Pancreatoduodenectomy. Results when the operation is performed infrequently.

A series of 13 pancreatoduodenectomies were performed in a medium-sized university hospital by seven different primary surgeons during an eight-year period without an operative death. The incidence of fistula, wound infection, and other major complications compares favorably with other, larger series. All but two of these operations were performed by resident surgeons. The suggestion that one must have a large experience with this operation in order to perform it safely has not been borne out by our experience. We believe that careful preoperative preparation and meticulous operative technique are the primary factors enabling the safe performance of the operation.