Risk Factors for Intra-Abdominal Infection after Pancreaticoduodenectomy – A Retrospective Analysis to Evaluate the Significance of Preoperative Biliary Drainage and Postoperative Pancreatic Fistula

2012 ◽  
Author(s):  
Fumiaki Watanabe ◽  
Hiroshi Noda ◽  
Hidenori Kamiyama ◽  
Takaharu Kato ◽  
Nao Kakizawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Retrospective Analysis ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Postoperative Pancreatic Fistula ◽  
Abdominal Infection ◽  
Intra Abdominal Infection

scholarly journals Predictive Factors for Postoperative Pancreatic Fistula—A Swedish Nationwide Register-Based Study

2020 ◽  
Vol 44 (12) ◽  
pp. 4207-4213
Author(s):  
C. Williamsson ◽  
K. Stenvall ◽  
J. Wennerblom ◽  
R. Andersson ◽  
B. Andersson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Weight Gain ◽  
Pancreatic Fistula ◽  
Predictive Factors ◽  
Biliary Drainage ◽  
National Registry ◽  
Preoperative Biliary Drainage ◽  
Postoperative Pancreatic Fistula ◽  
Periampullary Cancer ◽  
High Bmi

Abstract Background A serious complication after pancreatoduodenectomy (PD) is postoperative pancreatic fistula (POPF). The aim of this study was to analyse the incidence and predictive factors for POPF by using a large nationwide cohort. Methods Data from the Swedish National Registry for Pancreatic and Periampullary Cancer for all patients undergoing a PD from 2010 until 30th June 2018 were collected. The material was analysed in two groups, no POPF and clinically relevant (grade B and C) POPF. Results A total of 2503 patients underwent PD, of which 245 (10%) developed POPF. Patients with POPF had significantly more overall complications (Clavien Dindo ≥3a, 75% vs. 21%, p < 0.001) and longer hospital stay (median 23 [16–35] vs. 11 [8–15], p < 0.001) than patients without POPF. The risk of POPF was higher with increased BMI (OR 1.08, p < 0.001). Preoperative presence of diabetes (OR 0.52, p = 0.012) and preoperative biliary drainage (OR 0.34, p < 0.001) reduced the risk of POPF. Reconstruction with pancreaticojejunostomy caused a more than two folded increase in POPF compared with pancreaticogastrostomy (OR 2.41, p < 0.001). Weight gain ≥2 kg on postoperative day 1 was also a risk factor (OR 1.76, p < 0.001). Conclusion A high BMI, a pancreaticojejunostomy and postoperative weight gain were risk factors for developing POPF. Diabetes or preoperative biliary drainage was protective.

Clinical Impact of Preoperative Cholangitis after Biliary Drainage in Patients who Undergo Pancreaticoduodenectomy on Postoperative Pancreatic Fistula

2014 ◽  
Vol 80 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Hiroaki Yanagimoto ◽  
Sohei Satoi ◽  
Tomohisa Yamamoto ◽  
Hideyoshi Toyokawa ◽  
Satoshi Hirooka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Biliary Drainage ◽  
Multivariate Analyses ◽  
Preoperative Biliary Drainage ◽  
Postoperative Pancreatic Fistula ◽  
Prophylactic Antibiotics ◽  
Clinical Background ◽  
Study Population ◽  
Independent Risk Factors

The objective of this study was to examine whether the development of cholangitis after preoperative biliary drainage (PBD) can increase the incidence of postoperative pancreatic fistula (POPF). The study population included 185 consecutive patients who underwent pancreaticoduodenectomy from April 2006 to March 2011. All patients were divided into two groups, which consisted of a “no PBD” group (73 patients) and a PBD group (112 patients). Moreover, the PBD group was divided into a “cholangitis” group (21 patients) and a “no cholangitis” group (91 patients). Clinical background, clinical outcome, and postoperative complications were compared between groups. All patients received prophylactic antibiotics using cefmetazole until 1 or 2 days postoperatively. There was no difference between noncholangitis and non-PBD groups except the frequency of overall POPF. Clinically relevant POPF and drain infection occurred in the cholangitis group significantly more than in the noncholangitis group ( P < 0.05). Univariate and multivariate analyses showed that development of preoperative cholangitis after preoperative biliary drainage and small pancreatic duct (less than 3 mm diameter) were independent risk factors for clinically relevant POPF. The frequency of clinically relevant POPF was 8 per cent (eight of 99) in patients without two risk factors, 19 per cent (15 of 80) in patients with one risk factor, and 50 per cent (three of six) in patients with both risk factors. The development of preoperative cholangitis after PBD was closely associated with the development of clinically relevant POPF under the limited use of prophylactic antibiotics.

scholarly journals The Effect of Preoperative Biliary and Pancreatic Drainage on Postoperative Pancreatic Fistula: A Retrospective Cohort Study

2018 ◽  
Vol 04 (01) ◽  
pp. e37-e42 ◽  
Author(s):  
John Manipadam ◽  
Mahesh S. ◽  
Jacob Kadamapuzha ◽  
Ramesh H.
Keyword(s):  
Cohort Study ◽  
Pancreatic Fistula ◽  
Biliary Drainage ◽  
Harmful Effect ◽  
Rare Event ◽  
Preoperative Biliary Drainage ◽  
Postoperative Pancreatic Fistula ◽  
Study Cohort ◽  
Biliary Stenting ◽  
Pancreatic Anastomosis

Background Surgeons and endoscopists welcome routine preoperative biliary drainage prior to pancreaticoduodenectomy despite evidence that it increases complications. Its effect on postoperative pancreatic fistula is variably reported in literature. Simultaneous biliary and pancreatic drainage is rarely performed for very selected indications and its effects on postoperative pancreatic fistula are largely unknown. Our aim was to analyze the same while eliminating confounding factors. Methods Retrospective single center cohort study of patients who underwent pancreaticoduodenectomy over the past 10 years for carcinoma obstructing the lower common bile duct. Patients who underwent biliary stenting alone, biliary and pancreatic stenting, and no stenting prior to pancreaticoduodenectomy were the three study cohort groups and their records were scrutinized for the incidence of postoperative pancreatic fistula. Results Sixty-two patients underwent biliary stenting alone, 5 patients underwent both biliary and pancreatic stenting, and 237 patients were not stented in the adenocarcinoma group without chronic pancreatitis. The pancreatic fistula rate was similar in the patients who underwent biliary stenting alone when compared with the group which was not stented. (24/62 versus 67/237, odds ratio [OR] =0.619, confidence interval (CI) =0.345–1.112, p = 0.121). However, the patients who underwent both biliary and pancreatic stenting had a significant increase in postoperative pancreatic fistula compared with the not stented (p = 0.003). By univariate and multivariate analysis using Firth logistic regression, pancreatic texture (OR = 1.205, CI = 0.103–2.476, p = 0.032) and the presence of a biliary and pancreatic stent (OR = 2.695, CI = 0.273–7.617, p = 0.027) were the significant factors affecting pancreatic fistula. Conclusion Preoperative biliary drainage alone has no significant influence on postoperative pancreatic fistula except when combined with pancreatic stenting. We need more such studies from other centers to confirm that the rare event of preoperative biliary and pancreatic stenting has indeed this harmful effect on healing of postoperative pancreatic anastomosis.

Retrospective analysis of risk factors for postoperative pancreatic fistula after distal pancreatectomy

Pancreatology ◽  
2013 ◽  
Vol 13 (3) ◽  
pp. S41-S42
Author(s):  
Akira Muraki ◽  
Satoshi Mizutani ◽  
Hideyuki Suzuki ◽  
Takayuki Aimoto ◽  
Seiji Yamagishi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Retrospective Analysis ◽  
Distal Pancreatectomy ◽  
Postoperative Pancreatic Fistula

scholarly journals Risk factors for post‐pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra‐abdominal infection

2019 ◽  
Vol 119 (7) ◽  
pp. 925-931 ◽  
Author(s):  
Ryan J. Ellis ◽  
Aakash R. Gupta ◽  
D. Brock Hewitt ◽  
Ryan P. Merkow ◽  
Mark E. Cohen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Abdominal Infection ◽  
Intra Abdominal Infection

Non-operative Risk Factors and the Implications of Sandostatin for Postoperative Pancreatic Fistula in Malignant Pancreatic Surgery

2018 ◽  
Vol 68 (12) ◽  
pp. 2875-2878
Author(s):  
Delia Rusu Andriesi ◽  
Ana Maria Trofin ◽  
Irene Alexandra Cianga Spiridon ◽  
Corina Lupascu Ursulescu ◽  
Cristian Lupascu
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Surgery ◽  
Postoperative Pancreatic Fistula ◽  
University Center ◽  
Preoperative Hemoglobin ◽  
Term Administration ◽  
Postoperative Administration

Pancreatic fistula is the most frecquent and severe postoperative complication after pancreatic surgery, with impressive implications for the quality of life and vital prognosis of the patient and for these reasons it is essential to identify risk factors. In the current study, who included 109 patient admitted to a single university center and who underwent pancreatic resection for malignant pathology, we assessed the following factors as risk factors: age, sex, preoperative hemoglobin value, preoperative total protein value, obesity and postoperative administration of sandostatin. Of the analyzed factors, it appears that only obesity and long-term administration of sandostatin influences the occurrence of pancreatic fistula.

Predicting the Severity of Pancreatic Fistula after Pancreaticoduodenectomy: Overweight and Blood Loss as Independent Risk Factors: Retrospective Analysis of 277 Patients

2019 ◽  
Vol 20 (6) ◽  
pp. 486-491 ◽  
Author(s):  
Alban Zarzavadjian Le Bian ◽  
David Fuks ◽  
Filippo Montali ◽  
Manuela Cesaretti ◽  
Renato Costi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Pancreatic Fistula ◽  
Retrospective Analysis ◽  
Independent Risk Factors

Patients with Risk Factors for Complications Do Not Require Longer Antimicrobial Therapy for Complicated Intra-Abdominal Infection

2016 ◽  
Vol 82 (9) ◽  
pp. 860-866 ◽  
Author(s):  
Rishi Rattan ◽  
Casey J. Allen ◽  
Robert G. Sawyer ◽  
John Mazuski ◽  
Therese M. Duane ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Surgical Site Infection ◽  
Chronic Health Evaluation ◽  
Health Evaluation ◽  
Site Infection ◽  
Chronic Health ◽  
Abdominal Infection ◽  
Short Course ◽  
Intra Abdominal Infection

A prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-abdominal infection resulted in similar outcomes when compared with a longer duration. We hypothesized that patients with specific risk factors for complications also had similar outcomes. Short-course patients with obesity, diabetes, or Acute Physiology and Chronic Health Evaluation II ≥15 from the STOP-IT trial were compared with longer duration patients. Outcomes included incidence of and days to infectious complications, mortality, and length of stay. Obese and diabetic patients had similar incidences of and days to surgical site infection, recurrent intra-abdominal infection, extra-abdominal infection, and Clostridium difficile infection. Short- and long-course patients had similar incidences of complications among patients with Acute Physiology and Chronic Health Evaluation II ≥15. However, there were fewer days to the diagnosis of surgical site infection (9.5 ± 3.4 vs 21.6 ± 6.2, P = 0.010) and extra-abdominal infection (12.4 ± 6.9 vs 21.8 ± 6.1, P = 0.029) in the short-course group. Mortality and length of stay was similar for all groups. A short course of antibiotics in complicated intraabdominal infection with source control seems to have similar outcomes to a longer course in patients with diabetes, obesity, or increased severity of illness.

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