OBJECTIVE The incidence of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy has been reported to be 30% to 70%. METHODS Between January 1996 and December 2002, 43 patients underwent pylorus-preserving pancreaticoduodenectomy, involving pylorotomy, in the First Department of Surgery, Kinki University School of Medicine. The first step in pylorotomy is to cut the duodenal stump obliquely. The next is incision of the pyloric sphincter along its inferior aspect. The incidences of postoperative complications and changes in body weight were collated retrospectively. RESULTS Delayed gastric emptying was observed in 4 patients (9.3%). However, this complication did not last more than 1 month in any patients. Two patients (4.7%) developed reflux esophagitis 1 month after surgery, but this complication had resolved by 6 months. Weight gain was noted beginning 3 months after surgery. CONCLUSIONS Pylorus-preserving pancreaticoduodenectomy involving pylorotomy may reduce the incidence of delayed gastric emptying and preserve the long-term quality of life more than similar procedures.