Background: Resection of the body and tail of the pancreas are done in 10-15% of all pancreatic resections. There is a widespread view among surgeons that distal pancreatectomies are harmless operations with few complications compared to pancreaticoduodenectomies. Recent data from larger series would however indicate that this is not the case. Aims: To describe the morbidity pattern after resection of the corpus and tail of the pancreas and to analyze factors of significance for the occurrence of complications. Methods: Since 1997, 279 cases of pancreatic resection were registered prospectively in the database at Karolinska University Hospital Huddinge, Stockholm, Sweden. Among those had 48 patients a distal resection, 34 females and 14 males. Mortality and morbidities were analyzed with focus on pancreatic leak and fistula formation (PF).Results: The preoperative diagnoses were pancreatic tumor (41), chronic pancreatitis (4), trauma (1) and gastric cancer (2). All patients had an operation with stapling of the gland transsection area in 34 and hand-sutured techniques in 14 cases. No postoperative mortality was observed. However, postoperative complications were registered in 21 pts (44%) with (PF) noticed in 17(35%) cases. Of the latter did 4 pts develop local abscesses, 1 patient had bleeding and 1 patient had delayed gastric emptying. All these complications were treated conservatively except for one case, where an additional operation was required. (PF) was more common in malignant disease (9/20: 45%) than in benign (8/28: 29%) (p=0.35). Complications were more frequent after hand-sutured techniques (11/14; 79%) compared to the use of staplers (10/34; 29%) (p<0.01).Conclusions: Distal pancreatic resection is a complex operation with high morbidity even in a high volume center emphasizing the need for preventive measures. The rate of (PF) seems to depend on the surgical technique and the underlying disease state.