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Recenly, we routinely performed “mesenteric approach”, includes exposing the superior mesenteric vein (SMV) and superior mesenteric artery (SMA) from inframesocolic root and the dissection continued cranially for pancreatic head cancer. This technique facilitates early assessment of tumor resectability prior to the irreversible step. However, the dissection of inframesocolic SMV to allow for identification of the SMA is occasionally challenging due to the complex anatomic course of the first jejunal trunk in relation to the SMA. Herein, we draw attention to the anatomical variation of the first jejunal branch of the SMV and report which approach facilitates pancreaticoduodenectomy in the presence of this variation.