Ulcerogenic potential exists after subtotal gastrectomy, pancreatic resection and separation of the pancreatic and bile ducts from the gastric outlet. Collectively, as with radical pancreatoduodenectomy or total pancreatectomy, a substantial risk of an anastomotic ulcer developing can be expected. To elucidate this, we reviewed the records of 297 patients who had undergone either radical pancreatoduodenectomy (VVhipple procedure) or total pancreatectomy. We found that 18 patients (6%) had developed an anastomotic ulcer and that total pancreatectomy was statistically more ulcerogenic than a Whippie procedure. An anastomotic ulcer was a virulent complication; two-thirds of the patients had bleeding, and it was a contributing cause of death in 22% of patients in whom ulcer developed. In patients who have a favorable prognosis, the addition of vagectomy to either procedure should be considered.