Pancreaticoduodenectomy is the only potentially curative treatment for adenocarcinoma of the pancreatic head. Although perioperative mortality has fallen to 1–2%, postoperative morbidity remains high at 40–60%, with infectious complications, delayed gastric emptying, and pancreatic fistula contributing to patient burden and healthcare utilisation. The gut microbiome plays a critical role in nutritional metabolism by maintaining the intestinal barrier integrity, enhancing immune responses, and preventing pathogenic colonisation. Pancreaticoduodenectomy disrupts this ecosystem through perioperative fasting, antibiotic exposure and surgical stress. Permanent anatomical changes contribute further to this disruption. Molecular sequencing studies demonstrate postoperative reduction in microbial diversity and depletion of beneficial commensal organisms, changes that are associated with increased postoperative infectious complications. Microbiome disruption facilitates bacterial translocation, where intestinal bacteria or their products cross the mucosal barrier into systemic circulation. Prospective studies in pancreatic surgery identified occult bacterial translocation in a significant proportion of patients, which is associated with surgical site infection. Probiotics, prebiotics, and synbiotics represent a plausible adjunct in pancreatic surgery by maintaining microbial diversity, strengthening epithelial barrier function, and enhancing immunity. Randomised controlled trials in pancreaticoduodenectomy patients demonstrate reductions in postoperative infections, delayed gastric emptying, antibiotic use, and length of hospital stay with perioperative supplementation. This poster highlights current evidence linking microbiome disruption to postoperative morbidity following pancreaticoduodenectomy and reviews emerging strategies for perioperative microbiome maintenance.