The effect of a preoperative biliary prosthesis on the infectious complications of the pancreaticoduodenectomy.

Introduction: there is controversy about the effect of a preoperative biliary prosthesis (PBP) on complications of pancreaticoduodenectomy (PD). There are no recommendations for antibiotic prophylaxis in these patients. The objective of the study was to analyze the association of PBP, bacteriology and the development of complications after PD.

Methods: this was a retrospective observational study with 90 consecutive patients that underwent DP between 2015 and 2018. PBP was indicated in patients with total bilirubin levels > 12 mg/dl who could not be operated on within a reasonable time. Antibiotic prophylaxis with cefoxitin was administered in patients without PBP and a five-day treatment with piperacillin-tazobactam for PBP. A bile culture was systematically performed.

Results: the average age of the patient cohort was 69 years. Fifty-one patients suffered complications (56%), with a mortality rate of 3%. The average hospital stay was eleven days and PBP was placed in 51 patients (56%). Antibiotic prophylaxis was adequate in 62 patients (69%). The most frequently isolated bacteria were E. faecium (30%), E. coli (20%) and E. faecalis (19%). Patients with PBP had a significantly higher percentage of positive cultures (98% vs 25%, p < 0.01), a higher number of bacteria (2.9 vs 0.5, p < 0.01) and perioperative sepsis (31% vs 12%, p = 0.03), but without an increased hospital stay or overall morbidity.

Conclusions: PBPs increase the risk of perioperative sepsis, the percentage of positive cultures and the average number of isolated bacteria. The protocol of prophylaxis with cefoxitin and the administration of pipercillin-tazobactan with PBP adequately treated 69% of patients. With this protocol, PBPs do not imply an increase in complications or hospital stay.