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Published on: May 2, 2025
Surgical Site Infections in Patients of Periampullary Carcinoma Undergoing Delayed Bile Duct Division (COMBILAST) in
Prakash Kumar Sasmal1, Kallol Kumar Das Poddar1, Tushar Subhadarshan Mishra1
1Department of Surgery, AIIMS, Bhubaneswar 751019, Odisha, India.
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.
Insights
A modified Whipple procedure using the COMBILAST technique shows promise in reducing surgical site infections (SSIs) and hospital stays for pancreaticoduodenectomy patients. This approach may also offer surgical advantages without compromising oncological outcomes.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Infectious Disease Prevention
Background:
- Surgical site infections (SSIs) are a major complication following pancreaticoduodenectomy, increasing patient morbidity and mortality.
- The Whipple procedure, a complex operation for periampullary malignancies, carries a significant risk of SSIs.
Purpose of the Study:
- To evaluate the incidence of SSIs in patients undergoing a modified pancreaticoduodenectomy sequence using the COMBILAST technique.
- To explore other potential benefits, such as reduced hospital stay and surgical advantages.
Main Methods:
- A prospective cohort study involving 42 patients undergoing pancreaticoduodenectomy for periampullary malignancy.
- Implementation of the modified COMBILAST technique, focusing on operative sequence.
- Analysis of SSI incidence, operative duration, blood loss, complication severity (Clavien-Dindo grade), mortality, and length of hospital stay.
Main Results:
- The incidence of superficial SSIs was 16.7%, with an additional 4.8% experiencing deep SSIs.
- Positive intraoperative bile culture was strongly associated with SSI (OR: 20.25).
- The average hospital stay was 13.00 days, with 33.3% of patients experiencing Clavien-Dindo grade III or higher complications and 7.1% mortality from septicemia.
Conclusions:
- The modified Whipple procedure with the COMBILAST technique appears promising for reducing SSIs and hospital stay after pancreaticoduodenectomy.
- This modified sequence offers potential surgical advantages, including reduced risk of injury to the right hepatic artery, without compromising oncological safety.
