BACKGROUND: Resection of lesions of the root of the mesentery is difficult because of their proximity to the blood supply of the intestine. Damage of its vessels necessitates resection of the otherwise intact intestine leading the patient to short bowel syndrome and intestinal failure. For this reason, curative, clear margin resection of lesions with an extensive involvement of the root of the mesentery is sometimes impossible using the conventional surgical procedures. STUDY DESIGN: We describe a surgical technique drawn from our experience in intestinal transplantation, in which the root of the mesentery including the lesion, as well as the head or the entire pancreas, duodenum, small intestine and part of the colon are excised en block and preserved in a cold solution. Resection of the lesion is facilitated by being performed in a bloodless field at the back bench. Following resection, the salvaged intestine is reimplanted in the abdominal cavity. We performed this procedure in four patients. Their underlying diseases were different, (mesenteric fibroma, mesenteric hemangioma, pancreatic cancer, desmoid tumor), but in all of them there was extensive involvement of the root of the mesentery. RESULTS: Clear margin resection was achieved in all four cases, preserving at the same time enough small intestine to avoid short bowel syndrome. All patients survived the surgery and live on enteral nutrition, 2.5 to 46 months after the procedure. CONCLUSIONS: Exenteration, ex vivo resection and autotransplantation may be useful in the treatment of extensive, otherwise unresectable lesions of the root of the mesentery.