Cholangitis in the postoperative course after biliodigestive anastomosis
Background Hepatobiliary surgery with biliodigestive anastomosis (BDA) results in a loss of the sphincter of Oddi with consecutive ascension of bacteria into the bile system which may cause cholangitis in the postoperative course. Methods Patients who received reconstruction with a BDA after hepatob...
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| Veröffentlicht in: | Langenbeck's archives of surgery 2016-08, Vol.401 (5), p.715-724 |
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| creator | Cammann, Sebastian Timrott, Kai Vonberg, Ralf-Peter Vondran, Florian W. R. Schrem, Harald Suerbaum, Sebastian Klempnauer, Jürgen Bektas, Hüseyin Kleine, Moritz |
| description | Background
Hepatobiliary surgery with biliodigestive anastomosis (BDA) results in a loss of the sphincter of Oddi with consecutive ascension of bacteria into the bile system which may cause cholangitis in the postoperative course.
Methods
Patients who received reconstruction with a BDA after hepatobiliary surgery were analyzed retrospectively for their postoperative course of disease depending on intraoperatively obtained bile cultures and antibiotic prophylaxis.
Results
Two hundred forty-three patients were included in the analysis, 49.4 % of whom had received endoscopic stenting before the operation. Stenting was significantly associated with the presence of drug-resistant bacteria in the intraoperatively obtained bile sample (
p
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| doi_str_mv | 10.1007/s00423-016-1450-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1803452725</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1803452725</sourcerecordid><originalsourceid>FETCH-LOGICAL-c410t-f966c42b18779f26c320168ac04872c9a17c6d6d24e694d14ae24352633350fc3</originalsourceid><addsrcrecordid>eNp9kM1OwzAQhC0EoqXwAFxQjlwC6584zRFVQJEqcYGz5TpO6yqJgzdBgqfHJaVHTrvSfjuaGUKuKdxRgPweAQTjKVCZUpFB-n1CplTwLGUio6fHXfAJuUDcAYDMC3FOJixnXLICpmS52PpatxvXO0xcm_Rbm3Qee9_ZoHv3aRPjh4A20VVvQ7J2tfOl21j8velWR7Tx6PCSnFW6Rnt1mDPy_vT4tlimq9fnl8XDKjWCQp9WhZRGsDWd53lRMWk4i_bn2oCY58wUmuZGlrJkwspClFRoy2IKJjnnGVSGz8jtqNsF_zFEH6pxaGwdQ1g_oKJz4CKLAbOI0hE1wSMGW6kuuEaHL0VB7QtUY4EqOlD7AtV3_Lk5yA_rxpbHj7_GIsBGAOOp3digdrGgNkb-R_UH4TJ7fw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1803452725</pqid></control><display><type>article</type><title>Cholangitis in the postoperative course after biliodigestive anastomosis</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Cammann, Sebastian ; Timrott, Kai ; Vonberg, Ralf-Peter ; Vondran, Florian W. R. ; Schrem, Harald ; Suerbaum, Sebastian ; Klempnauer, Jürgen ; Bektas, Hüseyin ; Kleine, Moritz</creator><creatorcontrib>Cammann, Sebastian ; Timrott, Kai ; Vonberg, Ralf-Peter ; Vondran, Florian W. R. ; Schrem, Harald ; Suerbaum, Sebastian ; Klempnauer, Jürgen ; Bektas, Hüseyin ; Kleine, Moritz</creatorcontrib><description>Background
Hepatobiliary surgery with biliodigestive anastomosis (BDA) results in a loss of the sphincter of Oddi with consecutive ascension of bacteria into the bile system which may cause cholangitis in the postoperative course.
Methods
Patients who received reconstruction with a BDA after hepatobiliary surgery were analyzed retrospectively for their postoperative course of disease depending on intraoperatively obtained bile cultures and antibiotic prophylaxis.
Results
Two hundred forty-three patients were included in the analysis, 49.4 % of whom had received endoscopic stenting before the operation. Stenting was significantly associated with the presence of drug-resistant bacteria in the intraoperatively obtained bile sample (
p
< 0.001, OR = 4.09). Of all patients, 14.4 % developed postoperative cholangitis. This was significantly associated with the postoperative length of stay in the intensive care unit (
p
= 0.002, OR = 1.035). The highest incidence of postoperative cholangitis was found in patients with cholangiocellular carcinoma (
n
= 12,
p
= 0.046, OR = 2.178). Patients were more likely to harbor strains with resistance against the antibiotic that was given intraoperatively.
Conclusion
The risk for the presence of drug-resistant bacteria is increased by preoperative stenting of the common bile duct. Bile culture by intraoperative swabs can be altered by the perioperative antibiotic prophylaxis as it induces microbiological selection in the common bile duct.</description><identifier>ISSN: 1435-2443</identifier><identifier>EISSN: 1435-2451</identifier><identifier>DOI: 10.1007/s00423-016-1450-z</identifier><identifier>PMID: 27236290</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdominal Surgery ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical - adverse effects ; Antibiotic Prophylaxis ; Bile ; Bile Duct Neoplasms - surgery ; Cardiac Surgery ; Cholangitis - etiology ; Cholangitis - prevention & control ; Drug Resistance, Bacterial ; Female ; General Surgery ; Humans ; Length of Stay ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Pancreatic Neoplasms - surgery ; Postoperative Complications - etiology ; Postoperative Complications - microbiology ; Postoperative Complications - prevention & control ; Retrospective Studies ; Stents - adverse effects ; Thoracic Surgery ; Traumatic Surgery ; Vascular Surgery ; Young Adult</subject><ispartof>Langenbeck's archives of surgery, 2016-08, Vol.401 (5), p.715-724</ispartof><rights>Springer-Verlag Berlin Heidelberg 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c410t-f966c42b18779f26c320168ac04872c9a17c6d6d24e694d14ae24352633350fc3</citedby><cites>FETCH-LOGICAL-c410t-f966c42b18779f26c320168ac04872c9a17c6d6d24e694d14ae24352633350fc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00423-016-1450-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00423-016-1450-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27236290$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cammann, Sebastian</creatorcontrib><creatorcontrib>Timrott, Kai</creatorcontrib><creatorcontrib>Vonberg, Ralf-Peter</creatorcontrib><creatorcontrib>Vondran, Florian W. R.</creatorcontrib><creatorcontrib>Schrem, Harald</creatorcontrib><creatorcontrib>Suerbaum, Sebastian</creatorcontrib><creatorcontrib>Klempnauer, Jürgen</creatorcontrib><creatorcontrib>Bektas, Hüseyin</creatorcontrib><creatorcontrib>Kleine, Moritz</creatorcontrib><title>Cholangitis in the postoperative course after biliodigestive anastomosis</title><title>Langenbeck's archives of surgery</title><addtitle>Langenbecks Arch Surg</addtitle><addtitle>Langenbecks Arch Surg</addtitle><description>Background
Hepatobiliary surgery with biliodigestive anastomosis (BDA) results in a loss of the sphincter of Oddi with consecutive ascension of bacteria into the bile system which may cause cholangitis in the postoperative course.
Methods
Patients who received reconstruction with a BDA after hepatobiliary surgery were analyzed retrospectively for their postoperative course of disease depending on intraoperatively obtained bile cultures and antibiotic prophylaxis.
Results
Two hundred forty-three patients were included in the analysis, 49.4 % of whom had received endoscopic stenting before the operation. Stenting was significantly associated with the presence of drug-resistant bacteria in the intraoperatively obtained bile sample (
p
< 0.001, OR = 4.09). Of all patients, 14.4 % developed postoperative cholangitis. This was significantly associated with the postoperative length of stay in the intensive care unit (
p
= 0.002, OR = 1.035). The highest incidence of postoperative cholangitis was found in patients with cholangiocellular carcinoma (
n
= 12,
p
= 0.046, OR = 2.178). Patients were more likely to harbor strains with resistance against the antibiotic that was given intraoperatively.
Conclusion
The risk for the presence of drug-resistant bacteria is increased by preoperative stenting of the common bile duct. Bile culture by intraoperative swabs can be altered by the perioperative antibiotic prophylaxis as it induces microbiological selection in the common bile duct.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anastomosis, Surgical - adverse effects</subject><subject>Antibiotic Prophylaxis</subject><subject>Bile</subject><subject>Bile Duct Neoplasms - surgery</subject><subject>Cardiac Surgery</subject><subject>Cholangitis - etiology</subject><subject>Cholangitis - prevention & control</subject><subject>Drug Resistance, Bacterial</subject><subject>Female</subject><subject>General Surgery</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - microbiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Retrospective Studies</subject><subject>Stents - adverse effects</subject><subject>Thoracic Surgery</subject><subject>Traumatic Surgery</subject><subject>Vascular Surgery</subject><subject>Young Adult</subject><issn>1435-2443</issn><issn>1435-2451</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1OwzAQhC0EoqXwAFxQjlwC6584zRFVQJEqcYGz5TpO6yqJgzdBgqfHJaVHTrvSfjuaGUKuKdxRgPweAQTjKVCZUpFB-n1CplTwLGUio6fHXfAJuUDcAYDMC3FOJixnXLICpmS52PpatxvXO0xcm_Rbm3Qee9_ZoHv3aRPjh4A20VVvQ7J2tfOl21j8velWR7Tx6PCSnFW6Rnt1mDPy_vT4tlimq9fnl8XDKjWCQp9WhZRGsDWd53lRMWk4i_bn2oCY58wUmuZGlrJkwspClFRoy2IKJjnnGVSGz8jtqNsF_zFEH6pxaGwdQ1g_oKJz4CKLAbOI0hE1wSMGW6kuuEaHL0VB7QtUY4EqOlD7AtV3_Lk5yA_rxpbHj7_GIsBGAOOp3digdrGgNkb-R_UH4TJ7fw</recordid><startdate>20160801</startdate><enddate>20160801</enddate><creator>Cammann, Sebastian</creator><creator>Timrott, Kai</creator><creator>Vonberg, Ralf-Peter</creator><creator>Vondran, Florian W. R.</creator><creator>Schrem, Harald</creator><creator>Suerbaum, Sebastian</creator><creator>Klempnauer, Jürgen</creator><creator>Bektas, Hüseyin</creator><creator>Kleine, Moritz</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160801</creationdate><title>Cholangitis in the postoperative course after biliodigestive anastomosis</title><author>Cammann, Sebastian ; Timrott, Kai ; Vonberg, Ralf-Peter ; Vondran, Florian W. R. ; Schrem, Harald ; Suerbaum, Sebastian ; Klempnauer, Jürgen ; Bektas, Hüseyin ; Kleine, Moritz</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c410t-f966c42b18779f26c320168ac04872c9a17c6d6d24e694d14ae24352633350fc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anastomosis, Surgical - adverse effects</topic><topic>Antibiotic Prophylaxis</topic><topic>Bile</topic><topic>Bile Duct Neoplasms - surgery</topic><topic>Cardiac Surgery</topic><topic>Cholangitis - etiology</topic><topic>Cholangitis - prevention & control</topic><topic>Drug Resistance, Bacterial</topic><topic>Female</topic><topic>General Surgery</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - microbiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Retrospective Studies</topic><topic>Stents - adverse effects</topic><topic>Thoracic Surgery</topic><topic>Traumatic Surgery</topic><topic>Vascular Surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cammann, Sebastian</creatorcontrib><creatorcontrib>Timrott, Kai</creatorcontrib><creatorcontrib>Vonberg, Ralf-Peter</creatorcontrib><creatorcontrib>Vondran, Florian W. R.</creatorcontrib><creatorcontrib>Schrem, Harald</creatorcontrib><creatorcontrib>Suerbaum, Sebastian</creatorcontrib><creatorcontrib>Klempnauer, Jürgen</creatorcontrib><creatorcontrib>Bektas, Hüseyin</creatorcontrib><creatorcontrib>Kleine, Moritz</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Langenbeck's archives of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cammann, Sebastian</au><au>Timrott, Kai</au><au>Vonberg, Ralf-Peter</au><au>Vondran, Florian W. R.</au><au>Schrem, Harald</au><au>Suerbaum, Sebastian</au><au>Klempnauer, Jürgen</au><au>Bektas, Hüseyin</au><au>Kleine, Moritz</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cholangitis in the postoperative course after biliodigestive anastomosis</atitle><jtitle>Langenbeck's archives of surgery</jtitle><stitle>Langenbecks Arch Surg</stitle><addtitle>Langenbecks Arch Surg</addtitle><date>2016-08-01</date><risdate>2016</risdate><volume>401</volume><issue>5</issue><spage>715</spage><epage>724</epage><pages>715-724</pages><issn>1435-2443</issn><eissn>1435-2451</eissn><abstract>Background
Hepatobiliary surgery with biliodigestive anastomosis (BDA) results in a loss of the sphincter of Oddi with consecutive ascension of bacteria into the bile system which may cause cholangitis in the postoperative course.
Methods
Patients who received reconstruction with a BDA after hepatobiliary surgery were analyzed retrospectively for their postoperative course of disease depending on intraoperatively obtained bile cultures and antibiotic prophylaxis.
Results
Two hundred forty-three patients were included in the analysis, 49.4 % of whom had received endoscopic stenting before the operation. Stenting was significantly associated with the presence of drug-resistant bacteria in the intraoperatively obtained bile sample (
p
< 0.001, OR = 4.09). Of all patients, 14.4 % developed postoperative cholangitis. This was significantly associated with the postoperative length of stay in the intensive care unit (
p
= 0.002, OR = 1.035). The highest incidence of postoperative cholangitis was found in patients with cholangiocellular carcinoma (
n
= 12,
p
= 0.046, OR = 2.178). Patients were more likely to harbor strains with resistance against the antibiotic that was given intraoperatively.
Conclusion
The risk for the presence of drug-resistant bacteria is increased by preoperative stenting of the common bile duct. Bile culture by intraoperative swabs can be altered by the perioperative antibiotic prophylaxis as it induces microbiological selection in the common bile duct.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>27236290</pmid><doi>10.1007/s00423-016-1450-z</doi><tpages>10</tpages></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Abdominal Surgery Adult Aged Aged, 80 and over Anastomosis, Surgical - adverse effects Antibiotic Prophylaxis Bile Bile Duct Neoplasms - surgery Cardiac Surgery Cholangitis - etiology Cholangitis - prevention & control Drug Resistance, Bacterial Female General Surgery Humans Length of Stay Male Medicine Medicine & Public Health Middle Aged Original Article Pancreatic Neoplasms - surgery Postoperative Complications - etiology Postoperative Complications - microbiology Postoperative Complications - prevention & control Retrospective Studies Stents - adverse effects Thoracic Surgery Traumatic Surgery Vascular Surgery Young Adult |
| title | Cholangitis in the postoperative course after biliodigestive anastomosis |
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