Background: Closure of the pancreatic stump after pancreatic left resection (plr) is still a controversial issue. Postoperative pancreatic fistula (ppf) rates of up to 20% after plr have been reported even from high volume centers. While modern imaging guided percutaneous drainage techniques combined with antisecretory regimen circumvent the need for surgical re-intervention in most patients, ppf may prolong recovery and therefore rise in-hospital stay and costs considerably. Therefore, we tested the feasibility of routine drainage of the pancreatic stump into a Roux-en-Y loop following plr in order to decrease the incidence of ppf. Methods: Group1: Since June 2003, all 23 patients undergoing plr were enrolled into a prospective study. Following plr, the main pancreatic duct and the pancreatic stump were oversewn with PDS and additionally anastomosed into a jejunal Roux-en-Y loop by a single layer PDS suture. A drainage was placed near the anastomosis and patients received octreotide for 5-7 days postoperatively (3x0.2mg sc daily). Drainage volume was registered daily and amylase concentration of drained fluid was recorded every 2nd day. Patient’s demographics, length of hospital stay, incidence of pancreatic fistulas, peri-operative morbidity and follow-up after discharge was recorded and compared with our initial series of patients in whom the pancreatic remnant was oversewn only (Group 2, 19 cases). A pancreatic fistula was defined as secretion of at least 30ml of amylase-rich fluid (more than 5000 units/l) per day for at least 10 days. Results: Indications for plr were: chronic pancreatitis in 7 cases, pancreatic tumors in 28 cases, other tumors in 5 cases and other reasons in 2 cases. Indications for resection and patient demographics were comparable between the two groups. Median Op-time did not differ between groups and was 326 (range 195-480) vs 298 min (range 180-450) in group 1 and 2, respectively. Median blood loss was 813ml (range 200-4000) in group 1 vs 940ml (range 100-3000) in group 2(n.s.). There was no difference considering the ability to tolerate an oral diet between the two operative procedure. There were 4 (21%) pancreatic fistulas in group 2 whereas none in group 1 (p = 0.035). Total surgical-related morbidity was 37% in the oversewn group versus 22% in the anastomotic group (n.s.). Median hosp. stay and long-term morbidity was not influenced by the surgical procedure. Conclusions: The Roux-en-Y pancreaticojejunostomy prevented the occurrence of ppf and showed a trend towards a lower number of surgery related morbidity following plr. Therefore, we feel at ease to continue our current surgical approach.