Purpose: Hepaticojejunostomy leak and bile fistula after pancreaticoduodenectomy (PD) are less frequent than pancreatic leaks. Patients with biliary fistula (BF) have an increased risk of serious complications and an extended hospital stay. This study has investigated the occurrence and outcome of BF.Methods: All patients who underwent a PD from January 1st, 2015 to December 31st, 2019 were included. The significance of multiple risk factors was examined. Univariate analysis was used to identify predictive variables for postoperative BF.Results: Of the 552 patients who underwent PD, 38 patients (6.7%) developed a BF. Patients with nonmalignant diagnoses and malignancies without bile duct obstruction had a greater risk of developing BF. BF did not increase the mortality, though most patients had complications, including surgical site infections, intraabdominal abscesses, and an extended hospital stay.Conclusion: BF after PD leads to an increased risk of subsequent complications and an extended hospital stay but does not increase mortality. Patients with nonmalignant diagnoses and malignancies without bile duct obstruction have an increased risk of BF.