The technique of wide, local resection of the ampulla with excision of a full-thickness button of duodenum, division of the common duct and pancreatic duct, with or without wedge excision of pancreatic tissue is presented. Pancreaticoduodenectomy is needed. Its role in the management of benign, premalignant and selected malignancies is discussed. Results of 14 cases are presented. Diagnostic limitations of preoperative biopsies and operative frozen sections are emphasized. A low threshold for conversion to pancreaticoduodenectomy is needed.