Abstract:Pancreaticojejunostomy is a critical step in pancreatoduodenectomy, and its quality directly affects the incidence of postoperative complications, including pancreatic fistula and hemorrhage. Despite continuous technical improvements, the risk of severe complications remains substantial. Based on pathological observations and histological analyses, and considering the migration characteristics of intestinal mucosa, we propose the concept of "mucosal priority healing". This concept emphasizes shortening the migration distance of intestinal mucosa and reducing the number of anastomotic sutures to facilitate rapid apposition and healing between the jejunal mucosa and the pancreatic duct epithelium. Pancreaticojejunostomy guided by this concept optimizes the healing mechanism of the anastomosis, ensures adequate pancreatic drainage, and may reduce the risk of severe complications such as postoperative hemorrhage, reoperation, and mortality. This article systematically reviews the theoretical basis, technical features, and clinical outcomes of this approach, and discusses future research directions in the context of current evidence, aiming to provide insights into the standardization and precision of pancreaticojejunostomy.