Abstract:Pancreaticoduodenectomy (PD) remains one of the most complex and high-risk procedures in abdominal surgery, with clinically relevant postoperative pancreatic fistula (CR-POPF) being a significant determinant of morbidity and mortality. Recent evidence suggests that merely modifying the pancreatoenteric anastomosis technique fails to achieve a consistent reduction in fistula incidence. The Department of Pancreatic Surgery at Zhongshan Hospital, Fudan University, has developed a prophylactic dual biliary-pancreatic diversion system that simultaneously drains bile and pancreatic juice during PD. This system provides dual protection through "decompression and separation," preventing premature activation of pancreatic enzymes and reducing anastomotic stress. This article introduces the system's conceptual framework, design principles, and clinical application, summarizes ongoing multicenter randomized controlled trials, and discusses key issues, including indication selection, intraoperative management, external drainage care, and patient compliance. Furthermore, it outlines future directions in risk stratification, antimicrobial stewardship, intelligent drainage, and biomaterial innovation. As a conceptual and translational advance, this dual diversion strategy may redefine the paradigm of postoperative complication prevention after PD.