biliary flora is predominantly sterile or monomicrobial. This colonization by multiresistant germs may have consequences in the postoperative period, in fact, up to 49% of the germs found in the bile samples are also found in the samples taken during postoperative infectious events. This microbial release could make it more difficult to take care of postoperative infections, with less efficacy of conventional antibiotic treatments.
The aim of the present prospective study was, first, to verify the correlation between biliary colonization and postoperative infectious complications, and secondarily to asses morbidity and mortality in patients who underwent pancreaticoduodenectomy. Patients whit colonized bile and patients with sterile bile were compared for these outcomes.
Dates
| Last Verified: | 04/30/2018 |
| First Submitted: | 04/25/2018 |
| Estimated Enrollment Submitted: | 05/13/2018 |
| First Posted: | 05/14/2018 |
| Last Update Submitted: | 05/13/2018 |
| Last Update Posted: | 05/14/2018 |
| Actual Study Start Date: | 01/31/2017 |
| Estimated Primary Completion Date: | 01/31/2018 |
| Estimated Study Completion Date: | 04/01/2018 |
Condition or disease
Intervention/treatment
Other: Patients with Bile Samples
Phase
Arm Groups
| Arm | Intervention/treatment |
|---|---|
| Patients with Bile Samples Patients underwent pancreaticoduodenectomy who had intraoperative bile sampling for bacterial examination. | Other: Patients with Bile Samples At the beginning of pancreaticoduodenectomy, patients had bile sampling from the gallbladder or from the common bile duct for bacterial examination and study of susceptibility to antibiotics. |
Eligibility Criteria
| Ages Eligible for Study | 18 Years To 18 Years |
| Sexes Eligible for Study | All |
| Sampling method | Probability Sample |
| Accepts Healthy Volunteers | Yes |
| Criteria | Inclusion Criteria: - patients over the age of 18 - patients underwent programmed pancreaticoduodenectomy Exclusion Criteria: - Patients underwent emergency pancreaticoduodenectomy (delay less than 48 hours) - Patients had not been taken of a biliary sample in intraoperative period |
Outcome
Primary Outcome Measures
1. Postoperative infectious complications at postoperative day 90 [Postoperative time until day 90]
Secondary Outcome Measures
1. Mortality before ICU discharge [90 days]
2. Mortality post operative day 28 [28 days]
3. Mortality post operative day 90 [90 days]
