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The records of 25 patients with chronic pancreatitis who underwent pylorus-preserving pancreatoduodenectomy (PPPD) were reviewed. A comparison was made with the clinical results obtained from 20 patients with side-to-side pancreatojejunostomy and from 33 patients with distal resection. 88% of the patients treated with PPPD and 93% of the patients treated with distal resection reported complete improvement in pain; after side-to-side pancreatojejunostomy 10% patients had partial improvement in pain and 20% needed narcotics. Diabetes developed in 10% of patients following side-to-side pancreatojejunostomy and in 24% of patients following distal resection. Exocrine dysfunction developed in 64% after PPPD, in 15% after side-to-side pancreatojejunostomy and in 8% after distal resection. PPPD is very effective in relieving pain and preserving endocrine function, but precipitates exocrine dysfunction early on after the operation.