Personal experience with the Whipple operation: outcomes and lessons learned.

Pancreaticoduodenectomy (PD) has evolved into a safe procedure in major high-volume medical centers. This retrospective outcome review is from a database of 134 consecutive PDs from 1985 through 2002; all of whom underwent resection in a community hospital with a general surgery residency. All resections were performed by senior residents under the supervision of the same attending surgeon (V.L.H.). Follow-up was 100 per cent. There were 117 (88%) pyloric-sparing pancreaticoduodenectomies (PSPD) and 17 (12%) standard Whipple (SW) operations. Mean age for patients was 60 years with a range 29 to 84 years. There were 62 female and 72 male patients. Resections performed were periampullary malignancies, 83.6 per cent; benign neoplasm, 3.7 per cent; and non-neoplastic disease, 12.7 per cent. For the pancreatic anastomoses, 84 (63%) were pancreaticogastrostomies (PGs) and 50 (37%) were pancreaticojejunostomies (PJs). Mortality was 3.7 per cent, and 60 major complications occurred in 38 patients (28%) which included pancreatic fistula, 5.2 per cent; bile leak, 0.7 per cent; other anastomotic leaks, 1.5 per cent; intra-abdominal abscesses, 8.2 per cent; intra-abdominal bleeding, 3.0 per cent; upper gastrointestinal bleeding, 3.7 per cent; bowel ischemia, 1.5 per cent; and delayed gastric emptying (DGE), 17.9 per cent. Reoperation was required in only five patients (3.7%). There were no complications in 96 patients (72%) with an average hospital stay of 9.0 days. Long-term complications were peptic ulcer disease, liver abscess, hepatic stones, pancreatic insufficiency, and radiation jejunal strictures. Long-term survival was achieved in periampullary malignancies including pancreatic with excellent functional status.