Bacteriobilia in Hepato-Pancreato-Biliary Surgery: an Enemy or a Friend in Disguise?

Bacterial colonization of bile, known as bacteriobilia, is predisposed by biliary obstruction and/or biliary interventions. It can lead to an increase in postoperative infective complications through impairment of hepatic synthetic and immunological function and breakdown of intestinal mucosal barrier. However, various reports of bacteremia and increase in infective complications have not been translated into increased postoperative morbidity and mortality. Biliary interventions, including preoperative biliary drainage, have been shown to increase the rates of bacteriobilia, and in turn positive biliary cultures. However, the clinical implication of this biliary colonization and strategies to prevent postoperative infective complications are not well understood. Bacteriobilia may be difficult to prevent completely due to its occurrence from non-modifiable risk factors. However, sparing use of biliary interventions and early identification and treatment of bacteriobilia with culture-directed antibiotics can help prevent catastrophic postoperative infective complications. It is necessary for this culture-based practice to become part of a routine protocol, and every step must be taken to prevent bacteriobilia, and thereby avoid postoperative infective complications and optimize patient outcome.