The gallbladder, antrum of the stomach, head of the pancreas, and duodenum have been separated to call attention to the various relationships, including the blood vessels that must be ligated in this procedure. These structures are numbered for convenient identification. The gallbladder is removed since there is a tendency for gallstone formation in case of long survival. To facilitate the anastomosis, as much of the common duct as possible should be saved below the junction of the cystic duct except in cases of possible cholangiocarcinoma. The common hepatic artery and its branches must be identified carefully. The right gastric and the pancreaticoduodenal vessels are identified and ligated in order to gain access to the region of the portal vein. Since no vessels enter at the anterior surface of the portal vein, this is the logical point for dividing the head of the pancreas from the body and tail. A number of pancreatic veins enter at the lateral border of the portal vein opposite the point where the splenic vein joins the superior mesenteric to form the portal vein. The middle colic artery and vein should be preserved.