The influence of preoperative endoscopic stent insertion into the common bile duct on postoperative outcome after a Traverso- Longmire Whipple surgical reconstruction A retrospective analysis of prospectively collected clinical data

Weistra, J. (Joyce) (2016) The influence of preoperative endoscopic stent insertion into the common bile duct on postoperative outcome after a Traverso- Longmire Whipple surgical reconstruction A retrospective analysis of prospectively collected clinical data. thesis, Medicine.

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Abstract

BACKGROUND: Surgical resection for pancreatic cancer offers the only chance for cure. About 40% of the patients undergo a preoperative biliary stent insertion. The role of preoperative biliary drainage in patients with biliary obstruction prior to pancreatic surgery with reconstruction remains controversial. STUDY DESIGN: At the department of General and Visceral Surgery, Pius-Hospital, Oldenburg, Germany, a cohort of 152 patients undergoing either (pylorus-preserving) Traverso-Longmire, classic Whipple or total pancreaticoduodenectomy from January 2009 up to and including July 2015 was analyzed. The research design is a retrospective analysis of the influence of bile duct stenting in patients prior to pancreaticoduodenectomy on various outcomes. Data was gathered clinically. Patients with external or surgical pre-operative biliary drainage were excluded. RESULTS: Forty percent (62 out of 152) of the included patients underwent preoperative biliary !4 drainage for a median time period of 26 days (range 1 to 215) prior to resection. Retrospective, bile duct cultures in 17 out of 152 patients were missing, and a total of 135 patients were used for the analysis of bacteria. In 53% (71 out of 135) bile duct cultures were positive, whereas 47% (64 out of 135) of bile duct cultures remained sterile. Enterococcus spp. were the most frequent bacterial isolates in bile (49%) in common. After preoperative biliary stenting 98% of the participants show a positive intraoperative gathered bile duct culture in comparison to 21% in the group without preoperative bile duct stenting. In 59% of the group with a common bile duct stent enterococcus spp. was found. No difference of postoperative surgical complications between stented and non-stented patients was found. A statistically significant higher incidence of definite cholangitis on the first postoperative day was found in patients with stents compared with patients without stent placement. CONCLUSIONS: Preoperative biliary drainage by means of an implantation of endoprothesis does not affect the incidence of postoperative complications, such as bleeding and insufficiency of the hepaticojejunostomy, in patients undergoing pancreatic surgery with reconstruction. Antibiotic prophylaxis is required to prevent post-operative infections of the bile ducts: in patients with biliary stents placed for obstructive jaundice an antimicrobial therapy with anti-enterococcal activity should be chosen. Conclusions are limited because of the retrospective nature of the study and exact incidence of postoperative complications cannot be given.

Item Type:	Thesis (Thesis)
Supervisor name:	Weyhe, Dr. med. Dirk and Chef der Allgemein- und Viszeralchirurgie and Pius-Hospital, Oldenburg
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:39
Last Modified:	25 Jun 2020 10:39
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/43

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