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Only 20-30% of patients with malignant neoplasms of the pancreatic head or distal biliary tree can be cured by surgery. Palliative procedures play an important role in their management. We sought to determine if surgical or non-surgical management was the most appropriate therapy for the treatment of obstructive jaundice in the palliative setting. We retrospectively analyzed the outcomes of our pat. with regard to method of treatment and complications as well as the survival times.The pat. were divided into three groups based on treatment. Pat. in Group 1 underwent endoscopic bile duct stent placement.Group 2 underwent preoperative stenting followed by laparotomy with curative intent. When pat. were found to have unresectable or metastatic disease intraoperatively, a palliative hepaticojejunostomy was performed. Moreover,hepaticojejunostomy was performed in pat. with stent failure and unresectable disease.Group 3 underwent hepaticojejunostomy without preoperative stenting. For pat. in Group 1, we determined the frequency of rehospitalization for recurrent jaundice. In these pat., a new endoprosthesis was placed when possible.Over an 8-year period, 342 pat. (151women, 191men) with adenocarcinoma of the pancreatic head or distal biliary tree received palliative treatment. Median age was 63ys (range 36-89.Symptoms of obstructive jaundice were exhibited by 26 pat.(76%). In 14 pat., none of the aforementioned procedures were performed. The remaining 247 pat. were divided into the groups described: Group 1(n=138,56%);Group 2(n= 68,28%);Group 3(n=41,16%).The 30-day mortality rates for pat. in Groups 1,2,and 3 were 2.2%,0%,and 2.4%. The morbidity rates were 6.5%,19.1%,and 14.6%, respectively. For the pat. treated with endoscopic stenting, the mean interval between initial stent placement and stent replacement was 70.8 days (± 32). Median survival time for pat. treated only with endoscopic stent implantation (Group 1) was significantly (p<0.001) shorter than that of pat. who were first stented and subsequently treated with hepaticojejunostomy (Group 2) (5.1 vs. 9.4 months). None of the pat. who underwent surgery were rehospitalized for recurrent jaundice. In conclusion, we found that surgical hepaticojejunostomy can be performed with adequate results and an acceptable complications. Considering that biliary stents need to be replaced (mean time to stent replacement 70 days),management by hepaticojejunostomy may be superior to endoscopic stenting, especially for pat. with a life expectancy of greater than 6 months. The operative approach should be especially favored in patients whose disease is first found to be unresectable in the intraoperative setting.