Inclusion Criteria:  All cases of resectable periampullary carcinomas (cancer head of pancreas, ampullary carcinoma, distal cholangiocarcinoma and second part of duodenum adenocarcinoma) that are surgically fit according to ASA.  Exclusion Criteria:  1. Surgically unfit cases according to ASA 2. Locally advanced irresectable cases Abutment or encasement of coeliac trunk Encasement of SMA less than 180 degree of its axis  Encasement of portal/SMV more than 180 degree of its axis or infiltration segment too long more than 2.5 cm that the remaining segment will not coapts after resection.  3. Metastatic disease