Does Fungal Biliary Contamination after Preoperative Biliary Drainage Increase Postoperative Complications after Pancreaticoduodenectomy? †

SIMPLE SUMMARY: Biliary drainage leads to bacterial biliary contamination, but there are few studies on the impact of fungal biliary contamination after pancreaticoduodenectomy (PD). This retrospective multicenter study identified two groups: bacterial contamination only (B+, n = 154; 75%), and bacterial and fungal contamination (BF+, n = 52; 25%). An extended duration of preoperative drainage (62 vs. 49 days; p = 0.08) increased the risk of fungal contamination, but there were no differences between the two groups in relation to specific or infectious postoperative complications. According to this study, there is no argument to recommend the use of anti-fungal treatment as a prophylactic treatment during PD preceded by biliary drainage. ABSTRACT: (1) Background: preoperative biliary drainage before pancreaticoduodenectomy (PD) is associated with bacterial biliary contamination (>85%) and a significant increase in global and infectious complications. In view of the lack of published data, the aim of our study was to investigate the impact of fungal biliary contamination after biliary drainage on the complication rate after PD. (2) Methods: a multicentric retrospective study that included 224 patients who underwent PD after biliary drainage with intraoperative biliary culture. (3) Results: the global rate of positive intraoperative biliary sample was 92%. Respectively, the global rate of biliary bacterial contamination and the rate of fungal contamination were 75% and 25%, making it possible to identify two subgroups: bacterial contamination only (B+, n = 154), and bacterial and fungal contamination (BF+, n = 52). An extended duration of preoperative drainage (62 vs. 49 days; p = 0.08) increased the risk of fungal contamination. The overall and infectious complication rates were not different between the two groups. In the event of postoperative infectious or surgical complications, the infectious samples taken did not reveal more fungal infections in the BF+ group. (4) Conclusions: fungal biliary contamination, although frequent, does not seem to increase the rate of global and infectious complications after PD, preceded by preoperative biliary drainage.