BACKGROUND: Since Allen O. Whipple published his seminal paper in 1935, the procedure that bears his name has been performed widely throughout the world and is now a common operation in major medical centers. The goal of this study was to investigate the evolution of pancreatoduodenectomy at the Massachusetts General Hospital (MGH). METHODS: We sought to identify all pancreatoduodenectomies performed at the MGH since 1935. Cases were obtained from a computerized database, hospital medical records, and the MGH historical archive. Demographics, diagnosis, intraoperative variables and short-term surgical outcomes were recorded. RESULTS: The first pancreatoduodenectomy at the MGH was carried out in 1941; since then, 2,050 Whipple procedures have been performed. Pancreatic ductal adenocarcinoma was the most frequent indication (36%). Pylorus preservation has been the most important variation in technique, accounting for 45% of Whipple procedures in the 1980s; observation of frequent delayed gastric emptying after this procedure led to decline in its use. Pancreatic fistula was the most frequent complication (13%). Operative blood replacement and reoperation rates have decreased markedly over time; the most frequent indication for reoperation was intra-abdominal bleeding. Mortality has decreased from 45% to 0.8%, with sepsis and hypovolemic shock being the most frequent causes of death. Mean duration of hospital stay has decreased from >30 to 9.5 days, along with an increasing readmission rate (currently 19%). CONCLUSION: The Whipple procedure in the 21st century is a well-established operation. Improvements in operative technique and perioperative care have contributed in making it a safe operation that continues evolving.
BACKGROUND: Since Allen O. Whipple published his seminal paper in 1935, the procedure that bears his name has been performed widely throughout the world and is now a common operation in major medical centers. The goal of this study was to investigate the evolution of pancreatoduodenectomy at the Massachusetts General Hospital (MGH). METHODS: We sought to identify all pancreatoduodenectomies performed at the MGH since 1935. Cases were obtained from a computerized database, hospital medical records, and the MGH historical archive. Demographics, diagnosis, intraoperative variables and short-term surgical outcomes were recorded. RESULTS: The first pancreatoduodenectomy at the MGH was carried out in 1941; since then, 2,050 Whipple procedures have been performed. Pancreatic ductal adenocarcinoma was the most frequent indication (36%). Pylorus preservation has been the most important variation in technique, accounting for 45% of Whipple procedures in the 1980s; observation of frequent delayed gastric emptying after this procedure led to decline in its use. Pancreatic fistula was the most frequent complication (13%). Operative blood replacement and reoperation rates have decreased markedly over time; the most frequent indication for reoperation was intra-abdominal bleeding. Mortality has decreased from 45% to 0.8%, with sepsis and hypovolemic shock being the most frequent causes of death. Mean duration of hospital stay has decreased from >30 to 9.5 days, along with an increasing readmission rate (currently 19%). CONCLUSION: The Whipple procedure in the 21st century is a well-established operation. Improvements in operative technique and perioperative care have contributed in making it a safe operation that continues evolving.
Authors: Pari V Pandharipande; Curtis Heberle; Emily C Dowling; Chung Yin Kong; Angela Tramontano; Katherine E Perzan; William Brugge; Chin Hur Journal: Radiology Date: 2014-11-12 Impact factor: 11.105
Authors: Arja Gerritsen; Roos A W Wennink; Marc G H Besselink; Hjalmar C van Santvoort; Dorine S J Tseng; Elles Steenhagen; Inne H M Borel Rinkes; I Quintus Molenaar Journal: HPB (Oxford) Date: 2013-12-06 Impact factor: 3.647
Authors: Ioannis T Konstantinidis; Avinash Kambadakone; Onofrio A Catalano; Dushyant V Sahani; Vikram Deshpande; David G Forcione; Jennifer A Wargo; Carlos Fernandez-Del Castillo; Keith D Lillemoe; Andrew L Warshaw; Cristina R Ferrone Journal: World J Gastrointest Surg Date: 2014-07-27
Authors: Odo Gangl; Klaus Sahora; Peter Kornprat; Christian Margreiter; Florian Primavesi; Evelyne Bareck; Martin Schindl; Friedrich Längle; Dietmar Öfner; Hans-Jörg Mischinger; Johann Pratschke; Michael Gnant; Reinhold Függer Journal: World J Surg Date: 2014-02 Impact factor: 3.352
Authors: Sara J Temple; Peter T W Kim; Pablo E Serrano; Daniel Kagedan; Sean P Cleary; Carol-Anne Moulton; Ian D McGilvray; Steven Gallinger; Paul D Greig; Alice C Wei Journal: HPB (Oxford) Date: 2014-04-18 Impact factor: 3.647