Abstract: Postoperative pancreatic fistula (POPF) is one of the most challenging and dangerous complications in pancreatic surgery, significantly compromising patient recovery and contributing to excessive consumption of healthcare resources.Based on the similarities and differences between the two types of POPF——pancreatic stump/raw surface fistula and anastomotic fistula—this article systematically reviews the current status and difficulties of the perioperative prevention strategies for POPF.At present, preoperative prevention and prediction have focused on controlling high-risk factors and constructing multimodal prediction models, although the reliability of these models urgently requires breakthroughs through AI-driven data integration.Intraoperative prevention, as the core component, remains controversial: modified techniques for pancreaticojejunostomy and pancreaticogastrostomy continue to emerge, yet no consensus has been reached regarding which is superior; the effectiveness of stump closure reinforcement techniques still lacks high-level evidence; and the necessity of prophylactic drain placement is highly debated, with the omission of drains during pancreaticoduodenectomy being difficult to adopt as standard practice.Somatostatin is an important part of postoperative prevention, but the patient populations that truly benefit from it require further refinement.

Key words: pancreatic surgery, postoperative pancreatic fistula, prevention, perioperative management, abdominal drainage