World Journal of Surgery

, Volume 42, Issue 9, pp 2951–2962 | Cite as

Prognostic Impact of Bacterobilia on Morbidity and Postoperative Management After Pancreatoduodenectomy: A Systematic Review and Meta-analysis

  • Benjamin Müssle
  • Sebastian Hempel
  • Christoph Kahlert
  • Marius Distler
  • Jürgen Weitz
  • Thilo WelschEmail author
Original Scientific Report



Intraoperative bile analysis during pancreatoduodenectomy (PD) is performed routinely at specialized centers worldwide. However, it remains controversial if and how intraoperative bacterobilia during PD affects morbidity and its management. The aim of the study was a systematic review and meta-analysis of intraoperative bacterobilia and its impact on patient outcome after PD.


Five relevant outcomes of interest were defined, and a systematic review of the literature with meta-analysis was performed according to the PRISMA guidelines.


A total of 28 studies (8523 patients) were included. The median incidence of bacterobilia was 58% (interquartile range 51–67%). The most frequently isolated bacteria were Enterococcus species (51%), Klebsiella species (28%), and Escherichia coli (27%). Preoperative biliary drainage was significantly associated with bacterobilia (86 vs. 25%; RR 3.27; 95% confidence interval (CI) 2.42–4.42; p < 0.001). The incidence of surgical site infections (SSI) was significantly increased in cases with bacterobilia (RR 2.84; 95% CI 2.17–3.73; p < 0.001). Postoperative pancreatic fistula, overall postoperative morbidity, and mortality were not significantly influenced. Identical bacteria in bile and the infectious sources were found in 48% (interquartile range 34–59%) of the cases.


Bacterobilia is detected during almost every second PD and is associated with an increased rate of SSI. The microbiome from intraoperative bile and postoperative infectious sources match in ~50% of patients, providing the option of early administration of calculated antibiotics and the determination of resistance patterns.


Authors’ contributions

B.M. collected and analyzed the data and drafted the manuscript. S.H. assisted with the data collection. J.W., C.K., and M.D. worked on the final manuscript. T.W. collected and analyzed the data and finalized the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.

Supplementary material

268_2018_4546_MOESM1_ESM.pdf (313 kb)
Supplementary material 1 (PDF 313 kb)


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Benjamin Müssle
    • 1
  • Sebastian Hempel
    • 1
  • Christoph Kahlert
    • 1
  • Marius Distler
    • 1
  • Jürgen Weitz
    • 1
  • Thilo Welsch
    • 1
    Email author
  1. 1.Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany

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