World Journal of Surgery

, Volume 25, Issue 12, pp 1512–1518

Changes in Bacterial Concentration in the Liver Correlate with That in the Hepaticojejunostomy after Bile Duct Reconstruction: Implication in the Pathogenesis of Postoperative Cholangitis

Authors

  • Jiin-Haur Chuang
    • Department of Pediatric Surgery, Chang Gung Memorial Hospital, Kaohsiung and the Chang Gung University, Taiwan
  • Shin-Yi Lee
    • Department of Pediatric Surgery, Chang Gung Memorial Hospital, Kaohsiung and the Chang Gung University, Taiwan
  • Wei-Jen Chen
    • Department of Pathology, Chang Gung Memorial Hospital, Kaohsiung and the Chang Gung University, Taiwan
  • Chie-Song Hsieh
    • Department of Pediatric Surgery, Chang Gung Memorial Hospital, Kaohsiung and the Chang Gung University, Taiwan
  • Nyuk-Kong Chang
    • Department of Pediatric Surgery, Chang Gung Memorial Hospital, Kaohsiung and the Chang Gung University, Taiwan
  • Sing-Kai Lo
    • Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Yuk Choi Road, Hung Hom, Kowloon, Hong Kong
Article

DOI: 10.1007/s00268-001-0162-9

Cite this article as:
Chuang, J., Lee, S., Chen, W. et al. World J Surg (2001) 25: 1512. doi:10.1007/s00268-001-0162-9

Abstract

Postoperative cholangitis is a frequent and unpredictable complication of unknown etiology following bile duct reconstruction (BDR), particularly for biliary atresia. This study was undertaken to correlate the growth of bacteria in the hepaticojejunostomy with that in the liver after BDR. Quantitative bacterial culture was done on the specimens taken from the liver and from the hepaticojejunostomy at 1 week (group 1, n = 7), 1 month (group 2, n = 7), and 2 months (group 3, n = 7) following BDR with Roux-en-Y hepaticojejunostomy in piglets after 2 weeks of common bile duct ligation. The histological examination of the liver and the hepaticojejunostomy, as well as serial monitoring of hemogram and liver function tests, were performed to correlate the findings with the bacterial concentration of the liver and the hepaticojejunostomy following BDR. The bacterial concentration of the hepaticojejunostomy, expressed as log10 colony-forming units per gram (log10 CFU/g) of the hepaticojejunostomy, showed a progressive decrease from 8.38 ± 1.36 in group 1, 7.07 ± 2.54 in group 2, to 3.56 ± 1.31 in group 3 (p = 0.001). The log10 CFU/g of the liver also showed a progressive decrease from 5.02 ± 1.59 in group 1, 3.16 ± 1.56 in group 2, to 2.19 ± 1.09 in group 3 (p = 0.006). There was a significant positive correlation of the log10 CFU/g of the liver (n = 21) with that of the hepaticojejunostomy (n = 21) following BDR (r = 0.600, p = 0.004). Most of the infectious pathogens isolated from the liver were also isolated from the hepaticojejunostomy. The changes in hemoglobin, bilirubin, albumin, and ammonia significantly correlated with the changes of the bacterial concentration of the liver. The results of the study suggests that hepatic bacterial proliferation after BDR is significantly affected by microbial overgrowth in the bilioenteric anastomosis and is associated with deteriorated liver function and hemogram.

Copyright information

© Société Internationale de Chirurgie 2001