Background. Enucleation of pancreatic endocrine tumors (PETs) is considered a simple operation from the technical point of view, but with a pancreatic fistula rate ranging from 25 to 50%. A pancreatic related local complication rate of 29% is reported also after laparoscopic enucleation (1). Aim. Retrospective evaluation of our series of PETs that underwent surgical treatment. Methods. From 1980 to 2004, 109 patients underwent surgery for PET. Enucleation was performed in 33 patients, while 76 underwent several different procedures; 24 (73% of cases) were insulinoma. Age, sex, site and size of the tumor, associated diseases, hospital stay and complications were retrospectively reviewed by the clinical records. Since 1986 intraoperative ultrasonography (IOUS) allowed us to choose among different surgical procedures in relation to the distance of PET from the Wirsung duct. Furthermore, after enucleation IOUS allowed to verify that the Wirsung duct was intact. Results: Patients (12 males and 21 females) averaged 56.8 years, range 20-86 years. Mean size of the tumor was 1.7 cm and 54.5% were in the pancreatic head; 78.8% of cases had medical associated diseases. Overall hospital stay averaged 12 days (range 6-81 days) and it was reduced to 8.9 days in the last 5 years. Mean period of gastric suction was 4 days. Sixty percent had an uneventful postoperative course. Complications were divided in early (related to pancreatic surgery, to general open surgery and medical) and late events. Complication related to pancreatic surgery were 6/33 (18.2%); 5 pancreatic fistulas (4 low output) and 1 acute pancreatitis, while 5/33 had a general surgery complication (2 leaking due to gastric and duodenal associated operations). Medical complications were recorded in 7 cases. Late complications occurred in 4 cases (2 laparocele, 1 pseudocyst, and 1 keloid). No patient underwent surgery for pancreatic complication; 1 underwent treatment for evisceration and a somatostatinoma patient underwent urgent parathyroidectomy for postoperative hyperparathyroidism. No mortality occurred. Of notice, the fistula rate of the 24 insulinoma was 8% (2/24), and no fistula was registered since 1986 among 17 insulinoma patients in whom IOUS was applied. Conclusion. In our experience enucleation of PETs can be performed with a very low pancreatic fistula rate provided that IOUS is performed. 1) Mabrut JY, et al. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery. 2005 Jun;137(6):597-605.