<p>Ampullary neoplasms can be treated by a variety of methods in the form of endoscopic ampullectomy, transduodenal surgical ampullectomy (TSA), and even pancreatoduodenectomy if there is a suspicion of malignancy. In patients with tumors not feasible for endoscopic procedure or TSA, we present a novel method to tackle the tumor, sparing the morbidity of a pancreatoduodenectomy. We report a case of a 34-year-old lady with an incidental detection of a benign ampullary lesion. As the lesion had a significant extension into the common bile duct (CBD), we adopted a novel technique of approaching the ampulla in a retrograde fashion, by tracing the CBD from the hilum to its opening into the duodenum. Pancreatic duct was separated, and CBD was excised along with the ampulla. This technique ensured a complete excision of the tumor with safe negative margins, confirmed on intraoperative frozen section. Hepaticojejunostomy and pancreatojejunostomy were done using a Roux-en-Y jejunal limb. We conclude that retrograde ampullectomy with extraduodenal approach is a safe and feasible procedure for benign ampullary tumors.</p>