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Article

Surgical Site Infections in Patients of Periampullary Carcinoma Undergoing Delayed Bile Duct Division (COMBILAST) in Whipple’s Procedure: A Prospective Cohort Study

by
Prakash Kumar Sasmal
*,
Kallol Kumar Das Poddar
,
Tushar Subhadarshan Mishra
and
Pankaj Kumar
Department of Surgery, AIIMS, Bhubaneswar 751019, Odisha, India
*
Author to whom correspondence should be addressed.
Pathogens 2023, 12(3), 448; https://doi.org/10.3390/pathogens12030448
Submission received: 9 February 2023 / Revised: 9 March 2023 / Accepted: 11 March 2023 / Published: 13 March 2023
(This article belongs to the Special Issue Hepatobiliary and Pancreatic Infections)

Abstract

Surgical site infections (SSIs) following a pancreaticoduodenectomy have been a significant cause of morbidity and even mortality. A modified sequence of the Whipple procedure, using the COMBILAST technique, may reduce SSIs and the patient’s hospital stay. This prospective cohort study included 42 patients undergoing Whipple’s pancreaticoduodenectomy for a periampullary malignancy. The modified sequence pancreaticoduodenectomy technique, COMBILAST, was used to estimate the incidence of SSI and explore other advantages. Of the 42 patients, seven (16.7%) developed superficial SSIs, and two patients (4.8%) had an additional deep SSI. Positive intraoperative bile culture had the strongest association with SSI (OR: 20.25, 95% CI: 2.12, 193.91). The mean operative duration was 391.28 ± 67.86 min, and the mean blood loss was 705 ± 172 mL. A total of fourteen (33.3%) patients had a Clavien–Dindo grade of III or higher. Three (7.1%) patients died of septicemia. The average length of a hospital stay was 13.00 ± 5.92 days. A modified sequence of the Whipple procedure, using the COMBILAST technique, seems promising in reducing SSIs and the patient’s hospital stay. As the approach is only a modification of the operative sequence, it does not compromise the oncological safety of the patient. Moreover, it has an added surgical advantage in reducing the chance of injury to the aberrant or accessory right hepatic artery.
Keywords: pancreaticoduodenectomy; Whipple’s procedure; surgical site infections; biliary contamination; aberrant right hepatic artery; accessory right hepatic artery; postoperative morbidity pancreaticoduodenectomy; Whipple’s procedure; surgical site infections; biliary contamination; aberrant right hepatic artery; accessory right hepatic artery; postoperative morbidity

Share and Cite

MDPI and ACS Style

Sasmal, P.K.; Das Poddar, K.K.; Mishra, T.S.; Kumar, P. Surgical Site Infections in Patients of Periampullary Carcinoma Undergoing Delayed Bile Duct Division (COMBILAST) in Whipple’s Procedure: A Prospective Cohort Study. Pathogens 2023, 12, 448. https://doi.org/10.3390/pathogens12030448

AMA Style

Sasmal PK, Das Poddar KK, Mishra TS, Kumar P. Surgical Site Infections in Patients of Periampullary Carcinoma Undergoing Delayed Bile Duct Division (COMBILAST) in Whipple’s Procedure: A Prospective Cohort Study. Pathogens. 2023; 12(3):448. https://doi.org/10.3390/pathogens12030448

Chicago/Turabian Style

Sasmal, Prakash Kumar, Kallol Kumar Das Poddar, Tushar Subhadarshan Mishra, and Pankaj Kumar. 2023. "Surgical Site Infections in Patients of Periampullary Carcinoma Undergoing Delayed Bile Duct Division (COMBILAST) in Whipple’s Procedure: A Prospective Cohort Study" Pathogens 12, no. 3: 448. https://doi.org/10.3390/pathogens12030448

APA Style

Sasmal, P. K., Das Poddar, K. K., Mishra, T. S., & Kumar, P. (2023). Surgical Site Infections in Patients of Periampullary Carcinoma Undergoing Delayed Bile Duct Division (COMBILAST) in Whipple’s Procedure: A Prospective Cohort Study. Pathogens, 12(3), 448. https://doi.org/10.3390/pathogens12030448

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