The records of 73 consecutive patients who underwent pancreatoduodenectomy for chronic pancreatitis between 1960 and 1985 were reviewed. The median size of the pancreatic duct was 5 mm. Two operative deaths (2.7%) occurred early in the series. Eighty-eight percent, 86%, and 79% of the patients had improvement in pain at six months, two years, and five years, respectively. Diabetes was present preoperatively in 25% of patients and postoperatively in 37%, 45%, and 69% of patients at six months, two years, and five years, respectively. Pancreatic enzyme preparations were used preoperatively by 26% of patients; this use increased to 75% by five years. Only four of 17 late deaths could be related to diabetes or malnutrition. In most patients, pancreatoduodenectomy achieves long-term pain improvement and permits return to normal activities. Selection of patients is important to decrease the late morbidity and mortality.