Effect of preoperative endoscopic biliary drainage and stenting on postoperative infection and the outcome of surgery for benign obstructive jaundice

The effect of preoperative endoscopic biliary drainage on the outcome of surgery for patients presenting with obstructive jaundice [OJ] has been studied; increase the risk of morbidity, and mortality. This work aim to studying the bile samples from those patients before and after endoscopic retrograde cholangiopancreatography [ERCP] with biliary stenting and its possible association with postoperative septic complications. The study involved 79 patients with surgically corrected benign obstructive jaundice at Thodor Bilharze Research Institute. Preoperative [ERCP] was done for all of the patients and stent insertion was made in 60 of them. Bile specimens were obtained during endoscopic cholangiography by flushing technique and intra-operatively by puncture before incising the common bile duct. Bile samples were analyzed for their bacterial spectrum and sensitivity to antibiotics. Concomitant postoperative septic complications such as wound infection and cholangitis were also assessed. Bile culture of intra-operatively obtained specimens was positive in 39/60 [65.0%] of the patients in Group II [ERGP+ biliary stent], a significantly higher incidence than that observed in group I [ERCP only], in which 7/19 [36.8%] of the patients presented positive cultures [p=0.001]. There was no significant difference in general postoperative morbidity between groups. When infective complications [cholangitis, pneumonia, wound infection] were analyzed separately, a higher incidence, although without significance was found in Group II than in Group I. Preoperative biliary drainage using the endoscopic retrograde cholangiopancreatography [ERCP] and stent insertion in patients subjected to surgery for benign obstructive jaundice could provoke biliary bacterial colonization with a possible appearance of infective complications during the postoperative period