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Background: Pancreatic surgeons have employed numerous interventions, medical and surgical, in an effort to reduce the incidence of postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy (PD). Stenting the pancreatic anastomosis has been thought to reduce the incidence of POPF. In our experience, 0.9% (4/449) of patients have required endoscopic retrieval of the anastomotic stent. Although uncommon, these late complications have led us to investigate the efficacy of anastomotic stenting in the reduction of POPF. Methods: Between January 1999 and September 2010, 553 patients underwent PD by a single surgeon (MBF). Internal trans-anastomotic stenting was routine from January 1999 to May 2008 and, in the more recent years, a stent was only used temporarily to facilitate construction of the pancreaticojejunostomy. We have retrospectively reviewed patient records and compared clinicopathologic factors between stent (n=449) and no stent (n=104) groups to elucidate the effectiveness of trans-anastomotic stenting on the incidence of POPF.Results: The clinically relevant fistula (ISGPS grade B/C) rates in stent and no stent groups were similar, at 10% and 13% (p=0.385), respectively. The clinically relevant fistula rate in patients with a small pancreatic duct (≤ 3mm, n= 167) were also similar, at 17% (23/130) and 25% (9/37) (p=0.376), respectively. In the subgroup of patients with soft pancreatic gland (n = 64), grade B and C fistulae were 31% (13/41) for stent and 17% (4/23) for no stent groups (p=0.203), respectively. Conclusion: Internal trans-anastomotic pancreatic duct stenting does not decrease the frequency or severity of postoperative pancreatic fistulae.