Objective: To study whether the use of ultrasonically activated shears (UAS) would improve the safety of pancreatojejunal anastomosis after pancreaticoduodenectomy. Design: Retrospective analysis. Setting: University teaching hospital. Patients: Seventy patients underwent pancreaticoduodenectomy between April 1997 and May 2001. Main Outcome Measures: Leakage of pancreatojejunal anastomosis as judged from the contents of the drain within 7 days after operation, and defined as a high amylase level of discharge that was 3 times higher than that of serum. Results: Leakage of pancreatojejunal anastomosis was observed in 1 (1.4%) of the 70 cases. Other complications were stomal ulcer, bile leakage, renal failure, and intra-abdominal abscess in one case each. Conclusions: Use of UAS to perform pancreatectomy eliminates bleeding and pancreatic juice leakage from the branches of the pancreatic duct. Therefore, the cut surface of the pancreas is kept dry, simplifying anastomosis. Use of UAS improves the safety of pancreatojejunal anastomosis after pancreaticoduodenectomy.