History of pancreaticoduodenectomy: early misconceptions, initial milestones and the pioneers

Abstract

Pancreaticoduodenectomy is one of the most challenging surgical procedures which requires the highest level of surgical expertise. This procedure has constantly evolved over the years through the meticulous efforts of a number of surgeons before reaching its current state. This review navigates through some of the early limitations and misconceptions and highlights the initial milestones which laid the foundation of this procedure. The current review also provides a few excerpts from the lives and illuminates on some of the seminal contributions of the three great surgeons: William Stewart Halsted, Walther Carl Eduard Kausch and Allen Oldfather Whipple. These surgeons pioneered the nascent stages of this procedure and paved the way for the modern day pancreaticoduodenectomy.

Figure 1

William Steward Halsted by Thomas Corner, Oil on canvas, 1936, Courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions

Figure 2

(a) Walther Carl Eduard Kausch. Published with permission. Originally published in: Specht G, Stinshoff K. (2001) Walther Kausch (1867–1928) und seine Bedeutung für die Pankreaschirurgie. Zentralbl Chir 126:479–481, Georg Thieme Verlag KG. (b) Cholecystoenterostomy (Figure based on the original drawing of Kausch16). (c) Variations in restoring continuity: pancreatico-duodenostomy and pancreatico-jejunostomy respectively (Figure based on the original drawing of Kausch16)

Figure 3

(a) Allen Oldfather Whipple (Reprinted with permission from Dr Richard J. Bing). (b) First two-stage operation as described by Whipple in his original report in 1936. (c) Antecolic anastomosis with the loop of the jejunum in a one-stage procedure (Reprinted with permission from Elsevier. Originally published in Whipple AO. Observations on radical surgery for lesions of the pancreas. Surg Gynecol Obstet 1946; 82: 623–631). (d) Antecolic or retrocolic anastomosis with the vertical limb of a resected jejunum in a one-stage procedure (Reprinted with permission from Elsevier. Originally published in Whipple AO. Observations on radical surgery for lesions of the pancreas. Surg Gynecol Obstet 1946; 82: 623–631)