Impact of bactibilia on the development of post operative septic complications in patients undergoing pancreatico duodenectomy

BACKGROUND: Bile is normally sterile, but stasis, presence of foreign body (stones, parasites, stents), predispose to bactibilia. Pancreaticoduodenectomy is the definitive procedure for cancer of the head of pancreas and periampullary cancers. It is a morbid procedure with high incidence of post-operative complications. Septic complications are the leading cause of post-operative morbidity. This study intends to determine any association between positive bile cultures and post-operative septic complications. METHODS: Thirty consecutive patients undergoing pancreaticoduodenectomy in Christian Medical College, Vellore, were studied. Cefazolin, Amikacin and Metronidazole were given within 1 hour of skin incision in all patients. Cefazolin and Metronidazole were repeated at 4 hourly intervals during the operation. Patients, who had been stented previously or had any other biliary intervention, were given a single dose of Amikacin the day after the operation. This practice has since been discontinued. Intra-operatively, bile was sent was for culture, in a blood culture medium (BacT/ALERT FA Plus). Post-operatively, these patients were followed up for the development of septic complications. Antibiotics were given if there was hemodynamic instability (attributed to sepsis) or organ dysfunction. Choice of antibiotics was dependent on bile culture report. Cultures from blood or intra-abdominal collections were compared with the intra-operative bile cultures. The overall development of complications in the post-operative period was compared between bile culture positive and negative patients. RESULTS: Bactibilia was present in 60% of the study population. Of these Escherichia coli (56.7%) and Enterococci (43.3%) were the most common organisms isolated. Sixty percent of patients developed septic complications post-operatively. Post-operative septic complications included wound infection, intra-abdominal collections and septicemia. Pre-operative biliary intervention did not have any statistically significant association with infected bile or septic complications. Pre-operative variables like history of cholangitis, intra-operative variables like hypotension, tachycardia or blood transfusion, did not have any association with post-operative septic complications. Four of the study patients succumbed to septic complications. CONCLUSIONS: Pre-operative biliary intervention is not associated with increased incidence of infected bile. Bactibilia does not lead to infective complications post-operatively, in patients undergoing pancreaticoduodenectomy