Impact of Preoperative Biliary Stenting on Intestinal Dysfunction and Perioperative Complications After Pylorus-Preserving Pancreaticoduodenectomy
<i>Background and Objectives</i>: Preoperative biliary stenting (PBS) is commonly used to manage obstructive jaundice in patients undergoing pylorus-preserving pancreaticoduodenectomy (PPPD). However, the impact of PBS on intestinal barrier function and perioperative complications remain...
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2025-02-01
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| author | Gelu Mihai Breaza Florin Emil Hut Octavian Cretu Simona-Alina Abu-Awwad Ahmed Abu-Awwad Laurentiu Sima Radu Gheorghe Dan Cristina Ana-Maria Dan Raluca Maria Closca Flavia Zara |
| author_facet | Gelu Mihai Breaza Florin Emil Hut Octavian Cretu Simona-Alina Abu-Awwad Ahmed Abu-Awwad Laurentiu Sima Radu Gheorghe Dan Cristina Ana-Maria Dan Raluca Maria Closca Flavia Zara |
| author_sort | Gelu Mihai Breaza |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Preoperative biliary stenting (PBS) is commonly used to manage obstructive jaundice in patients undergoing pylorus-preserving pancreaticoduodenectomy (PPPD). However, the impact of PBS on intestinal barrier function and perioperative complications remains controversial. This study aims to evaluate the effect of PBS on intestinal dysfunction and surgical outcomes, focusing on the influence of the stent duration. <i>Materials and Methods</i>: In this prospective cohort study, 235 patients undergoing PPPD for resectable pancreatic neoplasms at Timișoara Municipal Emergency Clinical Hospital (2016–2024) were analyzed. Patients were divided into two groups: those with PBS (n = 98) and without PBS (n = 137). Intestinal barrier function was assessed pre- and postoperatively using biomarkers such as zonulin, fecal calprotectin, and serum lipopolysaccharides (LPS). Perioperative outcomes, including pancreatic fistula, delayed gastric emptying (DGE), infections, and hospital stay, were compared. Additionally, outcomes were stratified based on stent duration (2–3 weeks vs. 3–4 weeks). <i>Results</i>: PBS was associated with significantly higher levels of zonulin, fecal calprotectin, and serum LPS postoperatively, indicating compromised intestinal barrier function. The stented group had a higher incidence of pancreatic fistulas (Grade B/C: 27.5% vs. 13.1%, <i>p</i> < 0.01), DGE (25.5% vs. 13.1%, <i>p</i> = 0.008), postoperative infections (34.7% vs. 17.5%, <i>p</i> = 0.002), and prolonged hospital stay (16.9 ± 4.2 days vs. 14.5 ± 3.7 days, <i>p</i> = 0.019). Prolonged stenting (3–4 weeks) was associated with worse outcomes compared to shorter stenting durations (2–3 weeks), including increased rates of infections, sepsis, and ICU stay (<i>p</i> < 0.05 for all comparisons). <i>Conclusions</i>: Preoperative biliary stenting is associated with increased intestinal barrier dysfunction, systemic inflammation, and higher rates of perioperative complications following PPPD. Prolonged stenting durations (>3 weeks) further exacerbate these risks. Limiting the PBS duration to 2–3 weeks, alongside optimized perioperative management, may help reduce postoperative morbidity and improve surgical outcomes. |
| format | Article |
| id | doaj-art-23e23b6e2f2c493988352be85dcfa0b6 |
| institution | DOAJ |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | MDPI AG |
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| series | Medicina |
| spelling | doaj-art-23e23b6e2f2c493988352be85dcfa0b62025-08-20T02:42:22ZengMDPI AGMedicina1010-660X1648-91442025-02-0161339110.3390/medicina61030391Impact of Preoperative Biliary Stenting on Intestinal Dysfunction and Perioperative Complications After Pylorus-Preserving PancreaticoduodenectomyGelu Mihai Breaza0Florin Emil Hut1Octavian Cretu2Simona-Alina Abu-Awwad3Ahmed Abu-Awwad4Laurentiu Sima5Radu Gheorghe Dan6Cristina Ana-Maria Dan7Raluca Maria Closca8Flavia Zara9Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaUniversity Clinic of Surgery I, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaUniversity Clinic of Surgery I, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaIst Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, RomaniaDepartment XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaUniversity Clinic of Surgery I, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaUniversity Clinic of Surgery I, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaUniversity Clinic of Surgery I, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaDepartment of Pathology, Emergency City Hospital, 300254 Timisoara, RomaniaDepartment of Pathology, Emergency City Hospital, 300254 Timisoara, Romania<i>Background and Objectives</i>: Preoperative biliary stenting (PBS) is commonly used to manage obstructive jaundice in patients undergoing pylorus-preserving pancreaticoduodenectomy (PPPD). However, the impact of PBS on intestinal barrier function and perioperative complications remains controversial. This study aims to evaluate the effect of PBS on intestinal dysfunction and surgical outcomes, focusing on the influence of the stent duration. <i>Materials and Methods</i>: In this prospective cohort study, 235 patients undergoing PPPD for resectable pancreatic neoplasms at Timișoara Municipal Emergency Clinical Hospital (2016–2024) were analyzed. Patients were divided into two groups: those with PBS (n = 98) and without PBS (n = 137). Intestinal barrier function was assessed pre- and postoperatively using biomarkers such as zonulin, fecal calprotectin, and serum lipopolysaccharides (LPS). Perioperative outcomes, including pancreatic fistula, delayed gastric emptying (DGE), infections, and hospital stay, were compared. Additionally, outcomes were stratified based on stent duration (2–3 weeks vs. 3–4 weeks). <i>Results</i>: PBS was associated with significantly higher levels of zonulin, fecal calprotectin, and serum LPS postoperatively, indicating compromised intestinal barrier function. The stented group had a higher incidence of pancreatic fistulas (Grade B/C: 27.5% vs. 13.1%, <i>p</i> < 0.01), DGE (25.5% vs. 13.1%, <i>p</i> = 0.008), postoperative infections (34.7% vs. 17.5%, <i>p</i> = 0.002), and prolonged hospital stay (16.9 ± 4.2 days vs. 14.5 ± 3.7 days, <i>p</i> = 0.019). Prolonged stenting (3–4 weeks) was associated with worse outcomes compared to shorter stenting durations (2–3 weeks), including increased rates of infections, sepsis, and ICU stay (<i>p</i> < 0.05 for all comparisons). <i>Conclusions</i>: Preoperative biliary stenting is associated with increased intestinal barrier dysfunction, systemic inflammation, and higher rates of perioperative complications following PPPD. Prolonged stenting durations (>3 weeks) further exacerbate these risks. Limiting the PBS duration to 2–3 weeks, alongside optimized perioperative management, may help reduce postoperative morbidity and improve surgical outcomes.https://www.mdpi.com/1648-9144/61/3/391preoperative biliary stentingintestinal dysfunctionpancreaticoduodenectomyperioperative complicationsdelayed gastric emptyingpancreatic fistula |
| spellingShingle | Gelu Mihai Breaza Florin Emil Hut Octavian Cretu Simona-Alina Abu-Awwad Ahmed Abu-Awwad Laurentiu Sima Radu Gheorghe Dan Cristina Ana-Maria Dan Raluca Maria Closca Flavia Zara Impact of Preoperative Biliary Stenting on Intestinal Dysfunction and Perioperative Complications After Pylorus-Preserving Pancreaticoduodenectomy Medicina preoperative biliary stenting intestinal dysfunction pancreaticoduodenectomy perioperative complications delayed gastric emptying pancreatic fistula |
| title | Impact of Preoperative Biliary Stenting on Intestinal Dysfunction and Perioperative Complications After Pylorus-Preserving Pancreaticoduodenectomy |
| title_full | Impact of Preoperative Biliary Stenting on Intestinal Dysfunction and Perioperative Complications After Pylorus-Preserving Pancreaticoduodenectomy |
| title_fullStr | Impact of Preoperative Biliary Stenting on Intestinal Dysfunction and Perioperative Complications After Pylorus-Preserving Pancreaticoduodenectomy |
| title_full_unstemmed | Impact of Preoperative Biliary Stenting on Intestinal Dysfunction and Perioperative Complications After Pylorus-Preserving Pancreaticoduodenectomy |
| title_short | Impact of Preoperative Biliary Stenting on Intestinal Dysfunction and Perioperative Complications After Pylorus-Preserving Pancreaticoduodenectomy |
| title_sort | impact of preoperative biliary stenting on intestinal dysfunction and perioperative complications after pylorus preserving pancreaticoduodenectomy |
| topic | preoperative biliary stenting intestinal dysfunction pancreaticoduodenectomy perioperative complications delayed gastric emptying pancreatic fistula |
| url | https://www.mdpi.com/1648-9144/61/3/391 |
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