Role of preoperative biliary stents, bile contamination and antibiotic therapy in patients undergoing pancreaticoduodenectomy: A Retrospective Cohort Study

Background: The use of preoperative biliary drainage before pancreaticoduodenectomy (PD) remains controversial. The correlation between antibiotic prophylaxis and intraoperative biliary swab is a matter of further investigation to reduce postsurgical complications. Methods: The operative series of PD performed at the Pancreatic Surgery reference center for the USL Toscana Centro between January 1, 2021 and August 2023 were retrospectively analyzed. This study compared stented and nonstented patients undergoing PD to assess any differences in postoperative morbidity and mortality. In addition, intraoperative bile and abdominal drain fluid cultures were microbiologically assessed, and the susceptibility of bacterial isolates to antibiotics currently used for preoperative short-term prophylaxis was evaluated. Results: Almost 47/90 underwent preoperative stenting, 30/47 had jaundice above 12 mg/dl and went to upfront surgery, and 12/47 underwent neoadjuvant chemotherapy. Biliary microbial cultures were positive in 38/90 patients, among them 28 showed a polymicrobial flora. The most frequent postoperative complications detected were: abdominal abscess 9/90, pancreatic fistula type B-C 8/90, and delayed gastric emptying 7/90. From the statistical analysis, a P value = 0.0215 was obtained for the correlation between the preoperative stent group and P = 0.0285 with positive bile culture. Conclusion: There is no statistically significant correlation between the result of rectal and biliary swabs and the development of postoperative complications. Instead, biliary stent placement and positive biliary culture examination are two statistically significant risk factors for the development of postoperative complications. In relation to the increased rate of complications in patients subjected to preoperative stenting, careful presurgical evaluation is necessary to define who will have to undergo this procedure.