T-Tube Placement may not increase anastomotic stenosis risk during Hepaticojejunostomy in pancreatic surgery: Study

A new study published in the BMC Surgery revealed that T-tube placement during hepaticojejunostomy in pancreatic surgery does not increase the risk of anastomotic stenosis, even though it is more commonly used in patients with narrow bile ducts. These findings indicate that selective use of T-tubes does not negatively impact long-term biliary patency.

Hepaticojejunostomy stenosis is a known long-term concern following pancreatic procedures. This complication can lead to recurrent infections such as cholangitis and significantly affect a patient’s quality of life. To effectively reduce surgical challenges, especially in patients with very small bile ducts, surgeons sometimes place a temporary T-shaped tube (T-tube) to support this reconstruction. However, whether this practice contributes to later complications has remained unclear.

Thus, this retrospective cohort study was conducted at a high-volume pancreatic surgery center, and analyzed outcomes from 142 patients who underwent pancreatic surgery with hepaticojejunostomy between 2016 and 2018. The patients were divided into two groups based on whether a T-tube was placed during surgery.

The study found that more than half of the patients (55.6%) received a T-tube, and this group was significantly more likely to have narrow bile ducts. Despite this higher-risk profile, the incidence of hepaticojejunostomy stenosis was not statistically significant between these two groups. Stenosis occurred in 6.4% of patients with a T-tube when compared to 13.5% of those without, which was not statistically significant.

While the long-term risk of biliary narrowing was unaffected, the study did note a higher rate of early major postoperative complications in the T-tube group. These complications were classified using the Clavien–Dindo system, which found the rates of bile leakage were similar regardless of T-tube use.

This research also tracked cholestatic laboratory markers over time, which helped in indicating the bile flow and liver function. No significant differences were observed between the groups during follow-up, which suggests that long-term biliary function remained comparable.

The findings suggest that T-tube placement, when used selectively in technically challenging cases, does not compromise the long-term outcomes. Yet, this appears to be a safe tool particularly for patients with anatomically difficult bile ducts.

Overall, by showing that T-tubes do not increase the risk of hepaticojejunostomy stenosis, the findings of this investigation supports their continued use in appropriate cases without added concern for long-term biliary obstruction.

Reference:

Herzog-Niescery, J., Chedjou, W., Aghalarov, I., Uhl, W., & Herzog, T. (2026). Impact of T-tube placement on hepaticojejunostomy stenosis after pancreatic surgery. BMC Surgery, 26(1). https://doi.org/10.1186/s12893-026-03763-w