Biliary Tract Instrumentations Prior to Elective Cholecystectomy: Effect on Biliary Microbiome

Area of Science:

• Gastroenterology
• Microbiology
• Surgical Outcomes

Background:

• Calculus biliary disease frequently necessitates invasive procedures.
• The impact of biliary instrumentation on the biliary microbiome and subsequent surgical outcomes is not well understood.

Purpose of the Study:

• To evaluate how prior biliary instrumentation affects the biliary microbiome.
• To determine the influence of biliary instrumentation on clinical outcomes following cholecystectomy.

Main Methods:

• Retrospective study of 508 patients undergoing elective cholecystectomy for calculus biliary disease (2015-2020).
• Collected data on prior biliary instrumentation, intraoperative biliary cultures, and clinical outcomes.
• Compared outcomes between patients with and without prior biliary instrumentation.

Main Results:

• 109 patients had prior biliary instrumentation.
• Prior instrumentation correlated with older age, male sex, and higher conversion rates to open surgery.
• Increased rates of positive biliary cultures, polymicrobial growth, longer hospital stays, perioperative complications, and surgical site infections were observed in the instrumentation group.

Conclusions:

• Prior biliary instrumentation is linked to adverse clinical outcomes and alterations in the biliary microbiome.
• Findings suggest reconsidering empiric antibiotic regimens for patients with a history of biliary instrumentation.