It is done for tumors of head of pancreas, bile duct and duodenal tumors near ampulla. This procedure entails removal of part of pancreas, part of bile duct, part of stomach and whole of duodenum. There are three anastomosis in this procedure for drainage of pancreatic, biliary and stomach content into small bowel. As there are three major anastomosis, it makes this procedure highly morbid among all gastro-intestinal surgeries. I carries 2%-4% risk of patient death even in expert centers.