Introduction : After pancreatoduodenectomy (PD), postoperative pancreatic fistula (POPF) has been recognized as a challenging complication; therefore, there have been several studies of surgical techniques for preventing the POPF. In addition, remarkable bile leakage could result in longer hospital stay after PD. The aim of this study was to evaluate the feasibility and impact on postoperative complications of retrograde transhepatic biliary drainage (RTBD) inserted intraoperatively in PD.

Methods : A total of 97 patients who underwent PD or pylorus-preserving PD for periampullary diseases between October 2008 and December 2019 were enrolled in this retrospective single-center study.

Results : The patients were divided into the control group (n=19, 19.6%) and RTBD group (n=78, 80.4%). The incidence of POPF (ISGPS grade B/C) was similar in both groups (22.2% vs. 10.4%, P=0.232). There were also no significant differences in perioperative complications (Clavien-Dindo classification IIIa to V) between the two groups (47.4% vs. 25.6%, P=0.064). However, the incidence of remarkable bile leakage (>100cc/day) was significantly higher in the control group (21.1% vs. 2.6%, P=0.013) and the postoperative hospital stay was significantly shorter in the RTBD group (30.3 days vs. 20.8 days, P=0.006). RTBDs were clamped on 11 days after operations and removed at 4.4 postoperative week.

Conclusions : RTBD was not effective for preventing POPF, but a feasible procedure reducing bile leakage and hospital stay after PD by decompressing intraluminal pressure around biliary-pancreaticoenteric anastomosis.