Impact of T-tube placement on hepaticojejunostomy stenosis after pancreatic surgery

Abstract Background Hepaticojejunostomy stenosis represents a clinically relevant long-term complication after pancreatic surgery and may result in recurrent cholangitis and impaired quality of life. T-tube drainage is occasionally used during biliary reconstruction, particularly in technically challenging anastomoses involving narrow bile ducts; however, its impact on the development of hepaticojejunostomy stenosis remains controversial. This study aimed to evaluate the association between intraoperative T-tube placement and hepaticojejunostomy stenosis after pancreatic surgery. Methods This retrospective single-center cohort study included patients who underwent pancreatic surgery with hepaticojejunostomy between 2016 and 2018 at a high-volume pancreatic surgery center. Patients were stratified according to intraoperative T-tube placement. The primary endpoint was the incidence of hepaticojejunostomy stenosis, defined as radiologically confirmed biliary obstruction at the anastomotic site combined with persistent elevation of cholestatic laboratory parameters. Secondary endpoints included postoperative complications classified according to the Clavien–Dindo system and longitudinal cholestasis parameters during follow-up. Results A total of 142 patients were included, of whom 79 (55.6%) underwent hepaticojejunostomy with T-tube placement. Narrow bile ducts (< 5 mm) were significantly more common in the T-tube group (78.5% vs. 9.5%, p < 0.001). The incidence of hepaticojejunostomy stenosis did not differ significantly between patients with and without T-tube placement (6.4% vs. 13.5%, p = 0.475). T-tube placement was associated with a higher incidence of early postoperative major complications, whereas rates of biliary anastomotic leakage were comparable between groups. Longitudinal analysis of cholestatic laboratory parameters revealed no significant differences during follow-up. Conclusions T-tube placement during hepaticojejunostomy in pancreatic surgery was not associated with an increased risk of hepaticojejunostomy stenosis, despite its predominant use in patients with narrow bile ducts. These findings suggest that selective T-tube use does not adversely affect long-term biliary patency.