A meta-analysis and systematic review of intraoperative bile cultures association with postoperative complications in pancreaticoduodenectomy

Surgery. 2023 May;173(5):1231-1239. doi: 10.1016/j.surg.2022.12.012. Epub 2023 Jan 25.


Background: The aim of this meta-analysis and systematic review was to evaluate the association between intraoperative bile cultures and postoperative complications of patients undergoing pancreaticoduodenectomy.

Methods: A detailed literature search was performed from January 2015 to July 2022 in PubMed, Web of Science, Google Scholar, and EMBASE for related research publications. The data were extracted, screened, and graded independently. An analysis of pooled data was performed, and a risk ratio with corresponding confidence intervals was calculated and summarized.

Results: A total of 8 articles were included with 1,778 pancreaticoduodenectomy patients who had an intraoperative bile culture performed. A systematic review demonstrated that some of the most common organisms isolated in a positive intraoperative bile culture were Enterococcus species, Klebsiella species, and E. coli. Four studies also showed that specific microorganisms were associated with specific postoperative complications (surgical site infection and intra-abdominal abscess). The postoperative complications that were evaluated for an association with a positive intraoperative bile culture were surgical site infections (risk ratio = 2.33, 95% confidence interval [1.47-3.69], P < .01), delayed gastric emptying (risk ratio = 1.23, 95% confidence interval [0.63-2.38], P = n.s.), 90-day mortality (risk ratio = 0.68, 95% confidence interval [0.01-52.76], P = n.s.), postoperative pancreatic hemorrhage (risk ratio = 1.70, 95% confidence interval [0.33-8.74], P = n.s.), intra-abdominal abscess (risk ratio = 1.70, 95% confidence interval [0.38-7.56], P = n.s.), and postoperative pancreatic fistula (risk ratio = 0.97, 95% confidence interval [0.72-1.32], P = n.s.).

Conclusion: The cumulative data suggest that a positive intraoperative bile culture has no association with predicting the postoperative complications of delayed gastric emptying, 90-day mortality, postoperative pancreatic hemorrhage, intra-abdominal abscess, or postoperative pancreatic fistula. However, the data also suggest that a positive intraoperative bile culture was associated with a patient developing a surgical site infection.

Publication types

  • Systematic Review
  • Meta-Analysis
  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Abdominal Abscess* / epidemiology
  • Abdominal Abscess* / etiology
  • Bile
  • Escherichia coli
  • Gastroparesis* / etiology
  • Humans
  • Pancreatic Diseases* / complications
  • Pancreatic Fistula / etiology
  • Pancreaticoduodenectomy / adverse effects
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Hemorrhage / etiology
  • Surgical Wound Infection / etiology