In recent years, the use of nonoperative palliation for unresectable periampullary carcinoma has increased markedly, in part, because of the high morbidity and mortality rates after surgical palliation. The current analysis was undertaken to determine whether or not decreases in morbidity and mortality rates, recently observed after resection of periampullary carcinoma, are now being seen in the surgical palliation of unresectable periampullary carcinoma. During a 54 month period, 118 consecutive patients underwent surgical exploration with the finding of unresectable periampullary adenocarcinoma. Jaundice was the most common complaint at admission, being present in 73 percent of the patients. Abdominal or back pain, or both, was present in 71 percent of the patients and weight loss was observed in 61 percent of the patients. The most commonly performed procedure was combined biliary bypass and gastrojejunostomy, being performed upon 75 percent of the patients. A gastrojejunostomy was performed upon 107 of 118 patients (91 percent). The hospital mortality rate was 2.5 percent. Postoperative complications occurred in 37 percent of the patients but were seldom life-threatening. Wound infection was the most frequent postoperative complication (10 percent), followed by cholangitis (8 percent) and delayed gastric emptying (8 percent). During the late follow-up period, only 4 percent of the patients had gastric outlet obstruction, and only 2 percent had recurrent jaundice. The mean survival time postoperatively was 7.7 months. These results demonstrate that patients with unresectable periampullary carcinoma can undergo surgical palliation with minimal perioperative mortality, acceptable morbidity and good long term palliation. We conclude that surgical palliation is the treatment of choice for carefully selected patients with unresectable periampullary carcinoma.