INTRODUCTION Delayed gastric emptying is the most common complications after resection of the head of the pancreas and duodenum, regardless the operation methods – standard Whipple operation or Pylorus Preserving Pancreatoduodenectomy. The incidence of delayed gastric emptying vary from 15 to 40%, and represents half of total morbidity. For the duration of the delayed gastric emptying (2-6 weeks), oral nutrition is not possible, and intragastric feeding may cause or aggravate the condition. All this leads to a slow recovery of the patient, prolonged hospitalization and increased costs of final treatment. Despite numerous modifications, the frequency of complications is still remained high. The causative mechanisms of delayed gastric emptying are still unknown. Up to the present time, however, segmental resection of the proximal jejunum and Roux-en-Y reconstruction with defunctionalized jejunal loop is single method of resection and reconstruction and a common feature of various modifications following resection of the head of the pancreas and duodenum. Following new insights in the neural regulation and hormonal control of gastrointestinal motility, especially innervation of proximal jejunum, we altered our standard resection and reconstruction method, allowing immediate post operative enteral nutrition The essence of a our new method – Pylorus Jejunum Preserving Pancreatoduodenectomy is preservation of the proximal jejunum, pyloric dilatation and using omega method of jejunum anastomosis, instead of Roux-en-Y reconstruction method without pylorus dilatation. OBJECTIVE The purpose of the study is to determine if modified method of resection and reconstruction after pancreaticoduodenectomy may prevent or minimize delayed gastric emptying, the most common complication after pancreatoduodenectomy, allowing immediate post operative enteral nutrition. PATIENTS AND METHODS A prospective, clinical trial included 70 patients who underwent pancreatoduodenectomy from July 1995 to July 2006 at the Department of Digestive Surgery, University Hospital Rijeka. Patients were randomized into two groups regardless of whether the pylorus and jejunum are preserved or not, and depending on the method of reconstruction – omega with pyloric dilatation or Roux-en-Y, without pyloric dilatation. Assessment of gastrointestinal function was carried out based on the frequency of clinical delayed gastric emptying manifestations, rate of gastric emptying and tolerance of early enteral nutrition, through value of a gastric residual volume. RESULTS The incidence of delayed gastric emptying in modified Whipple operation group is significantly lower, none of the patients (0%), compared with those operated by standard methods, 9 (30%). The difference between the two groups is statistically significant (P<0,01). By applying the early enteral nutrition in all patients, gastric residual volume is lower in the modified Whipple operation group than standard methods group, (102 ± 90, v.s. 328 ± 155mL, P <0.05). Finally, earlier return to regular diet and the median length of postoperative hospital stay was significantly shorter in modified Whipple operation group (12 v.s.19 days, P<0,05). CONCLUSIONS On the basis of the presented results we can conclude that the use of a modified method improves the gastrointestinal function. It is demonstrated a lower frequency of delayed gastric emptying, increasing the possibility of early enteral nutrition and shorter hospital stay.