Preoperative biliary drainage: Impact on intraoperative bile cultures and infectious morbidity and mortality after pancreaticoduodenectomy

Whether it is necessary to perform biliary drainage for obstructive jaundic e before performing pancreaticoduodenectomy remains controversial. Our aim was to determine the impact of preoperative biliary drainage on intraoperat ive bile cultures and postoperative infectious morbidity and mortality foll owing pancreaticoduodenectomy. We retrospectively analyzed 161 consecutive patients undergoing pancreaticoduodenectomy in whom intraoperative bile cul tures were performed. Microorganisms were isolated from 58% of these intrao perative bile cultures, with 70% of them being polymicrobial. Postoperative morbidity was 47% and mortality was 5%. Postoperative infectious complicat ions occurred in 29%, most commonly wound infection (14%) and intra-abdomin al abscess (12%). Eighty-nine percent of patients with intra-abdominal absc ess (P = 0.003) and 87% with wound infection (P = 0.003) had positive intra operative bile cultures. Microorganisms in the bile were predictive of micr oorganisms in intraabdominal abscess (100%) and wound infection (69%). Mult ivariate analysis of preoperative anti intraoperative variables demonstrate d that preoperative biliary drainage was associated with positive intraoper ative bile cultures (P <0.001), postoperative infectious complications (P = 0.022), intra-abdominal abscess (P = 0.061), wound infection (P = 0.045), and death (P = 0.021). Preoperative biliary drainage increases the risk of positive intraoperative bile cultures, post-operative infectious morbidity, and death. Positive intraoperative bile cultures are associated with post- operative infectious complications and hare similar microorganism profiles. These data suggest that preoperative biliary drainage should be avoided in candidates for pancreaticoduodenectomy.