This paper reports on technical problems involved in pancreatoduodenectomy. Twenty cases of periampullary carcinoma underwent pancreatoduodenectomy. Pancreatic fistula developed in five cases: three of these patients recovered using simple drainage and TPN; one underwent a second operation in which a new pancreatico-jejunostomy was performed and another patient died (5% of the series) from sepsis and liver failure. After reviewing various techniques used in performing pancreatico-jejunostomy, it is concluded that the most suitable management of the pancreatic stump seems to be the duct-to mucosa anastomosis. But in cases in which this type of reconstruction is impossible, invagination yields satisfactory results.