{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T17:25:22Z","timestamp":1763400322313,"version":"build-2065373602"},"reference-count":46,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T00:00:00Z","timestamp":1756512000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy Cluj-Napoca, Romania, Doctoral Research Program","award":["PCD 778\/2\/13.01.2025"],"award-info":[{"award-number":["PCD 778\/2\/13.01.2025"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: 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. Materials and Methods: A retrospective cohort study was conducted at the Surgical Department of the \u201cOctavian Fodor\u201d 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. Results: 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. Conclusions: 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.<\/jats:p>","DOI":"10.3390\/medicina61091565","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T08:28:15Z","timestamp":1756715295000},"page":"1565","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Biliary Drainage for the Preoperative Management of Periampullary Neoplasms: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0960-9341","authenticated-orcid":false,"given":"Septimiu A.","family":"Moldovan","sequence":"first","affiliation":[{"name":"Department of Surgery, \u201cOctavian Fodor\u201d Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"},{"name":"Department of Surgery, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2972-3777","authenticated-orcid":false,"given":"Emil I.","family":"Moi\u0219","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cOctavian Fodor\u201d Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"},{"name":"Department of Surgery, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5887-3408","authenticated-orcid":false,"given":"Florin","family":"Graur","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cOctavian Fodor\u201d Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"},{"name":"Department of Surgery, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3097-707X","authenticated-orcid":false,"given":"Vlad I.","family":"Nechita","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cOctavian Fodor\u201d Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"},{"name":"Department of Medical Informatics and Biostatistics, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Louis Pasteur Str., No. 6, 400349 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lumini\u0163a","family":"Furcea","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cOctavian Fodor\u201d Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"},{"name":"Department of Surgery, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9618-9359","authenticated-orcid":false,"given":"Florin","family":"Zaharie","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cOctavian Fodor\u201d Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"},{"name":"Department of Surgery, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raluca","family":"Bodea","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cOctavian Fodor\u201d Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6318-3826","authenticated-orcid":false,"given":"Simona","family":"Mirel","sequence":"additional","affiliation":[{"name":"Department of Medical Devices, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Louis Pasteur Str., No. 4, 400349 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihaela \u0218.","family":"Moldovan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, County Emergency Hospital, Endocrinology Clinic, Louis Pasteur Str., No. 3-5, 400349 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tudor","family":"Mocan","sequence":"additional","affiliation":[{"name":"3rd Medical Department, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania"},{"name":"UBBMed Department, Babe\u0219-Bolyai University, 400349 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeno","family":"Sp\u00e2rchez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, \u201cOctavian Fodor\u201d Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"},{"name":"Department of Gastroenterology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrada","family":"Seicean","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, \u201cOctavian Fodor\u201d Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"},{"name":"Department of Gastroenterology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadim Al","family":"Hajjar","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cOctavian Fodor\u201d Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"},{"name":"Department of Surgery, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Croitorilor Str., No. 19\u201321, 400162 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,30]]},"reference":[{"key":"ref_1","first-page":"e1372","article-title":"Pre-Operative Biliary Drainage in the Periampullary Neoplasia\u2014A Systematic Review","volume":"31","author":"Barros","year":"2018","journal-title":"ABCD Arq. 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