AbstractWe report 45 consecutive pylorus‐preserving pancreatic resections performed from September, 1979, to August, 1983, for chronic pancreatitis or a variety of periampullary malignancies without an operative death. Of these, 36 patients had pancreatoduodenectomy with pancreatic anastomosis. The most common cause of postoperative morbidity was delay in gastric emptying, which extended beyond 10 days in 13 patients. Twenty‐eight patients could be evaluated for digestive function. Of these, 2 had mild dumping symptoms, and 14 required pancreatic exocrine supplements. A marginal ulcer developed in only 1 patient and was successfully treated by histamine H2‐receptor blockers. Food capacity was normal in 23 of 28 patients and 50–90% of normal in 5. A mean body weight of 93% of pre‐illness weight and 106% of preoperative weight had been regained. Ten of 11 patients with adenocarcinoma of the pancreas were dead of disease (median survival, 12 months), but 19 of 20 other patients with other periampullary malignancies were alive and free of disease up to 42 months postoperatively. Pylorus‐preserving pancreatectomy is the operation of choice for most lesions requiring removal of the periampullary area.