Pancreaticoduodenectomy has become the first considered surgical method for periampullary cancers and carcinomas of the distal common bile duct and the head of the pancreas, in which, postoperative pancreatic fistula is a common severe complication, and proper selection of pancreaticojejunostomy is curtail for reducing postoperative pancreatic fistula. Although many explorations and improvements for pancreaticojejunostomy technique have been made, pancreatic fistula is still unavoidable. The authors, based on literature review, address the technical development and improvement in pancreaticojejunostomy.