A well-functioning major duodenal papilla is an indispensable condition for freedom from complaint in the region of the biliary tract and pancreas. Intraoperatively, the papilla is the problem of the surgeon. With appropriate morphological changes, transduodenal papillotomy is a necessary and irreplaceable procedure for curing the bile ducts and the pancreas. It should, however, be strongly emphasized that this surgical papillotomy is a major intervention bearing a number of possible risks. For this reason, only the sufficiently functionally disturbed and morphologically altered papilla is to be operated on.