Specific Bile Microorganisms Caused by Intra-Abdominal Abscess on Pancreaticoduodenectomy Patients: A Retrospective Cohort Study

We retrospectively collected PD patients with a performance of bile culture between 2007 and 2019 in our institute. As to bile culture, we used a swab to do intraoperative bile cultures after transection of the CBD. IAA was defined as the documental bacteriological culture from either a turbid discharge from the intraoperatively placed drain in patients with a clinical picture consistent with infection or a postoperative fluid collection managed by CT-guided placement of drains. A total of 1244 PD patients were identified, and 539 (43.3%) subjects with bile sampling were included for analysis. Among these study patients, 433 (80.3%) developed bile contamination (positive bile culture). Bile contamination showed a significantly higher rate of IAA compared to non-bile contamination (17.1% vs. 0.9%, p < 0.001). The rate of co-shared microorganisms in both bile and abscess was 64.1%. On the multivariate analysis, age and specific bile microorganisms (Enterococcus species, Escherichia Coli, Streptococcus species, Citrobacter species, and Candida) are significantly associated with development of IAA. Specific bile microorganisms are the highly significant factors associated with development of IAA. The strategy to prevent bile spillage during PD should be considered to minimize afterward contamination of the abdominal cavity and prevent IAA.

EP.WE.739Antibiotics Prescriptions in Elective Laparoscopic Cholecystectomy

Aim To assess our compliance to the trust and national guidelines for antibiotic usage and prescription in elective laparoscopic cholecystectomy and to assess whether prophylactic antibiotics are prescribed appropriately and identify areas of improvement. Method Medical records for patients who underwent laparoscopic cholecystectomy over 3 months were collected (May – July 2019). Urgent laparoscopic cholecystectomies were excluded, and medical records were reviewed retrospectively for operative note details, patient risk factors, antibiotic prescribed, concomitant procedure, and complications. Results Appropriate antibiotic prescription represented 50% (Patient had at least one risk factor and prescribed antibiotic or no risk factors and wasn't prescribed antibiotics) and inappropriate prescription 50% (Patient had no risk factors and prescribed antibiotic or had risk factors and wasn't prescribed antibiotics). In the group with risk factors and wasn't prescribed antibiotics, Age was a risk factor in 17 patients, BMI in 25, Bile spillage in 10, and Diabetes in 3. Conclusion We are not compliant with the current guidelines for antibiotic prophylaxis in elective laparoscopic cholecystectomy, some patient with no risk factors received antibiotics while other with risk factors did not. We plan to disseminate this information in the governance meeting and print guidelines posters in theatres and then re-audit in 3 months’ time to assess progress.

Comparison of Frequency of Surgical Site Infection with or without Bile Spillage during Laparoscopic Cholecystectomy

Aim: To compare the frequency of surgical site infection with or without bile spillage during Laparoscopic Cholecystectomy. Methods: This randomized controlled trial was conducted at Department of Surgery, M. Islam Medical and Dental College Gujranwala from March 2020 to September 2020 over the period of 6 months. Total 68 pppatients of acute cholecystitis (as per operational definition) undergoing laparoscopic cholecystectomy either male or female having age from 20 60 years with duration of gal stone (single or multiple) ≥ 6 months were selected. After 2 weeks follow-up, surgical site infection was assed. Results: Mean age of the patients was 39.90 ± 12.04, mean age of patients of study group A was and B was 38.88 ± 13.01 and 40.91 ± 11.08 years respectively. Comparison of frequency of surgical site infection was done between both groups. In study group A (spillage group), SSI was found in 12 (35.29%) patients while in study group B (without spillage group), SSI was noted in 4 (11.76%) patients. Difference of frequency of SSI between the study group A and B was statistically significant (P = 0.022). Conclusion: Results of present study showed that surgical site infection is mostly occurred in patients with spillage of bile during Laparoscopic Cholecystectomy. Most of the patients were belonged to 3rd and 4th decade of life. Significantly higher rate of surgical site infection was noted in female patients of spillage of bile group. Keywords: Bile spillage, Laparoscopic Cholecystectomy, gall bladder, surgical site infection

Prevalence of surgical site infection in patient with bile spillage during laparoscopic cholecystectomy

Introduction: Iatrogenic gallbladder perforation with bile spillage (BS) during laparoscopic cholecystectomy (LC) occurs frequently but its impact to the patient can range from port site surgical site infection (SSI), bowel obstruction, intraperitoneal abscess to none. We aim to examine the prevalence of port site SSI in patients with bile spillage during laparoscopic cholecystectomy. Methods: A prospective descriptive cross-sectional study was undertaken which included consecutive patients who underwent LC over a period of six months and had intraoperative bile spillage. Patients were noted and evaluated for the presence of port site SSI. Patients were assessed clinically during hospitalization and on follow-up at five and even days post operatively. Bile spillage (BS) as a possible risk factor for port site surgical site infection (SSI) was analyzed. Results: Out of 318 patients, there were 229 (72%) female and 89(28%) male patients with a mean age of 46 ± 11.7 years. BS occurred in 66 (20.8%) patients. Port site SSI was present in 14 (4.4%) patients. SSI among patients with bile spillage was present in 8 (12.1%) and among patients without BS was 6 (2.3%). Conclusion: The present study reveals that iatrogenic gallbladder perforation with BS has higher prevalence of port site SSI.

Bile spillage and bacterobilia as risk factors for surgical site infection after laparoscopic cholecystectomy: a prospective study at tertiary care hospital

Background: Surgical site infection (SSIs), a significant postoperative complication, can lead to considerable patient’s morbidity and mortality.Methods: The study was conducted in the Department of Surgery, J.L.N. Medical College and Hospitals, Ajmer from January 2017 to September 2018. The study population constituted cases of cholelithiasis diagnosed by ultrasonography that underwent laparoscopic cholecystectomy and fulfilling the inclusion and exclusion criteria. Surgical site infection was graded according to Southampton grading system.Results: The overall frequency of SSI infection in laparoscopic cholecystectomy was 6%. The occurrence of surgical site infection in patients with bacterobilia was 14.28% which was found to be statistically significant. The SSIs in patients with gall bladder content spillage was found to be statistically insignificant.Conclusions: The frequency of SSI was more in patients with bacterobilia. The gallbladder content spillage does not lead to an increased occurrence of SSI.