Background : Leakage from the pancreatoenteric anastomosis has been one of the major co mplications of pancreaticoduodenectomy (PD). The aim of this study was to in vestigate the feasibility of retrograde installation of percutaneous transhepatic negative-pressure biliary drainage (RPTNBD), as part of which the drainage tu be is intraoperatively inserted into the bile duct and afferent loop by surgical g uidance to reduce pancreaticoenteric leakage after PD.

Methods : We performed intraoperative RPTNBD to decompress the biliopancreatic limb in all patients and compared their clini cal outcomes with those of internal controls. A duct-to-mucosa anastomosis was made between the pancreatic duct and the jejunal mucosa. A polyvinyl c hloride (PVC) stent was inserted in the jejunal opening and pancreatic duct to stabilize the inner strength of the pancreaticoenteric anastomosis. Before start ing CJ, we inserted a blunt- pointed probe into the cut bile duct. This probe w as passed through the peripheral duct and pulled through the liver parenchym a. A

Results : This is also an important precondition for per- forming RPTNBD. Althou gh we did not encounter any accidental hemorrhage, introduci ng a probe into the intrahepatic bile duct may harbor a risk of i njury to the hepatic structures.

Conclusions : In conclusion, if a skilled surgeon performs RPTNBD, pancreatic oenteric anastomosis may be stabilized after PD. RPTNBD is ex pected to be effective in minimiz- ing PJ or CJ anastomotic fail ure, which can arise in compromised patients.