Background: Surgical biliary bypass remains an important palliative option for patients with advanced pancreatic cancer in settings where endoscopic biliary drainage and interventional oncology are not consistently available. However, data on postoperative outcomes and survival after biliodigestive bypass in sub-Saharan Africa remain scarce. This study aimed to evaluate surgical procedures, postoperative morbidity, and survival after biliodigestive bypass for pancreatic cancer in two tertiary hospitals in Douala, Cameroon. Methods: We conducted a retrospective bicentric cohort study including patients who underwent surgical biliodigestive bypass for pancreatic cancer at Douala General Hospital and Laquintinie Hospital of Douala between January 2013 and December 2022. Sociodemographic, clinical, biological, radiological, operative, postoperative, and survival data were collected from medical records. Postoperative complications and survival outcomes were analyzed. Overall survival was estimated from the date of surgery to death or last follow-up. Results: Forty patients were included. The mean age was 60.1 ± 12.9 years, and 24 patients (60.0%) were male. All patients presented with stage IV disease. The most frequently performed biliary procedures were choledochoduodenostomy in 18 patients (45.0%) and choledochojejunostomy in 16 patients (40.0%). Gastroenterostomy was associated in all cases. Roux-en-Y double bypass was performed in 17 patients (42.5%), while an omega-loop configuration was used in 2 patients (5.0%). Overall postoperative morbidity within 30 days was 57.5%. The most common complications were surgical site infection in 5 patients (12.5%), biliary fistula in 3 patients (7.5%), and digestive fistula in 3 patients (7.5%). The median overall survival was 2.6 months (78 days). The estimated 1-month and 6-month survival rates were 87.5% and 12.5%, respectively. In multivariable analysis, diabetes mellitus (adjusted HR: 2.65, 95% CI: 1.10–6.38; p = 0.030) an