BackgroundRole of preoperative biliary stenting (PBS) before pancreaticodoudenectomy (PD) in patients with obstructive jaundice is debatable. The objective of the current study was to assess outcomes after PD in patients who underwent upfront surgery or PBS and determine the impact of stent to surgery duration on outcomes after PD. Methods We reviewed 147 patients who underwent PD between 2011 and 2019. Patients were grouped based on whether they underwent upfront surgery (N=76) or PBS (N=71). We further assessed outcomes based on stent to surgery interval < 4 weeks or > 4 weeks. We looked at 30 and 90 day morbidity and mortality rates in these patients.Results A significant increase in wound infections (7% vs 25%)(P=0.003), overall infectious complications (22.5% vs 38.1%)(P=0.04), re admissions (0 vs 10.5%)(P=0.005) and hospital stay (9 vs 10 days)(P=0.006) was seen in the PBS group. There was no significant difference in 30 day mortality (2.8 % vs 6.5%)(P=0.4). When compared with upfront surgery group, patients with stent to surgery duration > 4 weeks had higher rates of wound infection (7% vs 29%)(P=0.009), sepsis (11.2% vs 29%)(P=0.02), overall infectious complications (22.5% vs 45.1%)(P=0.02), re admissions (0 vs 12.9%) (P=0.007) and hospital stay (9 vs 10 days)(P=0.03). The lowest rate of infectious complications was seen when PD was performed within 2 weeks (22.2%) or 6-8 weeks (12.5%) after stenting. None of the patients with stent-surgery duration < 2 weeks developed sepsis. ConclusionsPBS appears to increase infection related morbidity after PD. In patients with PBS, low morbidity is seen with early (< 2 weeks) and delayed PD (6-8weeks).