Negative short-term impact of intraoperative biliary lavage in patients with hepatolithiasis

Table 1 Preoperative variables of patients in the control and lavage groups n (%)

	Control group(n = 254)	Lavage group(n = 678)	P value
Age (yr)	55.96 ± 13.48	50.81 ± 10.91	0.223
Gender (M:F)	81:173	180:498	0.119
Pulmonary disease	45 (17.7)	154 (22.7)	0.106
Hypertension	25 (9.8)	63 (9.3)	0.803
Diabetes mellitus	11 (4.3)	27 (3.9)	0.853
Past history of biliary tract surgery	119 (46.9)	287 (42.3)	0.235
Past history of cholangioenterostomy	11 (4.3)	15 (2.2)	0.115
Past history of liver resection	23 (9.1)	72 (10.6)	0.713
Stone location			0.892
Right	159 (62.5)	395 (58.3)
Left	215 (84.6)	577 (85.1)
Extra	158 (62.2)	406 (59.8)
Total bilirubin	15.8 ± 10.42	18.3 ± 24.33	0.110
ALB (g/L)	40.31 ± 3.45	39.45 ± 6.92	0.197
WBC (× 109/L)	5.61 ± 2.02	6.05 ± 4.7	0.462
AST (U/L)	39.6 ± 45.12	53.51 ± 61.38	0.155
ALT (U/L)	38.76 ± 54.37	64.61 ± 76.79	0.306

Data for age and levels of total bilirubin, ALB, WBC, AST, and ALT are presented as the mean ± SD. ALB: Albumin; WBC: White blood cells; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase.

Table 2 Intraoperative variables of patients in the control and lavage groups n (%)

	Control group(n = 254)	Lavage group(n = 678)	P value
Operation time (min)	124.2 ± 48.1	100.1 ± 51.9	0.036
Surgical approach			0.128
Open	233 (91.4)	641 (94.5)
Laparoscopy	21 (8.6)	37 (5.5)
Blood loss (mL)	235.3 ± 358.2	241.6 ± 256.9	0.918
Combined liver resection	137 (53.9)	355 (52.4)	0.713
Cirrhosis	71 (27.9)	229 (33.8)	0.098
Liver atrophy	97 (38.2)	282 (41.6)	0.369
Biliary stricture	23 (9.1)	92 (13.6)	0.113
Biliary distal dilatation	118 (46.4)	294 (43.4)	0.416
Cholangioenterostomy	8 (3.1)	15 (2.2)	0.491
Complete stone remove	207 (81.5)	523 (77.1)	0.249
Bile bacterial culture positive	15 (5.9)	38 (5.6)	0.874

Data for operation time and blood loss are presented as the mean ± SD.

Table 3 Postoperative variables of patients in the control and lavage groups n (%)

	Control group(n = 254)	Lavage group(n = 678)	P value
Death	1	1	0.471
Cost	RMB 28437.1 ± 8530.5	RMB 32264.2 ± 11893.2	0.043
Postoperative hospital stay (d)	6.67 ± 3.78	7.82 ± 4.34	0.024
Fever (> 37.5 °C)	207 (81.4)	618 (91.2)	0.001
High fever (> 38.5 °C)	101 (39.8)	372 (54.9)	0.001
Antibiotic up-regulation	67 (26.3)	259 (38.2)	0.001
Blood bacterial culture positive	34 (13.4)	175 (25.8)	0.001
Bile bacterial culture positive	60 (23.6)	276 (40.1)	0.001
Cholangitis	51 (20.1)	238 (35.1)	0.001
Pulmonary infection	5 (1.9)	22 (3.2)	0.383
Abdominal infection	12 (4.7)	59 (8.7)	0.051
Bile leakage	8 (3.1)	33 (4.8)	0.287
Complications
Grade I	69 (27.1)	174 (25.7)	0.250
Grade II	87 (34.2)	305 (45.0)
Grade III	7 (2.8)	16 (2.3)
Grade IV	2 (0.8)	3 (0.4)

Data for cost and postoperative hospital stay are presented as the mean ± SD.

Table 4 Species isolated in postoperative bacterial cultures n (%)

	Blood			Bile
	Control group(n = 254)	Lavage group(n = 678)	P value	Control group(n = 254)	Lavage group(n = 678)	P value
Escherichia coli	11 (4.3)	57 (8.4)	0.034	19 (7.4)	85 (12.5)	0.035
Klebsiella pneumoniae	9 (3.5)	48 (7.1)	0.046	15 (5.9)	69 (27.2)	0.041
Pseudomonas aeruginosa	8 (3.1)	18 (2.7)	0.659	7 (2.8)	42 (6.2)	0.046
Enterobacter cloacae	5 (2.0)	22 (3.2)	0.383	11 (4.3)	56 (8.3)	0.045
Enterococcus faecalis	2 (0.8)	13 (1.9)	0.379	7 (2.8)	21 (3.1)	0.265
Others	5 (2.0)	34 (5.0)	0.043	8 (3.1)	40 (5.9)	0.098
Total	40 (15.7)	192 (28.3)	0.001	67 (26.4)	313 (46.2)	0.001

Table 5 The varieties of the up-regulated antibiotics of the control and lavage groups n (%)

	Control group(n = 254)	Lavage group(n = 678)	P value
Imipenem	4 (1.6)	29 (4.3)	0.047
Ceftriaxone	8 (3.1)	21 (3.1)	1.000
Moxifloxacin	11 (4.3)	57 (8.4)	0.034
Piperacillin-tazobactam	15 (5.9)	69 (10.2)	0.041
Cefoperazone-sulbactam	18 (7.1)	80 (11.8)	0.041
Levofloxacin	4 (1.6)	10 (14.7)	0.261
Ciprofloxacin	5 (2.0)	7 (10.3)	1.000
Others	7 (2.8)	18 (26.5)	0.439
Total	72 (28.3)	291 (42.9)	0.005