Moldovan Septimiu A, Moiș Emil I, Graur Florin, Nechita Vlad I, Furcea Luminiţa, Zaharie Florin, Bodea Raluca, Mirel Simona, Moldovan Mihaela Ș, Mocan Tudor, Spârchez Zeno, Seicean Andrada, Hajjar Nadim Al
Department of Surgery, "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., No. 19-21, 400162 Cluj-Napoca, Romania.
Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Str., No. 19-21, 400162 Cluj-Napoca, Romania.
Medicina (Kaunas). 2025 Aug 30;61(9):1565. doi: 10.3390/medicina61091565.
Preoperative biliary drainage (PBD) in patients with periampullary neoplasms remains a debated topic, with various techniques available and conflicting evidence regarding their impact on postoperative outcomes. This study aimed to assess, in a high-volume pancreatic surgery center, whether the choice among endoscopic, surgical, or no preoperative biliary drainage influences postprocedural and postoperative complication rates. A retrospective cohort study was conducted at the Surgical Department of the "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology in Cluj-Napoca, Romania, between January 2017 and May 2023. A total of 655 patients undergoing pancreaticoduodenectomy or total pancreatectomy for resectable periampullary tumors were divided into three groups: no PBD, endoscopic PBD, and surgical PBD. Clinical, procedural, and postoperative variables were collected and statistically analyzed. Endoscopic drainage was associated with a significantly higher rate of postoperative intra-abdominal abscesses, postoperative pancreatic fistula (POPF), and pancreaticojejunostomy fistula compared to surgical drainage and no PBD. Patients in the endoscopic group also exhibited significantly higher rates of positive bile cultures, particularly with pluribacterial populations. Procedure-related complications, such as pancreatitis and cholangitis, were significantly lower in the surgical drainage group. No significant differences were found among groups regarding postoperative hospital stay, relaparotomy rates, or 90-day mortality. Surgical biliary drainage was associated with lower perioperative morbidity compared to endoscopic drainage. While endoscopic drainage remains the most commonly used approach, surgical drainage may offer a safer alternative in selected patients. Prospective randomized controlled trials are warranted to validate these findings.
壶腹周围肿瘤患者的术前胆道引流（PBD）仍是一个有争议的话题，有多种技术可供选择，且关于它们对术后结局影响的证据相互矛盾。本研究旨在评估在一个高容量胰腺手术中心，内镜、手术或不进行术前胆道引流的选择是否会影响术后并发症发生率和术后并发症发生率。在罗马尼亚克卢日-纳波卡的“奥克塔维安·福多尔”地区胃肠病学和肝病研究所外科进行了一项回顾性队列研究，时间为2017年1月至2023年5月。共有655例因可切除的壶腹周围肿瘤接受胰十二指肠切除术或全胰切除术的患者被分为三组：不进行PBD组、内镜PBD组和手术PBD组。收集临床、手术和术后变量并进行统计分析。与手术引流和不进行PBD相比，内镜引流术后腹腔内脓肿、术后胰瘘（POPF）和胰空肠吻合口瘘的发生率显著更高。内镜组患者胆汁培养阳性率也显著更高，尤其是多菌种感染。手术引流组胰腺炎和胆管炎等手术相关并发症显著更低。各组在术后住院时间、再次剖腹手术率或90天死亡率方面未发现显著差异。与内镜引流相比，手术胆道引流与围手术期发病率较低相关。虽然内镜引流仍然是最常用的方法，但手术引流可能为选定的患者提供更安全的选择。有必要进行前瞻性随机对照试验来验证这些发现。
