A 72 year old woman suffered from jaundice increasing bilirubin level and GPT, GOT, GGT with reduction of protrombine MRI, endoscopy and thoracic and abdominal CT were done. An ampuloma with 3cm diameter was diagnosed. Biopsy was performed and adenocarcinoma of the ampula was found. Ampulectomy was indicated. Right subcostal incision and duodenotomy was done. Resection of the ampula with implantation of choledochous and wirsung duct was demostreated. Free margin was correc. Posoperative course uneventful. Two years later local recurrence was diagnosed. Duodeno-pancreatectomy with pilorous preservation was indicated. Reoperation by the same incision. Mobilization of duodenum and pancreas done. Section of the duodenum by GIA. Hepato-duodenal lynfadenectomy extended to retroperitoneum, celiac axis Portal vein. Superior mesenteric artery and vein. Section of the pancreas and first jejunal loop. Reconsruction by means wirsung jejunostomy (one layer 4/0 interrupted stitches, choledoco-jejunostomy and duodeno-jejunostomy. Postop. uneventful. Endoscopy was shown in pre and posoperative period.