Two techniques of duodenum-preserving resections of the head of the pancreas have been described by Beger and Frey for treatment of chronic pancreatitis. These techniques were compared in a prospective randomized trial following a pilot study. The course of 31 patients with chronic pancreatitis was prospectively documented with 25 patients having undergone Beger’s and 6 Frey’s procedure. Thereafter 38 patients were randomly allocated to either Beger’s or Frey’s group. The mean interval between symptoms and surgery was 5.4 years in the pilot study and 5.6 years in the randomized study. 17 adjacent organs (13 common bile duct stenoses, 4 duodenal stenoses) were affected in 13 patients in the pilot study, and 35 adjacent organs (28 common bile duct stenoses, 6 duodenal stenoses, 1 pancreatopleural fistula) in 28 patients in the randomized study. The mean follow-up was 4.8 years in the pilot study and 1.5 years in the randomized study (minimum 6 months). In both series there was no mortality. Morbidity was 26% in the pilot study (28% Beger, 17% Frey) and 16% in the randomized study (21 % Beger, 11 % Frey). In the pilot study complete pain relief was achieved in 92 and 83% of patients after Beger’s and Frey’s procedure, and in the randomized trial in 95 and 89% of patients after Beger’s and Frey’s procedure. Associated affection of adjacent organs was definitively resolved in 94% (16 of 17) in the pilot study (92% Beger, 100% Frey) and in 94% (33 of 35) in the randomized study (90% Beger, 100% Frey). Both techniques of duodenum-preserving pancreatic head resection are equally safe and effective with regard to pain relief and definitive control of complications affecting