Forty-five patients with painful chronic pancreatitis underwent side-to-side pancreaticogastrostomy. Correct diagnosis was ensured by endoscopic retrograde cholangiopancreatography, decreased exocrine pancreatic secretion, abdominal calcifications, and histologic verification. A main etiologic factor was alcohol abuse (84 percent of patients). At a median follow-up period of 3.8 years, good, fair, and poor results were achieved in 56, 23, and 21 percent of patients, respectively. The operative mortality rate was 4.4 percent. At follow-up, 16 of the patients were employed, weight was increased by a mean of 2.5 kg, and the use of opiates was significantly reduced. Poor results were significantly related to preoperative use of tranquilizers and postoperative alcohol consumption. Neither patency of the anastomosis nor the time of observation were related to the operative result. The 8-year cumulative survival rate was 83 percent.