Results: Thirty onethirty patients (18 males and 13 females) with mean age of 67 y. o who were seriously sick with many concomitant illnesses (heart failure, pulmonary tuberculosis, hypertension, diabetes etc..) or those denying Whipple procedure, were attributed to duodenum opening and resection of the ampullary tumor followed by reconstruction of the choloedocho - pancreatic sphincter.