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Cholangitis in the postoperative course after biliodigestive anastomosis

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Abstract

Background

Hepatobiliary surgery with biliodigestive anastomosis (BDA) results in a loss of the sphincter of Oddi with consecutive ascension of bacteria into the bile system which may cause cholangitis in the postoperative course.

Methods

Patients who received reconstruction with a BDA after hepatobiliary surgery were analyzed retrospectively for their postoperative course of disease depending on intraoperatively obtained bile cultures and antibiotic prophylaxis.

Results

Two hundred forty-three patients were included in the analysis, 49.4 % of whom had received endoscopic stenting before the operation. Stenting was significantly associated with the presence of drug-resistant bacteria in the intraoperatively obtained bile sample (p < 0.001, OR = 4.09). Of all patients, 14.4 % developed postoperative cholangitis. This was significantly associated with the postoperative length of stay in the intensive care unit (p = 0.002, OR = 1.035). The highest incidence of postoperative cholangitis was found in patients with cholangiocellular carcinoma (n = 12, p = 0.046, OR = 2.178). Patients were more likely to harbor strains with resistance against the antibiotic that was given intraoperatively.

Conclusion

The risk for the presence of drug-resistant bacteria is increased by preoperative stenting of the common bile duct. Bile culture by intraoperative swabs can be altered by the perioperative antibiotic prophylaxis as it induces microbiological selection in the common bile duct.

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Authors’ contributions

SC: acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. KT: acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. RV: drafting of manuscript, critical revision of manuscript. FV: analysis and interpretation of data, drafting of manuscript. HS: analysis and interpretation of data, critical revision of manuscript. SS: drafting of manuscript, critical revision of manuscript. JK: study conception and design, acquisition of data, critical revision of manuscript. HB: study conception and design, acquisition of data, critical revision of manuscript. MK: study conception and design, analysis and interpretation of data, drafting of manuscript, Critical revision of manuscript.

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    Authors and Affiliations

    1. General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany

      Sebastian Cammann, Kai Timrott, Florian W. R. Vondran, Jürgen Klempnauer, Hüseyin Bektas & Moritz Kleine

    2. Institute for Medical Microbiology and Hospital Epidemiology, Hanover Medical School, Hanover, Germany

      Ralf-Peter Vonberg & Sebastian Suerbaum

    3. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation, Hanover Medical School, Hanover, Germany

      Harald Schrem

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    1. Sebastian Cammann
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    Correspondence to Sebastian Cammann.

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    This article does not contain any studies with animals performed by any of the authors. All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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    Sebastian Cammann and Kai Timrott contributed equally to this work.

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    Cammann, S., Timrott, K., Vonberg, RP. et al. Cholangitis in the postoperative course after biliodigestive anastomosis. Langenbecks Arch Surg 401, 715–724 (2016). https://doi.org/10.1007/s00423-016-1450-z

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    • DOI: https://doi.org/10.1007/s00423-016-1450-z

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