PancreasBacterobilia may trigger the development and severity of pancreatic fistula after pancreatoduodenectomy

BackgroundAlthough biliary infection (bacterobilia) is considered a risk factor for infectious complications after pancreatoduodenectomy, the association between bacterobilia and postoperative pancreatic fistula has remained unclear. The aim of this study is to investigate the impact of bacterobilia on the development of postoperative pancreatic fistula following pancreatoduodenectomy.MethodsWe conducted a retrospective review of the patients who underwent pancreatoduodenectomy between November 2010 and July 2014. Intraoperative bile cultures and cultures of the peripancreatic drainage fluid on postoperative days 1 and 3 were investigated in all patients.ResultsOf 264 patients, 151 (57%) patients had a positive intraoperative bile culture. The incidence of grade B/C postoperative pancreatic fistulas (by the international definition) was greater in patients with a positive intraoperative bile culture than in those with a negative intraoperative bile culture (38% vs 25%, P = .025). A multivariate analysis revealed that a positive intraoperative bile culture (odds ratio, 2.60; P = .002) and a body mass index of ≥22 kg/m2 (odds ratio, 2.18; P = .008) were independent risk factors for grade B/C postoperative pancreatic fistulas. Among the 151 patients with a positive intraoperative bile culture, the microorganism(s) isolated from the bile was detected in the drainage fluid of 100% of the patients on postoperative day 1 and in 88% of patients on postoperative day 3.ConclusionBacterobilia was found to be a risk factor for grade B/C postoperative pancreatic fistulas, and bacteria from the infected bile may be the source of the grade B/C postoperative pancreatic fistulas.