BACKGROUND: The trans T-tube cholangial drainage (TTCD) is a novel approach that is first reported in this study for the treatment of bile leakage at the biliary-enteric anastomosis. However, no researchers have compared it with percutaneous transhepatic cholangial drainage (PTCD) as yet. METHODS: The clinical and imaging data of patients with bile leakage at the biliary-enteric anastomosis treated with TTCD (TTCD group) or PTCD (PTCD group) at three centers were retrospectively evaluated. The differences between the two groups in terms of surgical outcomes, perioperative complications, intraoperative radiation exposure time, and total hospitalization costs were compared. RESULTS: There were 32 and 54 patients in the TTCD and PTCD group, respectively. No surgery-associated deaths occurred in both groups. The technical success rate was 100% in the TTCD group and 88.9% in the PTCD group (P = 0.051). Furthermore, within one week post-treatment, both groups showed a significant decrease in serum total bilirubin levels, with a greater reduction observed in the TTCD group (P < 0.05). The TTCD group had significantly less intraoperative bleeding compared to the PTCD group (P < 0.0001). In terms of surgical complications, there was a statistically significant difference in complications between the two groups (P = 0.031). Besides, the TTCD group had significantly shorter intraoperative radiation exposure time compared to the PTCD group (P < 0.0001). In addition, the TTCD group had shorter hospital stays after surgery (P < 0.0001) and lower surgical costs (P < 0.0001). CONCLUSION: Trans T-tube cholangial drainage catheter was a safe option with improved clinical outcomes compared to traditional PTCD drainage for the treatment of bile leakage at the biliary-enteric anastomosis.