Detailed Abstract
[BP Oral Presentation 1]
[BP OP 1-1] Clinical meaning of the existence of microbiome in gallbladder after laparoscopic cholecystectomy: Incidence and related factors
Dokyoon MOON1, Jae Seung KANG1, Yoonhyeong BYUN1, Yoo Jin CHOI1, Hae Won LEE2, Chang-Sup LIM*3, Jinyoung JANG1
1Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea, Korea
2Department of Surgery, Seoul National University Bundang Hospital, Seoul, Korea, Korea
3Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea, Korea
Introduction : In general, bile is sterile in normal status. However, there have been reports that bactibilia may exist at certain instances and its causal factors have not fully elucidated yet. To investigate the factors affecting bactiblia, we analyzed possible preoperative predictors and microflora in bile.
Methods : Bile samples were collected for culture during cholecystectomies from November 2018 to November. A total of 463 laparoscopic cholecystectomies were performed. Preoperative, intraoperative, and postoperative variables were compared between culture-positive and culture-negative groups.
Results : Of all patients, 157 (36.7%) of patients were culture-positive. Gram-negative bacteria (92, 58.6%) were more common, and Escherichia coli (43, 46.7%) and Klebsiella (20, 21.7%) were common species. The culture-positive group was older (53.9±16.2 vs. 68.4±12.3, p<0.001), more symptomatic (66.8% vs. 79.6%, p<0.001), underwent more preoperative procedures including endoscopic retrograde cholangiopancreatography (18 vs. 54, p<0.001), percutaneous transhepatic gallbladder drainage (24 vs. 41, p<0.001), and had more cases of emergency hospitalization (32.8% vs. 63.1%, p<0.001) than culture-negative group. In multivariate analysis, age (HR 2.874, 95% CI 1.769-4.670, p<0.001), abdominal pain (HR 1.730, 95% CI 1.026 – 2.919, p=0.002), ERCP (HR: 9.00, 95% CI 4.833 – 16.75, p<0.001), and PTGBD (HR: 2.86, 95% CI 1.440 – 4.901, p=0.002) were independent factors related with bactibila.
Conclusions : Among the patients who underwent laparoscopic cholecystectomy, the elderly, symptomatic, and preoperative drainage patients were more likely to have bacteria in the bile. In such cases, surgeon should be careful to prevent bile leakage during surgery, and consider administration of antibiotics that could cover gram-negative bacteria.
Methods : Bile samples were collected for culture during cholecystectomies from November 2018 to November. A total of 463 laparoscopic cholecystectomies were performed. Preoperative, intraoperative, and postoperative variables were compared between culture-positive and culture-negative groups.
Results : Of all patients, 157 (36.7%) of patients were culture-positive. Gram-negative bacteria (92, 58.6%) were more common, and Escherichia coli (43, 46.7%) and Klebsiella (20, 21.7%) were common species. The culture-positive group was older (53.9±16.2 vs. 68.4±12.3, p<0.001), more symptomatic (66.8% vs. 79.6%, p<0.001), underwent more preoperative procedures including endoscopic retrograde cholangiopancreatography (18 vs. 54, p<0.001), percutaneous transhepatic gallbladder drainage (24 vs. 41, p<0.001), and had more cases of emergency hospitalization (32.8% vs. 63.1%, p<0.001) than culture-negative group. In multivariate analysis, age (HR 2.874, 95% CI 1.769-4.670, p<0.001), abdominal pain (HR 1.730, 95% CI 1.026 – 2.919, p=0.002), ERCP (HR: 9.00, 95% CI 4.833 – 16.75, p<0.001), and PTGBD (HR: 2.86, 95% CI 1.440 – 4.901, p=0.002) were independent factors related with bactibila.
Conclusions : Among the patients who underwent laparoscopic cholecystectomy, the elderly, symptomatic, and preoperative drainage patients were more likely to have bacteria in the bile. In such cases, surgeon should be careful to prevent bile leakage during surgery, and consider administration of antibiotics that could cover gram-negative bacteria.
SESSION
BP Oral Presentation 1
Room B 3/25/2021 11:40 AM - 11:47 AM