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Surgery Today
Published in: Surgery Today 3/2020

01-03-2020 | Pancreaticojejunostomy | Original Article

Early postoperative drainage fluid culture positivity from contaminated bile juice is predictive of pancreatic fistula after pancreaticoduodenectomy

Authors: Tatsuo Hata, Masamichi Mizuma, Fuyuhiko Motoi, Kei Nakagawa, Kunihiro Masuda, Masaharu Ishida, Takanori Morikawa, Hiroki Hayashi, Takashi Kamei, Takeshi Naitoh, Michiaki Unno

Published in: Surgery Today | Issue 3/2020

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Abstract

Purpose

To investigate the impact of early postoperative drainage fluid culture positivity on the development of clinically relevant postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD).

Methods

We assessed the positive prevalence, distribution, and drug sensitivity of microorganisms in drainage fluid collected on postoperative day (POD) 1 after PD from 465 patients.

Results

Culture results were positive in pancreaticojejunostomy (PJ) drainage fluid from 26.0% of patients. Similar distributions of microorganisms were observed in the bile juice and PJ/hepaticojejunostomy (HJ) drainage fluid from these patients. PJ drain culture positivity was associated with an elevated drainage amylase level and with preoperative biliary drainage. No associations were seen between HJ drainage culture positivity and the drainage amylase and bilirubin levels. PJ drainage culture positivity was found to be an independent predictor of grade B/C POPF. According to the antibiogram, the bacteria identified were likely to be resistant to prophylactic antibiotics.

Conclusions

PJ drainage culture positivity on POD 1 in combination with an elevated drainage amylase level is an early predictor of grade B/C POPF. PJ drainage culture positivity may be attributable to bile juice contamination caused by intraoperative spillage and early postoperative leakage from the PJ anastomotic sites.
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Metadata
Title
Early postoperative drainage fluid culture positivity from contaminated bile juice is predictive of pancreatic fistula after pancreaticoduodenectomy
Authors
Tatsuo Hata
Masamichi Mizuma
Fuyuhiko Motoi
Kei Nakagawa
Kunihiro Masuda
Masaharu Ishida
Takanori Morikawa
Hiroki Hayashi
Takashi Kamei
Takeshi Naitoh
Michiaki Unno
Publication date
01-03-2020
Publisher
Springer Singapore
Published in
Surgery Today / Issue 3/2020
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-019-01885-8

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