Since the beginning of our pancreas transplantation program in November, 1987, 50 patients have received a segmental intraperitoneal neoprene-occluded pancreas graft and a contralateral kidney graft. The aim of this study is to present our surgical technique and the postoperative complications encountered. Operation in the donor: subtotal pancreatectomy is performed. A venous patch is preserved at the end of the splenic vein. The splenic artery is removed with a patch taken from the end of the celiac trunk and the origin of the common hepatic artery, even in case of right (n = 1) or left (n = 4) hepatic artery. The canal is injected with neoprene (2 to 3 cc) ex vivo and the pancreatic parenchyma is recut after stappling. Operation in the recipient: the transplant is inserted in an extraperitoneal location, between the bladder and the pubic arch, then anastomosed to the external iliac vessels. RESULTS All pancreas grafts functioned immediately. All patients but 3 are alive at present. Seven pancreas transplants were lost postoperatively due to venous thrombosis (n = 3), hemorrhage (n = 3) and death at D27 (n = 1). Many patients developed peripancreatic fluid collections and/or fistulae (the most frequent complication, probably due to the extraperitoneal site of transplantation). The actuarial survival rate of the patients, kidneys and pancreas after 2 years is 96%, 92% and 80%, respectively.