Surgical Management of Sectoral Bile Duct Injury after Cholecystectomy - A Case Series

Abstract

between the results of culture and postoperative outcomes in bile duct resection operation. Methods: The data was prospectively collected from 235 patients who underwent bile duct resection at Samsung Medical Center for one year from October 2018 to September 2019. The diseases included in the data are periampullary cancer, gallbladder cancer, hilar cholangiocarcionoma, and intrahepatic cholangiocarcinoma. Intraoperative bile smear test was performed in operation, and the included operation was pancreaticoduodenectomy and liver resection surgery with bile duct resection. Specimens were obtained from culture swab of bile drained during bile duct resection. Results: Of the 235 patients, microorganism was isolated in 141 patients (60%). The predominant microorganisms grown from the intraoperative bile cultures were Enterococcus faecalis (38 cultures, 27.0%), Enterococcus faecium (32 cultures, 22.7%), Klebsiella pneumoniae and Enterobacter cloacae (28 cultures, 19.9%). In postoperative complication, the positive results of intraoperative bile cultures was related with Clavien-Dindo ClassificationIII (OR3.117, 95%CI:1.498-6.485, p=0.002). Also, it was a risk factors for occurrence of surgical site infection (OR3.266, 95%CI:1.237-8.621, p=0.013) and intraabdominal abscess (OR1.145, 95%CI:1.057-1.240, p=0.003). In addition, the incidence of postoperative pancreatic fistula was increased in patients with microorganisms grown in bile (OR1.974, 95%CI:1.098-3.549, p=0.022). Conclusions: Smear positivity of intraoperative bile fluid is associated with occurrence of major complication. It was risk factor for surgical site infection and intra-abdominal abscess.