The operation depicts the resection of the head of the pancreas, the lower common bile duct and D2 - D3 -D4, preserving the pylorus with most of D-1. Treitz angle is left in place and closed. The first jejunal loop is brought to the upper abdomen and three anastomoses are performed in the following sequence: a) choledocho-jejunostomy; b) pancreatojejunostomy, with a stent in the Wirsung, to the whole pancreas surface; and c) duodenojejunostomy. All the anastomoses are in one layer of single stitches of fine silk. From the standpoint of peristalsis, c) is the highest or more proximal and a) the lowest, miming the normal passage of food and its mixingwith pancreatic and biliary juices after emptying the pylorus into the jejunum.