Background: The routine use of preoperative biliary drainage before pancreaticoduodenectomy (PD) remains\ncontroversial. This observational retrospective study compared stented and non-stented patients undergoing PD to\nassess any differences in post-operative morbidity and mortality.\nMethods: A total of 180 consecutive patients who underwent PD and had intra-operative bile cultures performed\nbetween January 2010 and February 2013 were retrospectively identified. All patients received peri-operative\nintravenous antibiotic prophylaxis, primarily cefazolin.\nResults: Overall incidence of post-operative surgical complications was 52.3 %, with no difference between stented\nand non-stented patients (53.4 % vs. 51.1 %; p = 0.875). However, stented patients had a significantly higher\nincidence of deep incisional surgical site infections (SSIs) (p = 0.038). In multivariate analysis, biliary stenting was\nconfirmed as a risk factor for deep incisional SSIs (p = 0.044). Significant associations were also observed for cardiac\ndisease (p = 0.010) and BMI �25 kg/m2 (p = 0.045). Enterococcus spp. were the most frequent bacterial isolates in bile\n(74.5 %) and in drain fluid (69.1 %). In antimicrobial susceptibilty testing, all Enterococci isolates were cefazolin-resistant.\nConclusion: Given the increased risk of deep incisional SSIs, preoperative biliary stenting in patients underging PD\nshould be used only in selected patients. In stented patients, an antibiotic with anti-enterococcal activity should be\nchosen for PD prophylaxis.
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