When the procedure is carried out for an inflammatory lesion of the body and tail of the pancreas, a direct exploration of this region is performed. When the procedure is carried out for tumor, a thorough exploration of the abdomen, with particular reference to the liver and the gastrohepatic ligament in the region of the celiac plexus, should be made for evidence of metastasis. A possible microscopic diagnosis of adenocarcinoma is sought by biopsy before proceeding with a total pancreatectomy from the left-side approach. Since the adenomas can be distributed throughout the pancreas, the head of the pancreas must be thoroughly explored by visualization and palpation preliminary to a definitive type of procedure on the left half of the pancreas. Evidence of gastric hypersecretion, as indicated by increased vascularity and thickening of the gastric wall, along with a hyperemic and hypertrophic duodenum and an ulcer in the duodenum or beyond the ligament of Treitz, adds support to the potential diagnosis of gastrinoma tumor of the pancreas. Likewise, the inner wall of the duodenum should be carefully palpated in the search for small adenomas extending into the lumen of the duodenum from the pancreatic side. Finally, a sterile ultrasound probe for intraoperative scanning of nonpalpable lesions is advocated by most surgeons.