BACKGROUND: Periampullary tumours (PAT) may cause obstruction of distal choledochus. The bile stasis is a risk factor for microbial colonisation of bile (bacteriobilia), cholangitis, hepatic insufficiency and coagulopathy. PAT obstruction can be managed surgically or non-operatively - by inserting a biliary drain or stent (BDS). Although BDS allows for adequate bile drainage, liver function restitution and coagulopathy, increased bacteriobilia has been reported and this is associated with an increased incidence of postoperative complications. METHODS: A monocentric, prospective, comparative study including 100 patients operated with PAT. The effects of bacteriobilia and the presence of a drain in the biliary tract on the development of postoperative complications were evaluated. RESULTS: Positive microbial findings in bile were found in 67% of patients. It was 98% in the biliary drain group vs. 36% in non-drained patients (p = 0.0001). In 68% 2 or more different bacterial strains were simultaneously present (p = 0.0001). Patients with a positive microbial finding in bile had more frequent incidence of infectious complications 40.2% (27) vs. 9.1% (3); p = 0.0011. The most frequent infectious complication was wound infection 29.8% (20) vs. 3.03% (1); p = 0.0014. Similarly, a higher incidence of postoperative infectious complications occurred in patients with BDS - 36% (18) vs. 24% (12); p = 0.2752. CONCLUSION: The presence of a drain or stent in the biliary tract significantly increases the microbial colonisation of bile. It is associated with a significant increase in infectious complications, especially infections in the wound.
- MeSH
- Cholangitis * epidemiology etiology surgery MeSH
- Cholestasis * MeSH
- Humans MeSH
- Neoplasms * MeSH
- Postoperative Complications epidemiology etiology MeSH
- Prospective Studies MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Navzdory řadě studií je role a timing endoskopické retrográdní cholangiopankreatikografie (ERCP) v případě akutní biliární pankreatitidy (ABP) nadále předmětem diskuzí. Jasná indikace časné ERCP do 72 hodin je u pacientů s ABP v koincidenci s obstrukcí choledochu, v případě cholangitidy pak ERCP do 24 hodin. Kontroverzní je poté úloha ERCP u pacientů s ABP bez příznaků cholangitidy, resp. bez obstrukce žlučových cest konkrementem. Pokud je ERCP u ABP indikována, je její časnější provedení spojeno s nižším výskytem komplikací. Rozhodnutí o provedení ERCP se často opírá o nálezy z biochemického a transabdominálního ultrazvukového vyšetření. Výsledky těchto vyšetření mohou, ale nemusí, potvrdit přítomnost kamenů v choledochu. Účinnou a bezpečnou metodou dosahující senzitivity ERCP v diagnostice konkrementů v choledochu je endoskopická ultrasonografie (EUS) a magnetická rezonanční cholangiopankreatikografie (MRCP). Z důvodu prevence recidivy pankreatitidy a biliárních obtíží by měla být po zvládnutí ataky ABP provedena cholecystektomie.
Despite several studies, the role and timing of endoscopic retrograde cholangiopancreatography (ERCP) in the case of acute biliary pancreatitis (ABP) remains a subject of discussion.There is a clear indication of early ERCP within 72 hours in patients with ABP andcholedochal obstruction, moreover the ERCP within 24 hours in cases of cholangitis. However, the role of ERCP in patients with ABP without symptoms of cholangitis or concrements obstructing the bile duct is controversial. If ABP is indicated for the ERCP, the earlier the ERCP is performed the less complications it is associated with. The decision to perform ERCP is often based on findings from a biochemical and transabdominal ultrasound examination. The results of these examinations may, but may not, confirm the presence of stones in the choledochus. An effective and safe method approaching the sensitivity of ERCP in the diagnosis of concrements in the choledochus is endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP). The cholecystectomy should be performed to prevent a recurrence of pancreatitis and biliary problems after the successfully treatment of ABP.
- MeSH
- Early Diagnosis MeSH
- Cholangiopancreatography, Endoscopic Retrograde MeSH
- Cholangitis diagnosis surgery MeSH
- Cholecystectomy MeSH
- Choledocholithiasis MeSH
- Humans MeSH
- Biliary Tract Diseases * diagnosis surgery MeSH
- Pancreatitis * etiology surgery physiopathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Overall MeSH
- MeSH
- Cholangitis diagnostic imaging etiology surgery MeSH
- Pancreatitis, Chronic diagnostic imaging surgery complications MeSH
- Middle Aged MeSH
- Humans MeSH
- Pancreaticojejunostomy standards MeSH
- Anastomosis, Roux-en-Y * standards utilization MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
Kolektiv autorů, chirurg, gastroenterolog, radiolog a praktický lékař, se snaží zkrácenou formou předložit lékařům prvé linie základní informace o diagnostice a léčbě obstrukčního ikteru s přihlédnutím k některým novým poznatkům v této oblasti, přičemž všichni vychází ze svých dlouhodobých praktických zkušeností v této oblasti medicíny.
Ateam comprising a surgeon, gastroenterologist, radiologist and general practitioner have attempted to present basic information for front-line physicians on the diagnostics and therapy of obstructive jaundice taking into consideration certain novel pieces of knowledge in this area while all of them drew upon their vast practical experience.
- MeSH
- Biliary Tract Surgical Procedures methods MeSH
- Cholangitis surgery complications MeSH
- Choledocholithiasis complications therapy MeSH
- Diagnostic Imaging methods MeSH
- Humans MeSH
- Pancreatic Neoplasms surgery complications MeSH
- Pancreatitis surgery complications MeSH
- Jaundice diagnosis therapy MeSH
- Check Tag
- Humans MeSH
- MeSH
- Cholecystitis, Acute drug therapy surgery MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Cefoperazone therapeutic use MeSH
- Biliary Tract Surgical Procedures methods utilization MeSH
- Cholangitis drug therapy surgery MeSH
- Humans MeSH
- Biliary Tract Diseases drug therapy surgery MeSH
- Peritonitis drug therapy surgery complications MeSH
- Check Tag
- Humans MeSH
- MeSH
- Cholangitis etiology surgery ultrasonography MeSH
- Cholecystectomy MeSH
- Humans MeSH
- Postoperative Complications etiology surgery ultrasonography MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Congress MeSH
