The stomach and duodenum should be evaluated thoroughly for evidence of an ulcer. Likewise, the gallbladder should be palpated carefully for evidence of stones, and the size of the common duct determined. In the presence of stones the gallbladder is removed and a cholangiogram is taken through the cystic duct. A small amount of contrast medium (5 mL) is first injected to avoid a dense shadow, which may hide small calculi in the common duct. Sufficient contrast medium should be injected subsequently to determine the patency of the papilla of Vater by visualization of the duodenum. It is advisable to carry out a Kocher maneuver to palpate the head of the pancreas, especially if there is radiographic evidence of an enlarged C-loop. Under such circumstances, needle aspiration may be carried out to search for evidence of a pancreatic cyst. The omentum, which is often quite vascular, is freed in the usual fashion from the transverse colon across to the region of the splenic flexure. The lesser sac may be obliterated, and sharp dissection may be required to separate the adhesions between the stomach and the pancreas that may be due to chronic pancreatitis. The stomach should be freed until the entire length of the fibrotic and lobulated pancreas can be explored easily (Figure 1). The transverse colon is returned to the peritoneal cavity, while the stomach is retracted upward with a large S retractor. The posterior wall of the antrum should be freed from the pancreas so that the pancreatic duct can be palpated and opened as far to the right as possible to remove any calculi that might be impacted in the duodenal end (Figure 2). After the lobulated fibrotic pancreas has been exposed clearly, an effort is made to identify the location of the pancreatic duct by needle aspiration (Figure 1). Occasionally, it is desirable to aspirate pancreatic juice from the dilated pancreatic duct and then to inject a limited amount of contrast medium to ensure x-ray visualization of the pancreatic duct. Evidence of calculi in the duct is obtained as well as evidence to indicate whether the papilla of Vater is blocked or patent.