Background: This study aimed to objectively evaluate the impact of the gap in surgical practice caused by COVID-19 on surgical skill decay. Methods: This retrospective cohort study enrolled 148 cases of adult patients who were qualified for elective or urgent laparoscopic cholecystectomy. This study compared the period of nine months before the pandemic outbreak and nine months after the end of the pandemic. We analyzed the duration of surgery, the number of intraoperative adverse events (IAEs), postoperative complications (PCs), and differences between the surgeries performed by residents and those performed by specialists. Results: The number of IAEs did not differ significantly between groups (after COVID-19 (AC) and before COVID-19 (BC)). A difficult gallbladder (DGB) was associated with an increased risk of IAEs during surgery in both groups (BC:OR = 2.94, p = 0.049; AC:OR = 2.81, p = 0.35). The multivariate analyses showed no significant differences in IAEs or PCs when the residents performed surgeries compared to specialists. The average duration of surgery was significantly longer in the post-pandemic group (BC–102.4 min vs. AC–119.9 min, p = 0.024). Conclusions: Measurable determinants of surgical skills are the duration of surgery and the number of intraoperative adverse events. By defining this indicators, our study objectively shows that the reduction in the volume of surgeries during COVID-19 resulted in a phenomenon known as surgical skill decay.

Background: Pancreatoduodenectomy (PD) remains the fundamental treatment for periampullary malignancies but is associated with considerable morbidity (20–50%) and mortality (2–7%). Bacteriobilia contributes to unfavourable postoperative outcomes. Current antibiotic prophylaxis recommendations endorse first-generation cephalosporins, which often fail to adequately target pathogens most frequently isolated from bile. To date, no specific guidelines for preoperative targeted antibiotic therapy have been established, although tailoring such strategies to the bile microbiome may improve surgical outcomes. This study aimed to characterize bile microbiology in patients undergoing PD for pancreatic ductal adenocarcinoma (PDAC), evaluating potential antibiotherapy regimens that provide effective coverage against the most frequently isolated pathogens. Methods: A retrospective cohort analysis of 725 patients surgically treated for pancreatic tumours at a high-volume pancreatic surgery center between 2017 and 2022 was performed. To minimize heterogeneity, study was restricted to 138 patients who underwent PD with histopathological confirmed PDAC. Intraoperative bile cultures were assessed. Results: Patients with bacteriobilia likewise experienced worse outcomes: higher 5-year mortality (OR 3.01, p = 0.007), greater overall postoperative pancreatic fistula (POPF) occurrence (OR 2.54, p = 0.044) and wound infections (OR 2.90, p = 0.038). Among bile microbiome the highest susceptibility rates were observed for combination of amoxicillin/clavulanic acid with gentamicin, while the lowest were noted for cephalosporin–metronidazole regimen (93.6% vs. 30.2%, respectively). Conclusions: Bacteriobilia contributes to postoperative complications and serves as a predictor of poorer survival after PD. Standard perioperative antibiotic prophylaxis in PD is insufficient. Based on our findings, perioperative antibiotic therapy with amoxicillin/clavulanic acid and gentamicin combination appears to provide superior coverage and may improve postoperative morbidity and overall survival following PD.

Background: Postoperative pancreatic fistula (POPF) is a major source of morbidity following a pancreatoduodenectomy (PD), often delaying or precluding adjuvant chemotherapy and potentially compromising long-term oncologic outcomes. While established risk models focus on anatomical and biochemical factors, the role of biliary microbiota remains underexplored. This study aimed to assess relationship between bacteriobilia and the incidence of POPF, as well as its impact on overall survival (OS) in patients undergoing a PD for pancreatic ductal adenocarcinoma (PDAC). Methods: We analyzed the medical histories of 725 patients with a pancreatic tumor who were qualified for surgery between 2017 and 2022. This retrospective cohort study included 138 patients who underwent a PD for histologically confirmed PDAC. Intraoperative bile cultures were obtained and analyzed for microbial presence and resistance patterns. Results: Bacteriobilia was detected in 76.8% of patients, including bacteria with resistance mechanisms (BRM) present in 12.3% of bile samples. Bacterial bile colonization conferred an increased odds of POPF grade B (OR 5.11; p = 0.088), whereas BRM were strongly predisposed to POPF grade C (OR 4.97; p = 0.026). Upon a multivariate analysis, bacteriobilia independently drove clinically relevant POPF and POPF grade B (OR 5.50; p = 0.034 and OR 8.04; p = 0.048, respectively), while BRM remained a key determinant of POPF grade C (OR 6.17; p = 0.047). Beyond morbidity, bile colonization markedly impaired overall survival irrespective of tumor stage (26.7 vs. 54.7 months; log-rank p = 0.009). Conclusions: Bacterial bile colonization may contribute not only to higher rates of POPF but to a significantly reduced OS in patients undergoing a PD for PDAC. Bacteriobilia should be considered as a prognostic factor for worse survival after a PD.