Background Pancreatoduodenectomy (Whipple’s Resection) remains the only potentially curative treatment for pancreatic adenocarcinoma. When an R0 resection is achieved, there’s approximately a 30% chance of five-year survival. The standard approach involves routine sacrifice of the gastroduodenal artery (GDA) with gastric perfusion maintained by the left gastric artery and left gastroepiploic artery. However, in patients with previous Ivor Lewis oesophagectomy, the right gastroepiploic artery (RGEA) remains the dominant vascular supply to the gastric conduit. Therefore, preservation of the RGEA is crucial to maintain the viability of the gastric conduit, which significantly increases the technical difficulties in surgical management of primary malignancies. We will discuss a successful RGEA preserving Whipple’s Resection after Ivor-Lewis Oesophagectomy, accompanied by a focused review of current literature. Summary A 72-year-old woman with a background of Ivor-Lewis oesophagectomy for distal oesophageal cancer presented with peri-ampullary carcinoma found on investigation for new biliary tree dilatation. Cytopathology from an endoscopic ultrasound confirmed primary adenocarcinoma with staging imaging demonstrating no evidence of metastases. Intraoperatively, the gastric conduit was healthy and demonstrated robust arterial flow via the GDA and RGEA. In this paper, we will describe a pylorus, gastroduodenal, and RGEApreserving pancreaticoduodenectomy without vascular reconstruction. Post-operatively, the patient developed a chyle leak, which resolved without surgical intervention. She has remained clinically well on follow-up. Conclusion Patients with previous Ivor-Lewis oesophagectomy with primary pancreatic malignancy may, in carefully selected cases, undergo right gastroepiploic artery preserving pancreaticoduodenectomy, allowing preservation of the native blood supply to the gastric conduit.