The surgical treatment of pancreatic carcinoma is palliative in 90% of cases. The authors report their experience with 25 patients with unresectable pancreatic exocrine cancer, 23 of whom underwent palliative surgery. Sixteen patients had a bilioenteric by-pass and in 7 cases a gastroenterostomy was associated. The postoperative mortality rate was 8.7% and morbidity 28.6%. Eight patients with bilioenteric bypass only survived and only two of these required gastroenterostomy later on because of neoplastic duodenal obstruction. The shorter hospital stay and the longer survival of patients treated by bilioenteric by-pass only suggest that prophylactic gastroenterostomy is unnecessary and should be associated in selected patients only.