Objective: To investigate the effectiveness and necessity of the prophylactic placement of abdominal irrigation tube for postoperative pancreatic fistula (POPF) following D2 radical total gastrectomy. Methods: From March 2012 to September 2013, 196 patients undergoing D2 radical total gastrectomy were equally randomized into control group and observational group. Patients in control group underwent routine abdominal drainage tube placement while, in addition to abdominal drainage tube placement, those in observational group had an irrigation tube placed at the antero-superior aspect of the pancreas, and by the latter tube, the cases who developed POPF underwent irrigation of the pancreatic region with normal saline instillation. The incidence of POPF between the two groups, and the amylase concentration in the postoperative drainage fluid, time to bowel function recovery and hospitalization costs in POPF cases between the two groups were compared. Results: The difference in the incidence of POPF between the two group had no statistical significance (P>0.05), but the incidence of grade B-C POPF in observational group was significantly decreased compared with control group (P<0.05). Comparison in POPF patients between the two groups showed that the amylase concentration in the postoperative drainage fluid was significantly decreased, time to bowel function recovery was significantly shortened and hospitalization cost is significantly reduced (all P<0.05), but the incidence of other complications had no statistical difference (P>0.05). Conclusion: Prophylactic placement of abdominal irrigation tube has demonstrable therapeutic effect for POPF, which is recommended for use in those patients with suspected pancreatic injury during surgery.