Since 1987, we have adapted PPPD by Imanaga procedure to 54 patients with cancer (pancreatic head :22, distal bile duct:10, am-pulla: 10, and others:5) and benign disease (7) of the pancreatic head and ampullary region. In the Imanaga procedure, gastrointes-tinal continuity was restored by duodeno-, pancreatic-, and choledocho-jejunostomy in this order. PPPD by Imanaga procedure has some advantages, one being is the high possibility for observation of the pancreatic and biliary stomas and precise evaluation for function for function of the remnant pancreas and early detection of local recurrence by postoperative endoscopy. We will present the operative procedure and findings of local recurrence and benign stenosis of pancreatic stoma detected by endoscopy.