PURPOSE: The status of tube jejunostomy for feeding after major gastrointestinal and pancreatobiliary surgery is being questioned because of concerns about procedure-related complications. This has led to a trend away from performing routine prophylactic tube jejunostomy. METHODS: We retrospectively analyzed 120 consecutive patients who underwent prophylactic tube jejunostomy as part of major gastrointestinal or pancreatobiliary surgery within a 2-year period at a tertiary referral center. The primary end-points were procedure-related morbidity and mortality. We also performed a subset analysis of the duration of enteral feeds and the need for parenteral nutrition (PN) in patients with complications related to the index surgery. RESULTS: There was no procedure-related mortality or major morbidity. Eight patients (6.7%) required supplementation with PN because enteral feeding failed to achieve the nutritional target. Patients who suffered complications required nutritional support for significantly longer (10.8 days vs 6.4 days; P < 0.001). The nutritional goal of 25 kcal/kg per day was attained with tube jejunostomy feeding in 82 (93%) of 84 patients without complications and in 30 (83%) of 36 patients with complications (P = 0.180). CONCLUSIONS: Prophylactic tube jejunostomy is safe and can be performed with low procedure-related morbidity. When postoperative complications result in delayed or inadequate oral intake, nutritional requirements can be met through tube jejunostomy feeds.