Antibiotic irrigation during pancreatoduodenectomy to prevent infection and pancreatic fistula: A randomized controlled clinical trial
| Autor: | Lava Timsina, Daniel J. Weber, C. Max Schmidt, Thomas K. Maatman, Leonidas G. Koniaris, Michael G. House, Attila Nakeeb, Nicholas J. Zyromski, Beenish Qureshi, Eugene P. Ceppa |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Fistula 030230 surgery Anastomosis Biliary Stenting Risk Assessment Pancreaticoduodenectomy Pancreatic Fistula 03 medical and health sciences 0302 clinical medicine Double-Blind Method Reference Values Humans Surgical Wound Infection Medicine Peritoneal Lavage Saline Survival rate Chi-Square Distribution Intraoperative Care business.industry Bile duct Length of Stay Middle Aged Prognosis medicine.disease Anti-Bacterial Agents Surgery Survival Rate Treatment Outcome medicine.anatomical_structure Pancreatic fistula 030220 oncology & carcinogenesis Female business Pancreas |
| Zdroj: | Surgery. 166:469-475 |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2019.05.053 |
| Popis: | Background Surgical site infection affects 25% of patients undergoing pancreatoduodenectomy. This double-blind, randomized controlled trial tested the efficacy of intraperitoneal antibiotic irrigation in decreasing infection and pancreatic fistula after pancreatoduodenectomy. Methods Patients undergoing pancreatoduodenectomy were randomized (1:1 ratio) to intraperitoneal antibiotic (polymyxin B, 500,000 units/L) irrigation or 0.9% NaCl irrigation. All patients received 1 dose of standard parenteral antibiotics within 1 hour of incision. The trial was powered to detect a 15% difference in any surgical site infection (primary endpoint) within 30 days after pancreatoduodenectomy. Results One hundred ninety patients undergoing pancreatoduodenectomy were randomized: 95 to antibiotic irrigation and 95 to saline irrigation. Groups were well matched regarding demographics, diagnosis, preoperative biliary stenting, bactibilia, texture of the pancreatic parenchyma, pancreatic and bile duct size, portal vein resection, and anastomotic technique. Overall, 30-day surgical site infection was observed in 24 (13%) patients: antibiotic irrigation in 10 (11%) versus saline in 14 (15%) (P = .62). Superficial (n = 9, 5%) and organ-space (n = 15, 8%) surgical site infection rates were 3% and 7% (antibiotic) and 6% and 8% (saline), respectively (P > .31). Clinically relevant postoperative pancreatic fistula occurred in 11 (12%) patients in the antibiotic arm and 10 (11%) in saline controls (P > .95). Conclusion The addition of antibiotic solution to intraperitoneal irrigation does not decrease the incidence of postoperative infectious complications or pancreatic fistula after pancreatoduodenectomy. |
| Databáze: | OpenAIRE |
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