The global concept of preoperative staging of malignancies is to select, as well as possible, those patients who are or are not candidates for operative resection. In the case of periampullary neoplasms, we have good, nonoperative palliation for patients with incurable neoplasms. A celiotomy for a periampullary neoplasm that proves to be nonresectable is not therapeutic and subjects the patient to a period of postoperative recuperation that can be considered unnecessary. Preoperative staging laparoscopy thus is valuable because it helps in selecting those patients who have the greatest chance for potentially curative resection while preventing celiotomy in most of those with unresectable disease.