Objective: To evaluate the value of percutaneous transhepatic gallbladder drainage (PTGD) in high-risk patients prior to undergoing pancreaticoduodenectomy (PD). Methods: The clinical data of 15 patients with pancreatic head or periampullary cancer who had high risk factors and treated from January 2008 to December 2012 were retrospectively analyzed. All these patients received PTGD to improve their general condition prior to undergoing PD procedure. Results: PTGD was carried out successfully in all 15 patients with no occurrence of complications such as bile leakage, pneumothorax or internal bleeding. Drainage tubes in all patients remained patent with a daily drainage volume of 800 to 2 500 mL. Jaundice reduction effect was satisfactory, and the serum bilirubin concentration in all patients was less than 200 μmol/L after drainage for 10 to14 d. Subsequently, PD procedure was performed successfully in all patients. No serious postoperative complications occurred in any patient of the entire group, and all patients recovered. Conclusion: For patients with pancreatic head or periampullary cancer who have high-risk factors such as severe jaundice, severe biliary infection, severe medical problems or malnutrition, the use of PTGD prior to PD can reduce the incidence of postoperative complications and increase surgical safety.